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  • 2014 09 24 - LOINC and RELMA For Diagnostic Imaging

    Transféré par

    Daniel Vreeman
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    Brief Introduction to LOINC and RELMA for Diagnostic Imaging presented by Daniel J. Vreeman, PT, DPT, MSc to the Canada Health Infoway, Standards Collaborative Working Group 10 for Diagnostic Imaging.

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    Brief Introduction to LOINC and RELMA for Diagnostic Imaging presented by Daniel J. Vreeman, PT, DPT, MSc to the Canada Health Infoway, Standards Collaborative Working Group 10 for Diagnostic Imaging.

    Droits d'auteur :

    Attribution Non-Commercial (BY-NC)
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    216 vues54 pages

    2014 09 24 - LOINC and RELMA For Diagnostic Imaging

    Transféré par

    Daniel Vreeman
    Brief Introduction to LOINC and RELMA for Diagnostic Imaging presented by Daniel J. Vreeman, PT, DPT, MSc to the Canada Health Infoway, Standards Collaborative Working Group 10 for Diagnostic Imaging.

    Droits d'auteur :

    Attribution Non-Commercial (BY-NC)
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 54

    Daniel J.

    Vreeman, PT, DPT, MSc


    Associate Research Professor, Indiana University School of Medicine
    Associate Director for Terminology Services, Regenstrief Institute, Inc
    2014
    LOINC and RELMA for
    Diagnostic Imaging
    Canada Health Infoway, Standards Collaborative Working Group 10 for Diagnostic Imaging
    Overview
    1. Welcome to LOINC
    2. LOINC Radiology Model (How we name
    imaging studies)
    3. Tools for implementers
    4. Use Case Samples
    5. Collaborations: RSNA, IHTSDO (if needed)
    photo via Vernio77
    photo via jamescridland
    Welcome to the
    LOINC Community!
    Logical
    Observation
    Identiers
    Names and
    Codes
    A universal code system that facilitates exchange,
    pooling, and processing of clinical data.
    LOINC is like a bar code for
    test data
    34,000+ registered users in 163 countries
    photo via puuikibeach
    WE DO
    MEASUREMENTS
    Laboratory LOINC
    Clinical LOINC
    If an observation is a question
    and the observation value is
    an answer
    LOINC provides codes for questions

    Where needed, other vocabularies
    provide codes for answers
    LOINC Diagnostic
    Imaging (Radiology)
    photo via Karen Roe
    In diagnostic imaging,
    LOINC provides codes for:

    Ordered (and returned) imaging study
    Sections within a report
    Measurements or observations made
    Update to CCDA currently in revision at HL7
    Diagnostic Imaging Report
    Structure from:
    Document Level Codes
    Abdomen CT
    Brain MRI W & WO Contrast IV
    Orbit X-ray for foreign body

    This is our
    bread and butter
    Radiology Report Terms
    Modality # LOINC Terms
    CT 716
    Mammography 145
    MRI 854
    Nuclear Medicine 455
    Ultrasound 442
    XR 1858
    Fluoroscopy 646
    > 5000 active terms
    Sections within a Report
    18785-6 Reason for study
    55108-5 Clinical presentation
    55111-9 Current imaging procedure descriptions
    11329-0 History general
    18782-3 Study observation (Findings)
    55107-7 Addendum
    55109-3 Complications
    55114-3 Prior imaging procedure descriptions
    55113-5 Key images
    19005-8 Impressions
    18834-2 Comparison study
    18783-1 Recommendation
    55115-0 Requested imaging studies information
    55112-7 Document summary
    55110-1 Conclusions
    Measurements / Observations
    38261-4 Hip DXA Bone density
    38264-8 Hip DXA [T-score] Bone density
    53626-8 CT Cerebral atrophic index
    8294-1 Chest XR Diameter.anterior-posterior
    In other domains, this is
    LOINCs main content
    Radiology Naming Model
    First some general principles
    Multiple Levels of Specicity
    Views
    named, counted, no specication
    Laterality
    right, left, bilateral, unilateral, unspecied
    Contrast
    W, WO, W&WO, unspecied
    37842-2:View AP:Find:Pt:Shoulder:Doc:XR
    37842-2
    LOINC Code
    View AP
    Find
    Pt
    Shoulder
    Doc
    XR
    Component
    Property Measured
    Timing
    System
    Scale
    Method
    There are six major LOINC axes
    Anatomy of a LOINC Term
    NOT part of a LOINC Name
    Reason for the test (disease it diagnoses)
    Testing instrument
    Specic details about the testing
    Priority (e.g. STAT)
    Where testing was done
    Who did the test
    Test interpretation
    Anything not part of naming the test
    Stuff carried in other parts of HL7 message
    Radiology Naming Model
    Radiology-specic conventions
    Component Structure
    1st Subpart - View
    Views descriptor Views, Multisection,
    Views for leg length
    ,
    # of views 3, greater than 3
    Beam orientation AP, lateral
    Body position Prone
    <view descriptor> [<number of views>]
    [<projection beam orientation>] [<body position>]
    Component Structure
    1st Subpart - Interventional
    Timing/existence W, W&WO, 48H post
    Substance given contrast, adenosine,
    Tc-99m Sestamibi
    Route IV, PO
    Guidance for <indication>
    Component Structure
    2nd Subpart - Challenge/Precondition
    <timing/existence><substance given><route>
    Examples

    Guidance for biopsy:Find:Pt:Breast:Nar:Mam
    Guidance for anesthetic block injection:Find:Pt:Celiac plexus:Nar:CT
    Guidance for drainage:Find:Pt:Extremity:Nar:US
    System
    The anatomic area being visualized
    Not necessarily the anatomic area of interest

    Examples
    24627-2 Chest CT
    24590-2 Brain MRI
    25011-8 Tibia and Fibula X-ray
    System Structure
    Super System
    Patient is the default
    Used to indicate:
    blood product unit, bone marrow donor, fetus
    11670-7:Blood !ow.mean:Vel:Pt:Aortic arch^fetus:Qn:US.doppler
    System^Super System
    Method
    Modality
    Modality CT, MRI, XR
    Submodality angio, uor, SPECT
    <modality><submodality>
    Side note: we handle ographies as synonyms. (e.g. arthrogram is
    linked to W contrast intraarticular
    Tools for
    Implementers
    photo via Robert S Donovan
    RELMA
    REgenstrief LOINC Mapping Assistant
    RELMA Features
    Browse LOINC content

    Map local terms to LOINC
    import/export
    translate local words to LOINC-speak
    manual/automated mapping
    Search Window
    Mapping Screen
    navigate through your local term set
    hit enter to run a search
    Assigning a LOINC Map
    Highlight the correct LOINC
    Assign a map
    (or double click)
    search.loinc.org
    online LOINC browser
    search.loinc.org
    Use Case Samples
    Taken from September 16, 2014 Terminology
    assessment example
    Modalities
    Recommendation
    LOINC doesnt have discrete codes for modalities.
    (They are the Method Part of a LOINC term).

    Hint
    Find codes with modality of ultrasound using method:US in searches

    Here is a code for a generic ultrasound study that doesnt specify
    any particular views or the exact body region

    Ultrasound
    25061-3:Multisection:Find:Pt:XXX:Doc:US
    Other Pieces of LOINC names
    Laterality
    Part of the Anatomic specication. Shoulder.left
    Hint: In RELMA you can exclude these.

    Contrast / Intervention
    Anatomic Region / Body Parts
    Procedures
    Recommendation
    Procedures are where LOINC shines. These are what the
    5000+ radiology terms in LOINC are meant for.

    Hint
    Here is a code for a typical OB ultrasound study

    Obstetrical Ultrasound
    11525-3:Multisection for pregnancy:Find:Pt:Pelvis+Fetus:Doc:US
    Reason for Exam
    Recommendation
    Recall that LOINC provides codes for questions (observations/
    measurements). So, LOINC has a code that represents the
    question what is the reason for the exam:


    The expected answers would be free text or drawn from another
    terminology like SNOMED CT. Often though, you dont need a
    LOINC code for this observation, because the information is sent
    in eld OBR-31 Reason for Study. LOINC doesnt have a code
    that means conrm 20 week gestational age.
    conrm 20 week gestational age
    18785-6:Reason for study:Find:Pt:Report:Nar:Radiology
    Clinical Findings/Diagnosis
    Recommendation
    There are a few ways to get BPD. Heres a code for a
    direct measurement:


    Likewise for head circumference. Heres a measured one:


    But, LOINC does not have a code for the diagnosis
    microcephaly. (That would come from SNOMED CT).
    US Bi-parietal Diameter, Head Circumference
    11820-8:Diameter.biparietal:Len:Pt:Head^fetus:Qn:US.measured
    11984-2:Perimeter:Len:Pt:Head^fetus:Qn:US.measured
    LOINC / RadLex Collaboration
    RadLex Playbook
    A special component of RadLex
    Developed by RSNA

    Information model tailored for radiology orders
    and results, and connected to other terms in
    RadLex (e.g., anatomy, visual features).

    RadLex is made freely available for private,
    research, and commercial use internationally.
    http://loinc.org/collaboration/rsna/
    Overall Goal:
    Produce a single unied source
    of names and codes for radiology
    procedures with a cooperative
    governance process.
    Main Deliverables
    Developing a Unied Model for Radiology
    Procedure Names

    Mapping the attribute-values between each
    terminology (i.e. LOINC Parts to RadLex RPIDs)

    Main Deliverables
    Devising collaborative integrated governance process
    for new terms

    Creating single point-of-contact and governance structure
    for the unied terminology

    New joint LOINC/RadLex Committee to be advisory body
    (Approved at Clinical LOINC Meeting 02/2014)

    LOINC codes as the primary identier for radiology
    procedures (e.g. the universal codes) while linking to the
    RadLex attribute/values for each term so that they can be
    used as meta-data
    LOINC / SNOMED Collaboration
    http://loinc.org/collaboration/ihtsdo
    Key Points
    Its NOT a merger, take-over
    It IS a long term working relationship

    Endorsed statement: LOINC for questions,
    SNOMED for answers

    We want to avoid duplication

    LOINC Parts not a standalone terminology

    Not adding SNOMED CT Observables


    4 Main Deliverables
    Mapping LOINC Parts to SNOMED CT concepts

    Mapping existing SNOMED CT Observables to
    LOINC terms

    LOINC terms associated with post-coordinated
    expressions

    LOINC terms with categorical answer values
    linked to SNOMED CT answers
    How Well Proceed
    Agreement starts with these domain areas
    Laboratory
    Including discrete orders and observations and panel
    names for orders (excluding panel structure)
    Anthropomorphic measurements and evaluations
    Vital signs and physiological measurements

    Agreement says we expect (but have not yet
    committed to) to expand into other
    observable domains (such as Radiology)

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