Browsing HIPAA Attachments with RELMA
RELMA makes it easy to find the LOINC terms used in attachments as specified by HIPAA.
Start with the HIPAA Menu
This opens up RELMA's Attachments browser and its four section tabs: Documents with implementation guide, Documents without implementation guide, Valid attachment requests, and Request modifier codes.
Documents with implementation guide
The Documents with implementation guide tab presents the high level attachment type classifications from the C-CDA and the HL7 Attachment supplement to C-CDA guide. Currently these consist of clinically-relevant HL7 implementation guides that use the U.S. Realm Header. In the LOINC database, these terms have a value of "IG Exists" (previous "STRUCTURED") in the HL7_ATTACHMENT_STRUCTURE field.
On the left side of the screen, for each implementation guide, the set of allowed LOINC document codes in that document type are listed under the Attachment Name.
For each attachment document type, the most generic LOINC code (i.e. the one that is approved for use as an attachment request) is indicated with a star icon.
When a document code is selected, the set of allowed section and entry-level codes for that implementation guide are shown on the right side of the display under CDA Recommended Sections and Entries.
Note: the LOINC terms listed under CDA Recommended Sections and Entries are not to be used in requesting a document. They do however elucidate the potential contents of the response.
Documents without implementation guide
The Documents without implementation guide tab lists all of the LOINC codes that are approved by the HL7 Attachments WG for use in requesting as an unstructured attachment.
These codes represent documents that may be needed by payers but for which an implementation guide that explicitly enumerates the expected contents has not yet been developed. In the LOINC database, these terms have a value of "No IG Exists" (previous "UNSTRUCTURED") in the HL7_ATTACHMENT_STRUCTURE field. This list was initially populated by the LOINC codes specified in the "Patient Information Unspecified Content (PIUC) Attachment Types" document from HL7 and will evolve based on the decisions of the HL7 ASIG.
Valid Attachment Requests
The Valid attachment requests tab contains the complete set of LOINC codes that can be used by payers as attachment requests. This set consists of a) the "top level" (i.e. preferred) document codes from clinically-relevant HL7 implementation guides that use the U.S. Realm Header, and b) the document codes without implementation guides that have been approved by the HL7 Attachment WG.
Request Modifier Codes
The Request Modifier Codes tab lists all the LOINC codes that can be used as request modifiers. For more information, see the HL7 Attachment Specification.