LOINC Version 2.61 and RELMA Version 6.20 Available

In this Update

We pleased to share with you another feature-packed LOINC release. We’ve significantly enhanced the content in LOINC and are excited to share several new release artifacts and documentation based on significant input from the LOINC user community. Here’s the outline:

1. LOINC content highlights
   1. New content
   2. Content edits
2. Readme and ReleaseNotes documentation for all release artifacts
3. New LOINC release artifacts
   1. LOINC Table Core File
   2. LOINC Answer File
   3. LOINC Part File
   4. LOINC Group File
   5. Canonical representation of LOINC as a FHIR CodeSystem
4. Updates to other LOINC release artifacts
   1. LOINC Multiaxial Hierarchy
   2. Top2000+ Common Lab Results
   3. LOINC/IEEE Medical Device Code Mapping Table
   4. LOINC/RSNA Radiology Playbook
5. Changes to the public LOINC data files in this release
6. Changes to the LOINC License in this release
7. Notice of changes to the public LOINC data files for the December 2017 Release
8. Notice of changes to the public LOINC data files for the June 2018 Release
9. LOINC Linguistic Variant Updates
10. RELMA highlights

Read on for the full details.

Highlights from our best LOINC release yet

New content

LOINC version 2.61 contains 84868 terms, an increase of 1491 since version 2.59. This release includes 772 new laboratory, 369 new clinical, 5 new attachment, and 345 new survey terms.

Some of the new content highlights in this version:

• Approximately 400 new microbiology terms, including more than 200 new terms for Streptococcus pneumoniae to replace existing ambiguous terms that were deprecated (see details in section below).
• Over 70 cancer pathology terms
• More than 30 new antimicrobial resistance gene terms
• New panels for laboratory terms, including:
  • CAP Colorectal cancer pathology panel 85905-8
  • CAP Breast cancer pathology panel 85904-1
  • Neisseria meningitidis serogroup DNA panel 85797-9
  • Kidney failure 2Y & 5Y risk panel 85626-0
• Over 100 new radiology terms, including mammography and fluoroscopy terms to complete RSNA Playbook mappings for these modalities.
• Approximately 100 Document Ontology terms
• About 50 new terms for CDC case reporting clinical history concepts
• New clinical and survey panels, including:
  • Inpatient Rehabilitation Facility – Patient Assessment Instrument – version 1.4 83265-9
    • This panel contains more than 30 panels nested underneath
  • Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) – version 3.00 85654-2
    • This panel contains more than 45 panels nested underneath
  • Renal replacement therapy goals panel NKDEP 85597-3
  • Retinal nerve fiber layer panel Retina by OCT 86291-2
  • Rubella surveillance panel 85701-1
  • Congenital rubella case report panel 85735-9
  • Kansas City cardiomyopathy questionnaire 71941-9
    • Added all of the individual survey questions to the existing panel term
  • Minnesota Living with Heart Failure Questionnaire 71939-3
    • Added all of the individual survey questions to the existing panel term

Edits contained in this release

About 7000 terms have been edited. This release contains a total of 2814 deprecated terms. Twelve terms have been undeprecated since the last release.

Here are some of the editing highlights:

• Updated the nomenclature for Streptococcus pneumoniae from the U.S. serotype numbering system to the widely accepted Danish system. This work included the following:
  • Updated approximately 80 terms in which the number specified in the Component was unambiguous to include “Danish serotype” with the corresponding Danish serotype number
  • Deprecated approximately 200 terms in which the number specified in the Component was ambiguous as to whether it represented the serogroup, U.S. serotype or Danish serotype and mapped to new, unambiguous terms
  • Replaced deprecated terms included in the Top 2000 Common Lab Results US & SI files with the corresponding map to term
  • Added the U.S. serotype numbers as related names to the corresponding Danish serotype Components
  • Added “PCV7”, “PCV13” and “PPSV23” as related names to the Components for the serotypes included in the Pneumococcal 7-valent, 13-valent and 23-valent vaccines, respectively
  • Wrote a new Technical brief about Streptococcus pneumoniae serotype nomenclature in the LOINC Users’ Guide
• Undeprecated 12 California encephalitis virus terms based on reviewing the latest literature and confirming that California encephalitis virus is a distinct member of the CAL serogroup in addition to LaCrosse virus (LACV), Jamestown Canyon virus (JCV), Snowshoe Hare virus, and Trivitattus virus.
• Updated approximately 75 cancer pathology terms for one or more reasons, including the following:
  • Removed Method of CAP cancer protocols for concepts that are not specific to CAP
  • Changed System from Cancer.XXX to Cancer specimen for pathology terms to clarify that the observation is specific to a cancer specimen, not the cancer as present in the patient
  • Added answer lists to Ordinal and Nominal terms
• Updated the Short Names to say Plts (platelets) instead of Thrb (thrombocytes) for consistency in terms with Platelets as the System.
• Updated the Long Common Name and Short Name for all radiology terms so that they begin with the modality in order to match the RSNA naming model. This change accounts for nearly 5000 of the 7000 term edits in this release.
• Removed the parentheses that were around the gene name in the Component for several terms in the ABXBACT Class. This is a work in progress and more terms will be updated for the next release.
• In an effort to shorten some of the LOINC Long Common Names, several changes were implemented including:
  • Removed the word Bacterial from the Long Common Name for bacterial resistance gene concepts (affected ~20 terms)
  • Changed Fluorescent in situ Hybridization to FISH (affected ~150 terms)
  • Changed Dried blood spot to DBS (affected ~380 terms)

Readme and ReleaseNotes documentation for all release artifacts

We are delighted to announce that this release contains a revised and improved approach to providing comprehensive documentation for our artifacts.

Each of our artifacts now contain a Readme text file that gives the user an overview of the artifact contents and details about the file structure. In general, the Readme file will contain:

• Overview of the file and its intended usage
• Version history
• Directory listing
• Detailed description of file fields and how they relate to each other

Each artifact now also contains a ReleaseNotes document that will summarize version to version changes.

Both of these new files are included in the artifact archive (zip) files.

New LOINC release artifacts

LOINC Table Core File

The purpose of the LOINC Table Core is to provide the essential LOINC content in a format that is stable over the long-run. The core table contains all of the LOINC terms that are in the complete table (i.e., the same number of rows), but a subset of the fields (i.e., different number of columns). The fields included in the core table are ones that are both crucial for defining each LOINC term and whose structure is not likely to change in the short-term.

We are providing this format in order to make it easier for implementers to update to the latest LOINC release without having to make changes to their database structure. However, depending on their use case, some implementers may still need to refer to the complete LOINC table in order to find all of the relevant information.

LOINC Answer File

The purpose of the LOINC Answer File is to provide the connections between LOINC observation terms and associated answer lists. LOINC includes two types of Answer Lists in this file:

1. Answer Lists that contain an enumerated list of LOINC answer strings; and
2. Externally defined Answer Lists, which are not enumerated in LOINC but rather include pointers (e.g., OID, URL) to the external site where that answer list is maintained.

We previously released these connections within the LOINC Panels and Forms File, but only for LOINC terms contained in panels. This new artifact contains connections between all LOINC codes and their answer lists.

Please see the AnswerFile_Readme.txt file for more details.

LOINC Part File

The brand new LOINC Part File contains the LOINC parts and their associations to LOINC terms and key mappings to external vocabularies. The LOINC Part File contains all of the primary LOINC parts that are associated with any of the LOINC terms included in the current LOINC release.

The types of parts fall into four major categories:

1. Six major parts that define a LOINC term (Component, Property, Time Aspect, System, Scale, and Method)
2. Additional parts that contribute to the term, such as the Divisor, Challenge, and Class
3. Parts that define document codes within the Document Ontology
4. Parts that define radiology codes according to the LOINC/RSNA Radiology Playbook unified model

Linkages between LOINC terms and LOINC parts are categorized into 4 types: Primary, Search, DocumentOntology, and Radiology.

Mappings between LOINC parts and other vocabulary standards such as SNOMED CT and RadLex are also provided, based on ongoing collaborative work.

Please see the PartFile_Readme.txt file for more details.

LOINC Group File

The goal of the LOINC groups project is to create a flexible, extensible, and computable mechanism for rolling up groups of LOINC codes for various purposes. In particular, these groups, or “equivalence classes”, could be useful for aggregating data for display on a flowsheet within an electronic health record (EHR) system, retrieving data for quality measure reporting, or processing data for research.

In this release, we are pleased to announce the publication of our initial release format and set of roll-up groups. This first publication set contains 12 Parent Groups and 2178 Groups that aggregate a total 6438 unique LOINC terms.

Here’s an example group that collects all the LOINC codes in the Chemistry Class, measuring Glucose with a Property of MCnc, Timing of Pt, a System containing ANY of the following: Blood, Serum, or Plasma, and ANY Method:

Terms in the Glucose|MCnc|Pt|ANYBldSerPlas Group:

• Glucose [Mass/volume] in Arterial blood 41651-1
• Glucose [Mass/volume] in Blood 2339-0
• Glucose [Mass/volume] in Blood by Automated test strip 2340-8
• Glucose [Mass/volume] in Blood by Test strip manual 2341-6
• Glucose [Mass/volume] in Capillary blood 32016-8
• Glucose [Mass/volume] in Capillary blood by Glucometer 41653-7
• Glucose [Mass/volume] in Serum or Plasma 2345-7
• Glucose [Mass/volume] in Serum, Plasma or Blood 74774-1
• Glucose [Mass/volume] in Venous blood 41652-9
• Deprecated Glucose [Mass/volume] in Serum or Plasma 6777-7

With this initial release, we are seeking feedback from the LOINC community on the file format, the content of the LOINC Groups created, and intended uses.

We welcome such comments as posts on the LOINC User Forum.

Please also see the GroupFile_Readme.txt file for more details.

Canonical representation of LOINC as a FHIR CodeSystem

Together with the HL7 FHIR® team, we are working to create a specification for the canonical representation of LOINC in FHIR as a CodeSystem resource. This is a work in progress.

An initial draft of that specification is available at https://loinc.org/fhir/loinc.xml.

This specification is specific to HL7 FHIR®, and it’s definitions of the LOINC attributes would supercede the general guidance about names for attributes (properties) given above. For example, in the canonical representation for FHIR, the radiology LOINC attribute Rad.View.Aggregation will be named closer to the conventions for FHIR-style property names as “rad-view-aggregation”.

Feedback on this new specification is welcome.

Updates to other release artifacts

LOINC Multiaxial Hierarchy

The LOINC Multiaxial Hierarchy was originally created for the Laboratory domain, but over time, a few other clinical domains (e.g. radiology, document ontology) were added.

We are pleased to announce that for the first time in the history of the world, the LOINC Multiaxial Hierarchy now includes all of the LOINC terms in a LOINC release!

The Multiaxial Hierarchy contains four top-level branches to match the four broad types of LOINC codes: Laboratory, Clinical, Attachments, and Survey.

Each top-level branch (except for Attachments) contains a “NotYetCategorized” node, which includes all terms in a given class that could not be placed elsewhere. For now, all of the Survey terms are in the “SurveyNotYetCategorized” node.

Over time, we intend to more fully develop the hierarchies in these areas and hope to reduce the number of LOINC terms in “NotYetCategorized” branches.

Top2000+ Common Lab Results

Version 1.6 of the LOINC Top2000+ Common Lab Results (both US and SI versions) contains two main updates:

1. Replace the Deprecated Streptococcus pneumoniae terms
2. Update the Long Common Name for Active Streptococcus pneumoniae terms to align with the widely accepted Danish nomenclature for Streptococcus pneumoniae serotypes

LOINC/IEEE Medical Device Code Mapping Table

As part of our ongoing collaboration with IEEE, we continue publishing the LOINC/IEEE Medical Device Code Mapping Table. The current version contains 590 rows of data that represent mappings between 568 LOINC codes and 578 concepts from the IEEE 11073(TM) 10101 Standard for Health informatics – Point-of-care medical device communication – Nomenclature and 10101a Nomenclature amendment.

LOINC/RSNA Radiology Playbook

The updated LOINC/RSNA Radiology Playbook file reflects our ongoing collaborative work with the RSNA to develop a unified model for naming radiology procedures. To date all of the terms in the core RSNA Playbook except the RP modality (modality-agnostic radiology procedures) have been mapped to LOINC codes. All of the imaging modality LOINC terms have been updated to the unified model.

Going forward, the LOINC representation in the unified model will be the primary source for this content. We expect to complete the unified model representation for the modality-agnostic radiology procedures by the end of 2017.

The current version 5513 LOINC terms linked to 830 unique LOINC Radiology Parts, which are mapped to 782 unique RadLex RIDs. Out of the 5513 unique LOINC terms, 766 are mapped to 776 unique RPID concepts from the RSNA Core Playbook, for a total of 783 unique LOINC-RPID mappings.

Notice of of changes to the public LOINC data files in this release

LOINC Panels and Forms File

We have begun to unify the representation of LOINC answer lists in the FORMS and ANSWERS tabs of this file with the new structure defined in the AnswerList and LoincAnswerListLink files.

In this release, we added two columns to the FORMS tab for the AnswerListIdOverride and AnswerListTypeOverride.

You can expect further changes to this file to align with the Answer file in future releases.

Changes to the LOINC License in this release

With the publication of this LOINC release we have made modifications to the LOINC License. Specifically, we have added all of the new release artifacts to the license, following the same basic principles of usage and attribution terms as we do for the other artifacts. In addition, we have updated the section on Third Party Attributions to reflect that some of the distribution artifacts now contain mappings to content from SNOMED CT and RxNorm.

Notice of changes to the public LOINC data files for the December 2017 Release

As a reminder, a number of approved changes are coming in the December 2017 release. These changes include the expansion of most text field sizes to 255 characters.

Notice of changes to the public LOINC data files for the June 2018 Release

We are proposing the following changes for the June 2018 release.

Pascal Case

As described above, this release contains several new release artifacts. Inside the archive (zip) files, the .csv files are named using the Pascal Case naming convention. Our existing legacy files and table artifacts do no follow the ìpascal caseî naming convention, so to provide consistency and uniformity across the release we will updating these names in the June 2018 release.

The list of changes that you will see include:

• The loinc.csv file will be renamed to Loinc.csv
• The map_to.csv file will be renamed to MapTo.csv
• The source_organization.csv file will be renamed to SourceOrganization.csv
• The loinc.mdb file will be renamed to Loinc.mdb

Within the Loinc.mdb Access database, the legacy tables will be renamed as follows:

• The LOINC table will be renamed to Loinc
• The MAP_TO table will be renamed to MapTo
• The SOURCE_ORGANIZATION table will be renamed to SourceOrganization

LOINC Panels and Forms File

We have begun to unify the representation of LOINC answer lists in the FORMS and ANSWERS tabs of this file with the new structure defined in the AnswerList and LoincAnswerListLink files. You can expect further changes to this file to align with the Answer file in future releases.

LOINC Linguistic Updates

The global community of LOINC users continues to help produce a wonderful collection of translations. For many years we have made these linguistic variants (we support multiple translations of the same language) available in RELMA and in our online search.loinc.org application. You can also download the translations in the LOINC Linguistic Variants File.

Updated Linguistic Variants in this release:

1. zh_CN_5 – Chinese (CHINA)
2. fr_CA_8 – French (CANADA)
3. es_ES_12 – Spanish (SPAIN)
4. fr_FR_18 – French (FRANCE)

RELMA version 6.20

There are no new features in RELMA 6.20 other than to show off all the new content in LOINC as described above.