LOINC Release Notes, August 2023 (Version 2.75)

This section last updated: 2023-09-18 (7 months ago)

Version 2.75, August 2023

Table of contents:

• LOINC table core
• LOINC table
• Answer lists
• Change snapshot
• Consumer names
• Document ontology
• Document ontology OWL
• Groups
• Imaging document codes
• Linguistic variants
• LOINC/IEEE medical device code mapping table
• LOINC/RSNA radiology playbook
• LOINC Universal lab orders value set
• Component Hierarchy By System
• Panels and forms
• Parts
• Updates
• Upcoming RELMA Changes

LOINC table core

There were no structural changes to the core table in this release, and no future changes to announce at this time. See the Readme included in the LOINC Table Core download file for information about its current file structure.

See the LOINC table notes below for information on content updates included in this release.

LOINC table

Numbers

New terms and totals by type

Totals by Status

Term Status changes

Edits by change type

New content highlights

Mapping of LOINC Parts to External Ontologies

The Component Parts of a LOINC term can be linked to codes from external coding systems. The external mappings serve to provide links from LOINC detail pages to external information sources, and are also provided in the Partfile directory in the distribution in a file named PartRelatedCodeMapping.csv, which can be used in various ways to organize LOINC codes by external axes as needed. Such linkages in the laboratory domain include mappings to ChEBI (Chemicals of Biologic Interest) and NCBI’s PubChem for chemicals, NCBI’s Gene for genes, NCBI’s ClinVar for genetic variants, and NCBI’s Taxonomy for microorganisms. Clinical linkages include NLM’s RxNorm for drug ingredients and RSNA’s RadLex Clinical Terms for radiology concepts. There is also a set of LOINC Parts mapped to SNOMED CT (SCT) concepts.

For the current LOINC release 2.75, additional mappings were created between LOINC Component Parts and NCBI Taxonomy, Genes, and ClinVar databases, as well as FDA UNII codes.

Allergy Class Changes

1,015 concepts were deprecated and re-created to separate Component “Antibody.IgE” concepts from Method “RAST” Radioallergosorbent test. We added a new method in the Method attribute “RAST” and updated to a new scale in the Scale attribute “SemiQn.”

Semi-Quantitative project implementation

4,150 concepts were updated as a result of the semi-quantitative review project of the Laboratory Committee. The committee recognized that updates were necessary because often laboratory and clinical observations begin as numerical values that are either non-linear or that have large enough random error that pure numerical (analyses, such as mean and standard deviation), are not useful. The updates respond to the need for mechanisms to safely avoid over-interpretation of semi-quantitative results without losing valuable information. A designation of “semiquantitative” provides a warning that the data should not be assumed to be true “linear” quantities. LOINC version 2.75 re-introduces the semi-quantitative (SemiQn) scale for more explicit representation of non-continuous measurement of numeric values. This new scale option has an impact on the Property attribute. Recent updates are reflected in the following property categories:

• Mass (mass content, mass concentration)
• Substance (substance concentration)
• Titer
• Percentile
• Number concentration range
• Score range
• Log molar concentration
• Relative density

System representation improvement

94 concepts had “System” improved from “Respiratory” to a better representation “Respiratory System Specimen” for machine readability and semantic interoperability.

New Radiology data created

320 new concepts in the Radiology domain were created to support standardization and semantic interoperability across one major organization.

New MDS Panels

8 new panels were created for the Centers for Medicare and Medicaid (CMS). These assessments should be used for performance effective October 1, 2023.

New laboratory content highlights

• New concepts to detect circulating tumor DNA (ctDNA) for molecular residual disease (MRD) assessment and recurrence monitoring of patients previously diagnosed with cancer.
• New concepts to support efforts in alleviating and monitoring patients with chronic pain by monitoring 11 biomarkers into a single pain index score titled “Foundation pain index”
• New concepts to detect neoplastic clones associated with chromosome abnormalities seen in T-cell lymphomas.
• New external steroid panel, ACTH heterophile Ab interference panel; synthetic glucocorticoid panel; MA2EC and MA2ES (Ma2 Antibody in CSF and Ma2 Antibody in Serum); panel code for VBGLP; and for radiology concepts for Bone Density POC Screen and Beta-Amyloid 42/40
• Challenge related concepts are added for GGH (Pediatric Glucagon Stimulation for Growth Hormone), GSGHD (Glucagon Stimulation for Growth Hormone Deficiency), ITT (Insulin Tolerance [Glucose, Growth Hormone, Cortisol] and ASC2 (Arginine Stim/Cort).

Over 140 new microbiology concepts including and not limited to:

• PCR assays for probe detection of NAA from different matrices for the detection and quantification of BK virus (BKV) specific DNA in human plasma, whole blood and urine.
• New and updated orders related to SARS-Cov-2 virus and added 3 more for a qualitative detection and differentiation of SARS-CoV-2 and RSV viral antigens.
• New concepts for microbiology testing for assessment of an antibody response to tetanus and diphtheria toxoid vaccines and aiding in the evaluation of immunodeficiency, Prenatal hepatitis B & C panel; Blood group antibody screen; Neonatal ABORh & Ab antibody panel.
• Various tests related to Candida and Candida DNA; Respiratory syncytial/Influenza virus, Vaginal CTGC and Vaginitis/Vaginosis Molecular Detection, ThinPrep HPV Reflex, Screen and Diagnostic (STHPV/DTHPV) and ThinPrep with Human Papillomavirus (HPV) Co-Test, Screen and Diagnostic (STPCO/DTPCO).
• Cell marker concepts include Ki-67 Nuclear Ag+p16INK4a Ag and Leukotriene E4 panel, T-cell.

Other areas of Laboratory LOINC with additions and updates include:

• Updates in coagulation testing including Thromboelastography panel terms; Maximum clot strength amplitude. Kaolin induced; Beta-2 Glycoprotein 1 Antibody, Ig; Platelet Function Profile
• Additions to serology including testing for Calcium channel Ab.
• More than 50 new concepts related to molecular genetic testing including Cancer in lung tissue by sequencing; molecular testing to identify genetic abnormalities to predict response to targeted therapies, HBA1 & HBA2 gene full mutation analysis; MYC and BCL2 rearrangements; and Various MOLPATH and CHEM terms include proton monoclonal isotype, hereditary Wilms tumor multigene analysis, and T-Cell acute lymphoblastic leukemia; Apolipoprotein C-III also known as apo-CIII, and apolipoprotein C3 encoded by the APOC3 gene. Asparaginase, an enzyme that in humans is encoded by the AGA gene. With regard to gene mutation we included Ashkenazi Jewish Disease mutations, Detection of ALK gene for profiling of tumors from patients with Non-Small-Cell Lung.
• In Drug/Toxicology we added new concepts for Screening anti-hypertensive and anti-thrombotic drugs to screen on the presence of antihypertensive; Screening for Synthetic Cannabinoids EMP (Eculizumab Monitoring Panel) and RAVMP (Ravulizumab Monitoring Panel; and urine drug testing for xylazine.

New clinical content highlights

• Over 300 hundred new radiology concepts are added to the database. Data was collected from Cerner/Oracle systems from multiple users. They were normalized, but needed to be coded to a standard; LOINC in this case with the goal of semantic interoperability and good outcomes in data analytics.
• Concepts to screen for risk of malnutrition, assess neonatal pain, and evaluate the polygenic risk score to measure for risk for disease based on an individual’s genetic profile.
• New concepts to assess clinical risk using malnutrition risk screening tools and using gene to calculate polygenic risk score to calculate patient risk for developing a disease.
• New concepts for PTSD screening (Post traumatic stress disorder checklist - civilian version DSM-5; The Primary Care PTSD Screen for DSM-5)
• Additional concepts were created and added to the Survey class in the Document Ontology domain from The American College of Surgeons (ACS) disseminating and implementing synoptic operative reports for cancer surgery to improve accuracy and completeness of cancer surgery documentation, report about Abnormal Prion Protein, Goals and preferences note; Clinical pathology Laboratory report, and Special investigation unit (SIU) medical record.

New survey content

8 new MDS v3.0 - RAI v1.18.11 panels were created for the Centers for Medicare and Medicaid (CMS). These assessments should be used for performance effective October 1, 2023.

• MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set
• MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set
• MDS v3.0 - RAI v1.18.11 - Nursing home & Swing bed tracking (NT & ST) item set
• MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set
• MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set
• MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set
• MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set
• MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set

The Minimum Data Set (MDS) is part of a federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process entails a comprehensive, standardized assessment of each resident's functional capabilities and health needs.

New Method content

Two new methods for Laboratory:

• SPR: Surface plasmon resonance
• RT-QuIC: Real-time quaking-induced conversion

Term edit highlights

Changes based on internal review or as part of an ongoing project

• Harmonized the naming model for terms representing studies
• For studies detecting neutralizing antibodies, updated "Ab" to "Ab.Neut" in the Component
• Updated Thermoactinomyces sacchari to Laceyella sacchari in the Component
• Removed the Method from several terms that represent generic concepts to allow broader use
• Updated terms from TRIAL to ACTIVE status

Changes based on community input

• Corrected several minor typos in Components and display names
• Updated the Order and/or Observation value to Both in the Order/Observation field for several terms to allow for broader use
• Updated the Required (R) value to Optional (O) in the Conditionality field for several panels and/or added additional children to allow for broader use

Source Organization

LOINC version 2.75 contains copyrighted content that is used with permission from the organizations documented in the SourceOrganization table. Users of this content must follow the copyright holders' terms of use.

Change to the LOINC Table structure in this release

No changes mere made as part of version 2.75. Deletion of the COMMON_SI_TEST_RANK field was previously scheduled for this release but has been delayed until February 2024. See below for details regarding this change.

See Appendix A in the LOINC Users' Guide for the current LOINC table structure.

Changes to the LOINC Table structure planned for February 2024

Field Name: COMMON_SI_TEST_RANK

Formal Definition: Corresponding SI terms for 2000 common tests performed by laboratories in USA.

Action: DELETE

Discussion: In the 2.74 release, the old Top 2000 common ranks were updated with a new set of values. The new rankings do not differentiate between SI and mass based measurement making this field obsolete.

Answer Lists

See the ReadMe included in the Answer File folder for information about its current file structure.

This release contains all of the answer lists associated with any LOINC term published in the current release. There have been no changes other than the addition of new content since the last release.

Change Snapshot

See the ReadMe included in the Change Snapshot folder for information about its current file structure.

The LoincChangeSnapshot file contains all terms that had a change in Status between LOINC version 2.74 and version 2.75, such as from TRIAL to ACTIVE. It does not contain terms that were newly added in 2.75. In the future, this file will likely contain other types of term changes in addition to Status changes.

The PartChangeSnapshot file contains all of the Parts that had a change in Status between LOINC version 2.74 and version 2.75, such as from ACTIVE to DEPRECATED or ACTIVE to INACTIVE (see ReadMe for Status definitions). In the future, this file may contain other types of Part changes in addition to Status changes.

Consumer Names - Alpha

See the ReadMe included in the Consumer Name folder for information about its current file structure.

This release of the Consumer names file remains at Alpha pre-production status. It contains Consumer names for all Type 1 (Laboratory) and a subset of Type 2 (Clinical) terms in LOINC. The Consumer Names are created algorithmically based on the set of primary rules documented in the associated ReadMe notes.

Consumer Names are intended for downstream display only and are not intended to be used at any point in the clinical workflow, or for the purpose of mapping local terms to LOINC. Their use case includes consumer-facing health and wellness applications that use LOINC to encode the underlying data.

We welcome user feedback about these names.

Document Ontology

See the ReadMe included in the Document Ontology folder for information about its current file structure.

Document Ontology OWL - Alpha

See the ReadMe included in the Document Ontology OWL folder for information about its current file structure.

The Document Ontology OWL file released with LOINC version 2.74 includes all the changes and additions to LOINC documents and document ontology values in a format that allows navigation of document axis hierarchies and exchange as a formal ontology. It continues at Alpha status, meaning that it is part of a testing process, and the LOINC team continues to welcome comments regarding its usability and content.

Groups - Beta

See the ReadMe included in the Group File folder for information about its current file structure.

This release of the Group File remains at Beta pre-production status. We received no significant public comments about its contents, structure, or utility that we would have used as the basis for incrementing its maturity level or conceptualization. If you are using this file and have feedback (good or bad), please contact us.

Imaging Document Codes

See the ReadMe included in the Imaging Document folder for information about its current file structure and query used to generate the set of LOINC codes.‌

There have been no changes other than the addition of new content since the last release.

Linguistic Variants

See the ReadMe included in the Linguistic Variants folder for information about its current file structure.

Updated linguistic variants are generally based on the previous release version (i.e., LOINC version 2.74 is translated for inclusion in the 2.75 release). The de_DE German (GERMANY) linguistic variant for 2.75 does contain translations for new terms introduced in version 2.75.

Updated content for the LOINC 2.75 release has been provided by the translation for the following linguistic variants:

The table below shows the LOINC version when each linguistic variant included in this release was last updated.

Please note that some term translations are based on the translation of Parts. For such translations, even if no additional Part translations were provided by the producer, the number of translated terms may vary from release to release because new LOINC terms using previously translated Parts will also be included, and old LOINC terms that have been updated to use untranslated Parts will be excluded.

LOINC IEEE Medical Device Code Mapping Table

See the ReadMe included in the LOINC IEEE Medical Device Code Mapping Table folder for information about its current file structure.

There have been no changes to the structure or contents of this file since the LOINC 2.67 release in December 2019.

LOINC RSNA Radiology Playbook

See the ReadMe included in the LOINC RSNA Radiology Playbook folder for information about its current file structure.

There have been no changes other than the addition of new content since the last release.

The mappings to and content from the RSNA Playbook are based on version 2.4 of that terminology, and Radiology Part mappings are based on RadLex version 4.1 and pre-release 4.2.

We are still seeking feedback on the usefulness of the PartSequenceOrder field from anybody who is utilizing this file to help inform our future efforts, e.g., whether we should remove this field.

Known issues:

Parsing issue for terms with multiple Aggregation or View type values in which one or more values is not being assigned the correct PartSequenceOrder value. We plan to address the parsing procedure in a future release if necessary, depending on whether users find this field useful (see request for feedback above).

A few outstanding cases for LOINC Radiology Parts without mappings to RadLex RIDs exists. We plan to review these with RSNA and add mappings, as appropriate, in a future release.

Terms with XXX (meaning Unspecified) as the Region Imaged without an Imaging focus do not have an Anatomy attribute (Region imaged or Imaging focus) represented in the file. The LOINC/RSNA Committee is reviewing the representation of XXX without a specified imaging focus in the LOINC/RSNA model to determine how the Anatomy should be represented.

LOINC Universal Lab Orders Value Set

See the ReadMe included in the LOINC Universal Lab Orders Value Set folder for information about its current file structure.

There have been no changes to this file since the last release.

Component Hierarchy By System

The Component Hierarchy By System (formerly known as Multiaxial Hierarchy) file provides a way to organize LOINC codes based on multiple axes of each concept. See the ReadMe included in the Component Hierarchy By System folder for information about its current file structure.

There have been no changes other than the addition of new content since the last release.

Panels and Forms

See the ReadMe included in the Panels and Forms folder for information about its current file structure.

The PanelsAndForms.csv has a new column, "AdditionalCopyright", beginning with version 2.75. The new column is within the context of the panel.

Parts

See the ReadMe included in the Part File folder for information about its current file structure.

This file contains all of the parts associated with any LOINC term published in the current release. Note that it does not contain Parts that are used to organize terms in the Component Hierarchy By System.

There have been no changes to this file other than the addition of new content since the last release.

Updates

See the ReadMe included in the Updates folder for information about its current file structure.

For this release and going forward, the CHANGE_REASON_PUBLIC and STATUS_TEXT fields will no longer be considered when determining if a LOINC term has been updated because they contain information for users about term edits but are not directly related to the attributes of a term.

There have been no changes to this file other than the addition of new content since the last release.

Upcoming RELMA Changes

We will be retiring our online RELMA search engine. You will be able to still use the local search engine within RELMA; however, you will need to make a configuration change when the service is shut down for it to work. We will provide detailed instructions on how to make this configuration change on our forum in advance of the retirement date. Subsequent releases of RELMA will no longer include the online search feature.

The ability to create submissions from RELMA will be discontinued. We will be transitioning this function to our online submission form. The exact date of this change will be announced on the forum. If a user tries to submit a submission via RELMA after this date they will receive an error. Subsequent releases of RELMA will have the submission feature removed.