Why LOINC and why not only LOINC?

Data transmission to Electronic
Medical Record:
Why LOINC and why not only LOINC?
Dr Ph CAUCHIE
CHU de Charleroi
On behalf the lab data group steering committee

From the lab to the attend physician:
Why a code?
LAB
PHYSICIAN
DATA

The belgian experience
• Each EMR has its own internal codification
system. Frequently labs and EMR software
providers have to support several lab code
conversions.

Without translation system
LAB1
EMR1
EMR2
LAB2
EMR3
LAB3
EMR4
Each lab has to provide data on multiple coding system

The belgian experience
• Each EMR has its own internal codification system.
Frequently labs and EMR software providers have to
support several lab code conversions.
• ACTH: a unique experience:
– The laboratory sends one type of record (the ACTH code)
to a shared translation system
– The translation system provides the code “understood” by
the EMR software
– To date a database of more than 4700 records providing
translation to Gespro, Medigest, Medidoc and LOINC

With a translation system
LAB1
EMR1
EMR2
LAB2
EMR3
LAB3
EMR4
The translation system provides data following the requested format

The belgian experience
• Each EMR has its own internal codification system. Frequently
labs and EMR software providers have to support several lab
code conversions.
• ACTH: a unique experience:
– The laboratory sends one type of record (the ACTH code) to a shared
translation system
– The translation system provides the code “understood” by the EMR
software
– To date a database of more than 4700 records providing translation to
Gespro, Medigest, Medidoc and LOINC
• This system has to evolve
– From a regional to an universally accepted code, but respecting
existing work.
– From a home made database to a secured multi-access system
– Creating an eHealth authenticated source, freely available to all
involved healthcare actors

With a universal reference code
LAB1
EMR1
EMR2
LAB2
EMR3
LAB3
EMR4

Looking for a standard: LOINC
• Logical Observation Identifiers Names and Codes (LOINC) is a database
and universal standard for identifying medical laboratory observations. It
was developed and is maintained by the Regenstrief Institute, Inc., a US
non-profit medical research organization, in 1994.
• LOINC was created in response to the demand for an electronic database
for clinical care and management and is publicly available at no cost.
• It is endorsed by the American Clinical Laboratory Association and the
College of American Pathologist. Since its inception, the database has
expanded to include not just medical and laboratory code names, but
also: nursing diagnosis, nursing interventions, outcomes classification, and
patient care data set.
• LOINC applies universal code names and identifiers to medical
terminology related to the Electronic health record.
• Widely accepted:
– Switzerland : CUMUL (French- German- English- Italian- Spanish)
Based on LOINC 2.21 (december 2007), 5071 records
– France: CLUABM “version francisée de la nomenclature LOINC”
adopted e.g. by APHP. 4408 records
– Translated in Simplified Chinese,….

LOINC: everything is beautiful?
• Over 50,000 observation terms (LOINC 2.26 = 53344) that
can be accessed and understood universally.
• Each database record includes six fields for the unique
specification of each identified single test, observation, or
measurement:
1. Component- what is measured, evaluated, or observed
2. Kind of property- characteristics of what is measured, such as
length, mass, volume, time stamp and so on
3. Time aspect- interval of time over which the observation or
measurement was made
4. System- context or specimen type within which the observation was
made
5. Type of scale- the scale of measure. The scale may be quantitative,
ordinal, nominal or narrative
6. Type of method- procedure used to make the measurement or
observation

LOINC : side stack
• Powerful but complex:
– Multiple samples, methods, units,….
– Difference between some codes not always easy to understand
– E.g.: glucose 66 records
• 53344 items but still incomplete
– For hematology 20% of records are lacking
– E.g.: Owren PT (Thrombotest)
• Challenge tests and time dependence remain unresolved
• Bacteriology far from complete
– Always a problem for coding systems (antibiograms,….)
• Request codes

The labcodes data system
• Main features:
– A multiple access data base
– Web based
– Several security levels
– search tool in LOINC
– A “Belgium” primary code is automatically
provided by the system = code « Albert »
– Translation function

Labcodes data system
• Long-term Health-FPS initiative , long awaited
(founding, organisation)
• Mandatory for eHealth developments (building authentic
sources)
• Current Status:
– Contract with FPS (through FRATEM) for x top drafting tables in 2009 .
– >>LOINC + Belgian code when relevant
– Limited budget for expert fee
– Develop management application by SMALS (Q1-Q2 09)
– Reporting to eHealth advisory group
– Contact with EMR providers are mandatory to prepare the transition
– Steering committee : Philippe Cauchie, Annie Borremans, Tom Fiers, Francoise
Luyckx,

The Belgian labcodes database system

The belgiam system

Conclusions
• The steering comittee has to
– understand how to use LOINC
– define the rules of use
• Piloting work will be necessary
– Dimension (witch one? )
– Methods (all necessary?)