James T. Case

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  • James T. Case
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    I will give my opinion on your questions and allow others to chime in:

    1. Not clear on what you mean by assinging two LOINCs to the orderable, but if you are going to result both the culture results and the gram stain, (which is the usual practice, no?), the result set will contain two LOINC terms representing the culture and the gram stain. Bottom line is that whatever you are going to report, you need a corresponding LOINC code. If the processes are just part of an overall analysis and only the final result is reported, then you do not need the intermediate codes.

    2. Choose a method type that fully specifies what method you used, but no more. For example, “organism specific culture” implies that you are looking for one particular organism type and no others. These will often have a result set of “detected”, “not detected” or a nominal list of species of a particular bacterial genus. Aerobic cultures will have a nominal result set of organisms that can be cultured aerobically (thus no Clostridium sp. or other anaerobes). To my mind this would also include facultative aerobes. Culture is the least specific and more flexible in reporting the method used and implies that you actually tried to grow the organism, but not the specific method of growth.

    3. If you would be reporting any yeast or fungal growth out of a blood culture, then “Microorganism identified” wouldbe the most appropriate. Again, the LOINC you choose depends ont he value set for the results. You cannot (should not) use a LOINC code for “bacteria identified” and then report out a fungal organism. As for the source, the specimen information may be transmitted in a number of other places (e.g. OBR-15 or the SPM segment).

    4. This sounds like a limitation of your system as opposed to a limitation of LOINC. Stains are stains and you shouldn’t report a non-stain report for a stain result.

    5. LOINC works the same way for negative cultures as for positive, except that the result indicates a failure to detect an organism. This is dependent on the result value set that you have for the LOINC observation. It is perfectly fine to say “Bacteria identified = none (negative)”

    Hope this helps,
    Jim

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