Presentation Catalogue

CLEM MCDONALD LECTURE

Reimagining Health Care and Advancing Health Equity with Data

Gary Puckrein, PhD

Presentation description to follow.

Introduction to LOINC

Rita Baroni
Regenstrief Institute

LOINC is the universal standard for identifying health measurements, observations, and documents. It is now ubiquitous in health data systems worldwide and is an essential ingredient of system interoperability. This tutorial presents an overview of LOINC and its use around the world, discusses the LOINC concept model and data structures, and describes the resources available for implementing LOINC. If you are new(ish) to LOINC, this session should be your starting point.

Advanced LOINC Concepts

David Baorto, PhD, MD
Regenstrief Institute

This session will review LOINC's transition from a naming convention 25 years ago toward a richer semantic model involving LOINC Parts. We will cover in detail how these "LEGO bricks" known as Parts are used to build LOINC terms. We will review how these reusable pieces have many other applications within LOINC, including those related to descriptions and name building, and also can be used to link to resources outside of LOINC, such as external terminologies and taxonomies. Finally, we will touch briefly on the evolution of the various ways that Parts can be leveraged to create collections of LOINC terms (hierarchies and ontologies), as well as future directions. While basic knowledge of LOINC is recommended, this session is suitable for both novice and experienced LOINCers.

SearchLOINC, LOINC Hierarchy Browser, and Search Exercises

Steven Wagers
Regenstrief Institute

Tim Briscoe
Regenstrief Institute

John Hook
Regenstrief Institute

Rita Baroni
Regenstrief Institute

With nearly 100,000 terms, searching the LOINC database can be intimidating but does not have to be. We'll show you tips and tricks to help you find appropriate terms to fit your needs. This presentation will demonstrate all the features available in the latest version of SearchLOINC as well as the new Hierarchy Browser. We will also reserve time to walk through a number of practical examples using SearchLOINC. Bring your laptop so you may follow along!

Introduction to UCUM

Eza Hafeza, MD
Regenstrief Institute

Tim Briscoe
Regenstrief Institute

UCUM is the Unified Code of Units of Measure, another data standard developed by Regenstrief Institute. This brief session will introduce you to the concept of standardized units and explain recent developments.

LOINC and FHIR

Tim Briscoe
Regenstrief Institute

HL7®'s standard API known as FHIR® gets a lot of attention, and for good reason. It provides a consistent means of accessing health data programmatically. We'll show you how LOINC has an integral role in FHIR. We'll also explain the functions of LOINC's Terminology Service powered by FHIR as well as hint at future capabilities. This presentation will feature a fair amount of tech speak but also explain concepts at a nontechnical level.

Intro to New Submission Process for Requesting LOINC Concepts

Eza Hafeza, MD
Regenstrief Institute

Rita Baroni
Regenstrief Institute

Abstract to follow.

ROUNDTABLE

LOINC interoperability made real from the source of IVD data (from LOINC mapping to delivery of LOINC code through IVD systems)

Sabine Doerhoefer
Roche

Cornelia Felder
Roche

Renan Legeas
bioMérieux

Xavier Gansel
bioMérieux

bioMerieux & Roche Diagnostics, will present their vision and commitments to embrace the laboratory data semantic interoperability. The presentation will highlight an interoperability vision (data interoperability starts at the source of the data) and the steps it takes to get both progressive LOINC enabled IVD systems and middleware as well as LOINC mapping coverage and deliverables (aka. LIVD publications) made available. The presentation will also highlight challenges with implementing semantic interoperability.

The use of LOINC and UCUM in clinical research. Three years after Barcelona, where are we now?

Jozef Aerts
XML4Pharma

At the previous European LOINC conference in Mataró, near Barcelona, Spain, we presented the status of use of LOINC and UCUM in clinical research, and especially in relation with the CDISC set of standards. In this presentation, we review what has happened, i.e. what has changed and what has not in the use of LOINC and UCUM in research in the past three years.

HIE Interoperability: The Importance of Data Standardization and Data Quality

Sanji de Sylva
Malaffi (Abu Dhabi Health Data Services)

During the implementation of Malaffi, (the MENA region's first Health Information Exchange) several challenges related to the sharing and exchange of patient data were encountered. These included issues with interoperability, data standardisation and data quality. These issues had a negative impact on both clinical care delivery and delivering actionable insights/data analytics to frontline clinicians and regulatory bodies to better inform their decision making. Both potentially resulting in poor patient outcomes. The impact was further emphasised during the pandemic, when it was critical to centralise, share, and analyse data in a meaningful way to support the operational needs of the Abu Dhabi Emirate's pandemic response.

This presentation will cover some of the challenges faced with data quality from multiple source EMRs and the approach taken to identify, report, rectify and monitor these data quality issues and the drive towards standardising data in the HIE

Evaluation of LOINC semantic coverage for coding clinical observations related to environmental influenced diseases

Maria Teresa Chiaravalloti
Institute of Informatics and Telematics of the Italian National Council of Research

Environment and health are strictly related domains, as the first one produces a variety of effects on the second one. While terminologies exist for coding and classifying almost all the aspects of the healthcare process (actors, products, observations, etc.), a specific one focused on environmental related or caused health problems has not yet been developed, even if multiple glossaries of environmental health terms exist. Nonetheless, concepts related to the link between the two domains can be found in different medical terminologies. Among them, Logical Observation Identifiers Names and Codes (LOINC®) is the most widely used for identifying parameters connected to clinical conditions. This presentation will review efforts to: 1) identify a subset of existing LOINC codes of clinical observations influenced or related to environmental factors; 2) search for environmental concepts not covered by LOINC in the UMLS Metathesaurus to see if they are covered and how they are expressed in other medical terminologies; and consequently 3) detect LOINC concept gaps related to the link between environment and health to be filled by proposing new LOINC terms for standardizing identified clinical parameters.

Interoperability of patient-reported Outcome and Experience Measures using LOINC

Tim Benson
R-Outcomes Ltd

Using patient-reported outcome and experience measures as an example, this explains why interoperability is hard at both the technical and human level. In particular the presentation will focus on explaining:

• Why interoperability is so difficult to get right, covering both technical and human aspects.
• Why FHIR is a big step forward in both technical and human aspects.
• The necessity to use unambiguous codes for measures, items and options, as well as for people, places, conditions, tests and treatments. This is illustrated using LOINC.
• Greenhalgh's framework for understanding the reasons for non-adoption, abandonment and failure to scale-up, spread and sustain (NASSS) digital innovations. This provides context for the non-technical difficulties.

Implementation of a Terminology Server including LOINC, ICD10CM and SNOMEDCT coding to support the automatic reporting of notifiable diseases

Gloria González Gacio, PhD
BITAC

Mireia Rodríguez Naque
BITAC

Toni Mas Mota
BITAC

Joan Vega Aiguadé
BITAC

Victoria Bérez Baldrich
BITAC

Matilde Prieto
National Health Service

Luis Lozano
National Health Service

In 2020 we presented at the LOINC Conference: AI algorithms coding with international standards: ICD10-CM, LOINC and SNOMEDCT for the epidemiological Surveillance environment. It was pre-pandemic times. This project was addressed to the digital improvement strategy for health care processes in the SES, the National Health Service in Extremadura (one of the Regional Health areas in Spain). In this current conference we will showcase the next steps (second phase) of this project, highlighting an upgrade of our tool ctMAP to incorporate terminology services.

Addressing equity in health care and enhancing interoperability of a pediatric fall risk assessment scale.

Ivy Razmus, RN, CWOCN, PhD
University of Detroit Mercy, College of Health Professionals, McAuley School of Nursing at Aquinas

This presentation will present the need for developmentally specific criteria for our most vulnerable population: children. This presentation will present the process for determining pediatric specific risk factor and validation of risk factors in hospitalized children. This information has been disseminated through poster and peer reviewed publications and requested for use in numerous regions internationally. Recently interoperability has been enhanced as it was added to the LOINC’s assessment tools.

LOINC Adoption: A Clinical Trials Case Study

Pamela Banning, MLS(ASCP)cm
Lab LOINC Committee Chair

An international pharmaceutical company implements LOINC across 14 studies, 131 sites and 132 laboratories throughout 15 countries during the past year. The discussion will include pre-project LOINC recognition, percent of laboratories already mapped to LOINC, audited reviews, barriers to participation, communication means to entice non-adopters to participate and much more.

LOINC-on-OWL for worldwide interoperation of observation results

James R Campbell, MD
University of Nebraska Medical Center

This presentation will introduce the participant to an expanded definition of LOINC ontology. The session will employ a terminology server employing Description Logic integrating LOINC with SNOMED CT, RxNorm and other worldwide terminology standards. The session will begin with an exploration of the ontology extensions to the 5-part LOINC model that support the integration of multiple ontologies.

A Look at Laboratory LOINC and IVD Vendor LOINC Mapping

Andrea Pitkus, PhD, MLS(ASCP)CM
University of Wisconsin-Madison, School of Medicine and Public Health

This session will present results from the JAMIA article, "Encoding laboratory testing data: case studies of the national implementation of HHS requirements and related standards in five laboratories" featuring the results of SHIELD pilots assessing the comparison of LIVD LOINC maps with those mapped by laboratories. Factors impacting the matching of IVD vendor LOINCs and laboratory mapped LOINCs to the same result will be discussed, as well as ways to mitigate them. AST, a common lab result, was mismatched by multiple laboratories. Analysis shows a number of the implications from an interoperability and usability perspective especially to downstream users.

The proposed session will also present results information about how LOINC can help inform whether lab results can comingle or not. We'll look at a few examples with clinically significant differences in lab results highlighted by their different LOINCs to show the value of LOINC from a patient safety and data quality perspective. An example is analysis performed on AST here.

Encoding administered vaccines: the need for a unified representation

Jean-Louis Koeck
SYADEM

François Kaag
SYADEM

For most usages, such as logistics or dispensation, vaccines can be addressed like any other medicinal product. But there is a specificity when it comes to digitizing the vaccination history. We have to collect and describe as precisely as possible products that can have been administered anywhere in the world, anytime during the past century. Precision is crucial because not all vaccines against a given disease are substitutable and because the characteristics of vaccines already administered determine the characteristics of subsequent vaccines and vaccine schedules. There is a single ATC code for all Covid-19 vaccines, yet it is now clear to everybody that it is impossible to determine a course of action without knowing exactly which vaccine has been administered.

The data to digitize comes from many supports : paper trails with more or less degraded information (e.g. 'Tdap' or 'Flu vaccine', abbreviated brand names), stickers with pharmaceutical codes, 2D codes found on packaging, preexisting digital records according to very diverse codifications.
SYADEM designs and operates decision support systems for vaccination. To cope with this diversity we have created an ontology to bind the vaccines with their valences (minimal groups and dosage of antigens) and with any preexisting literal or digital representation. We populated it with a comprehensive set of vaccines, valences and code systems, in order to provide a pivot terminology allowing to match exactly or approximately (matching through a hierarchy of valences) between any couple of representation systems.

By the end of June 2022, the ontology included 917 vaccines, 293 valences and was aligned with 13 code systems, making it already the most comprehensive semantic resource on vaccines. It is a public resource in France and Luxembourg, and proposed as a common good to the European Union.

The Opportunity for LOINC to narrow the patient education gap in developing countries

Wasim Mohideen MD, MRCGP[INT]
Doc Crates

If we break it down, clinicians are expected to do three things:

1. Listen (and offer empathy)
2. Educate (about the symptoms, diagnosis, and procedures)
3. Provide clinical services (prescriptions/surgery/procedures)

The first two have taken a beating albeit differently in different countries. In most of the developing and under developing world, the first two are pretty much nonexistent, which has led to the internet becoming the go to source for patients But internet penetration is very high in many of these countries. In this presentation, we review how LOINC, by offering interoperability between labs and healthcare applications in developing nations can provide the platform for personalized patient education. We will also examine that by mapping patient history and symptoms to their lab reports, health applications can personalize patient education, which will reduce the stress on doctors. LOINC can champion this cause.

Extending LOINC Through Out the Enterprise Imaging Ecosystem

Cheryl Petersilge, MD, MBA
Visiting Clinical Professor of Radiology, University of Pittsburgh Medical Center

Sarah Manney, DO
CMIO, Essentia Health System

As Essentia Health has embarked upon its enterprise imaging journey it has embraced the need for standardization across all the entire imaging continuum. This standardization extends from technical integrations to workflows to identification of imaging studies. The need for standard identification of imaging studies posed a challenge when developing study descriptors across multiple modalities reaching well beyond radiology to include endoscopy, procedural imaging and photodocumention. These study descriptors will be used to index imaging studies within the electronic health record and will support searching, filtering and sorting in the enterprise and diagnostic image viewers. Adoption of an existing standard was desired, rather than creation of an internal standard. To date no such standard exists for the entire imaging health record. In recognition of LOINC as the vocabulary standard selected by the Office of the National Coordinator for Health Information Technology for the United States Core Data for Interoperability, Essentia Health decided to adopt and modify this vocabulary standard for all medical imaging studies stored in their vendor neutral archive.

This presentation will review the approach taken for creation of the study descriptor list, the current list of procedure names, challenges and future desires.

From first feature to rare disease co-management with LOINC

Liesbeth Siderius
Foundation Rare Care Word & Foundation Shwachman Diamond Syndrome Support Holland

Marc de Graauw
magrit.nl

We developed a data model using common coding standards such as LOINC, ICD, Orpha, HPO and ICF to describe disease-specific profiles. These profiles can be used to import a "disease" definition to facilitate customized disease management with information systems, including patient apps. This greatly facilitates a custom approach for less common diseases, where custom-built apps are usually not cost effective. This approach can enable large groups of patients with rare conditions, especially in less developed areas, to receive early and customized care and support.

LOINC for federated queries: opportunities and challenges

Kristin Gnodtke
Personalized Health Informatics Group, SIB Swiss Institute of Bioinformatics

Vasundra Touré
Personalized Health Informatics Group, SIB Swiss Institute of Bioinformatics

Katrin Crameri
Personalized Health Informatics Group, SIB Swiss Institute of Bioinformatics

Sabine Österle
Personalized Health Informatics Group, SIB Swiss Institute of Bioinformatics

Information retrieval systems enabling researchers to query for specific clinical information of patients are often limited to individual health care providing institutions. Why is it so hard to set up systems allowing queries across several hospitals? One of the hurdles is the limited semantic interoperability between data from the different institutions and information systems. Part of the solution for this issue are well-established international terminology standards, such as LOINC, implemented in source systems of healthcare institutions.

The Swiss Personalized Health Network (SPHN.ch), a Swiss initiative contributing to infrastructures for sharing interoperable health data for research, strongly supports the use of terminology standards and uses LOINC coded data, e.g., for its Federated Query System (FQS).

Use of LOINC codes for recording psycho-social scales within a COVID-19 context across cohorts in the ORCHESTRA project

Eugenia Rinaldi
Berlin Institute of Health at Charite Medical University Berlin

Caroline Stellmach
Berlin Institute of Health at Charite Medical University Berlin

The European ORCHESTRA project gathers data across several countries and cohorts to advance the knowledge on COVID-19 causes and long-time effects. Besides laboratory exams performed on samples, ORCHESTRA partners collect patient-level information on the psychological and social aspects of the SARS-CoV2 pandemic across clinical studies. In the attempt to harmonize and standardize data coming from different sources within the project, we mapped all possible clinical study data elements to pertinent international standard terminologies. Laboratory parameters as well assessment scales were preferably mapped to LOINC whenever possible. In case no appropriate LOINC codes were available, we started the term submission process with LOINC to include the new elements in the standard terminology. In this presentation, we describe the work accomplished so far and, in particular, present our contribution to the standardization of COVID-19 related psycho-social questionnaires through LOINC.

National-level Interoperability of French Laboratory Tests and Results: Lessons learnt from implementing a linguistic approach for mapping French laboratory terminologies with LOINC

Namrata Patel
Onaos

Fleur Brun
Onaos

Théodore Michel-Picque
Onaos

Guilhem Mayoral
Onaos

With the increasing use of electronic patient records, interoperability of patient-related data is of primary concern and international standards have been developed to assure compatibility between health data management systems.

The French government, with the "SEGUR du numérique en Santé", has launched a variety of programmes addressing this issue. One in particular, pertains specifically to LOINC, and requires all French laboratory tests to be written in accordance to the "Jeu de valeurs LOINC", a French terminology based on LOINC (Logical Observation Identifiers Names and Codes), ensuring interoperability between private and hospital laboratories.

The present study follows a pilot study conducted in 2021 by Onaos, expanding and improving upon the published results. Our objective is to develop a linguistic algorithm for mapping French laboratory terminologies with "Jeu de valeurs LOINC". This updated study presents our conclusions based on data obtained from 20 laboratories (both private and hospital laboratories) as part of Onaos' contribution to the SEGUR programme in biological data. Implementing national-level interoperability has been an exciting and challenging experience and in this presentation, share lessons learnt throughout the process.

Accelerating LOINC adoption and implementation towards building a standardized Health ecosystem

Manisha Mantri
Centre for Development of Advanced Computing (C-DAC)

Sayali Pophalkar
Centre for Development of Advanced Computing (C-DAC)

The Ministry of Health & Family Welfare (MoH&FW), Government of India notified Electronic Health Records (EHR) Standards in December 2016. The set of standards aims to bring uniformity in the creation and maintenance of healthcare information and address various aspects viz. structure, exchange, content, security, and privacy.

Logical Observation Identifiers Names and Codes (LOINC) being one of the widely used coding standards, is recommended in India for recording tests, measurements, and observations used for processing results and reports in the Laboratory and Imaging Information Systems.

This session will cover a brief overview of the standardization initiative taken in India and the national digital health mission called "Ayushman Bharat Digital Mission (ABDM)" towards the adoption of the LOINC standard. Introduction and demonstration of the FOSS toolkit C-DAC's Toolkit for LOINC (CLNtk) developed to support the integration of LOINC in HMIS/LMIS systems.

Safe possibilities to add PROMs questionnaires to LOINC, assuring continuous business possibilities to the license holders and the PROMs agents

Naveen Moses Raj Rajkumar
Berlin Institute of Health at Charite Medical University Berlin

Michael Rusongoza Muzoora
Berlin Institute of Health at Charite Medical University Berlin

This presentation will cover the following:

1. Introduction of interoperable PROMs usage in the national (Germany) and international projects.
2. Various PROMs questionnaire submissions to LOINC requested from individual projects
3. The process of requesting permissions from the license holders
4. Demands of the license holders/ PROMs agencies
5. Possible methods to safeguard the discreteness of the PROMs questionnaires.

Our experience of LOINC adaptation in laboratory diagnostics of HIV/AIDS and tuberculosis in cooperation with the MOH of Ukraine

Valentyna Lemish, MD
TerraLab

Andrii Bilyi

This presentation will highlight our experience and challenges faced when adapting LOINC in Ukraine and what further steps are necessary to make LOINC implementation a success in Ukrainian laboratory diagnostics. We will also discuss 1) the cooperation with the MOH of Ukraine and donors, 2) the information collections from laboratories that work in diagnostics of HIV/AIDS and tuberculosis in Ukraine, 3) our approaches to analysis and studying of LOINC та RELMA in short terms and 4) our approach to translation and adaptation of LOINC.

A solution for comparing foreign language translations to improve the national LOINC Part-based translation process

Giovanna Aracri
Institute for informatics and telematics of the National Research Council

Maria Teresa Chiaravalloti
Institute for informatics and telematics of the National Research Council

Elena Cardillo
Institute for informatics and telematics of the National Research Council

Maria Teresa Guaglianone
Institute for informatics and telematics of the National Research Council

In this presentation we review the consolidated translation practice, and the work is to improve the Part-based translation process by means of a tool which compares translations in multiple languages. The core idea at the basis of the tool design is the integration of foreign languages domain vocabularies, as authoritative sources, to propose a set of possible translations of a specific Part in the target language, having as a source language not only the English master. This work could produce benefits for both the translator, allowing the evaluation of the context in which the term appears and managing homography, synonymy and polysemy, and the Regenstrief Institute, allowing a general control over the consistency and coherence of the Part-based translations in multiple languages in order to validate them or detect inconsistencies.

Current activities and use of LOINC in Germany

Jeremy Lieth
Federal Institute for Drugs and Medical Devices (BfArM)

Alexandra Hoffmann
Robert Koch Institute (RKI)

In this presentation we will review the use of LOINC in current interoperability initiatives in the health care system in Germany. The discussion will highlight the efforts in 2021 where the use of LOINC for electronic health records in Germany has been introduced by law. The Federal Institute for Drugs and Medical Devices (BfArM) coordinates the development of the LOINC linguistic variant for Germany and adaption to the needs of the German healthcare system. Activities in Germany are to be aligned with European activities, in particular the guidelines of the EU eHealth Network.

Also, the presentation will highlight the activities of the national public health institute in Germany (RKI) which currently develops the 'Electronic Reporting and Information System' (DEMIS) for surveillance of notifiable diseases. Notifications via DEMIS using LOINC and SNOMED CT were first introduced successfully in the COVID-19 pandemic in 2020. We will review the further development of DEMIS and the use of LOINC and SNOMED CT to ensure interoperability within the German healthcare system.

Mapping to LOINC to enable secondary use of laboratory data for clinical research: Challenges of a multi-centric global network

David Rubio Ruiz
TriNetX

Olivier Denquin
TriNetX

Luc De Keyser
TriNetX

David Pérez del Rey
Universidad Politécnica de Madrid (UPM)

Matvey Palchuk
TriNetX

TriNetX is a real world data network that includes data from more than 120 health care organizations and is present in 19 countries. The interoperability between different systems is a well-known topic in the clinical data area. One key aspect that enables TriNetX to operate is the semantic interoperability, the ability of the systems to communicate using the same standards. Within this framework, LOINC is used as the preference terminology to reuse the data coming from different Laboratory Information Systems (LISs).

In this presentation, we will share our experience in collaboration with the Universidad Politécnica de Madrid (UPM) integrating laboratory data in an international environment.

Exchanging laboratory results in the Netherlands: it should be and it is possible, but with care!

Dr. L.J. (Joost) van Pelt
UMCG

Dr. J.M.E.P. (Judith) Gillis
Amsterdam UMC

Dr. H. (Helena) Chon
ZGT

Dr. P.J. (Paul) Geutjes
CWZ

Dr. J.L.S. (Jan) Dols
IHE Netherlands

Dr. D. (Dirk) Bakkeren
Maxima Medical Centre

Dr. R.L (Ruben) Smeets
Radboud UMC

Laboratory results are an essential part of many healthcare processes. Access to the results of other laboratories has been an explicit wish of healthcare providers for years. It is difficult to explain why exchange has not been commonplace for years. The starting point of the IT-committee of the Dutch Association for Clinical Chemistry and Laboratory Medicine (NVKC) is that exchanging laboratory results must and is possible. The committee notes that the stakeholders - healthcare providers, but also patients, IT specialists and policymakers - have great confidence in the reliability of laboratory diagnostics. When it comes to data sharing, lab results are often seen as potential quick wins. However, when it comes to exchanging laboratory results between healthcare information systems, substantive laboratory knowledge is essential. A lack of knowledge about the organization and limitations of laboratory diagnostics leads to an underestimation of the complexity involved in the safe exchange of laboratory diagnostic results. An identical LOINC code does not guarantee exchangeable test results, e.g. equal units and test standardization are not guaranteed in LOINC. In this presentation we will discuss how organizations overcome these issues in the challenge to safely exchange laboratory test results and are there perhaps best-practices to realize these issues on a national or even European level.

Mapping errors between LOINC and local test names in a sample of 170 million mapping instances from a large research network and algorithm for correcting such errors

Clem McDonald, MD
U.S. National Library of Medicine

Abstract to follow.

Data Standards and Standardization for Public Health Emergency Management and Knowledge Discovery in COVID-19

Gong Mengchun, MD
Southern Medical University, China

Abstract to follow.