LOINC Submissions using RELMA

Regenstrief balances the desire to respond quickly to new term submissions with the review processes necessary for a high quality standard. We can only be quick if the requesters provide clear and comprehensive information about the terms they are submitting. For detailed instructions on what information to include in a LOINC submission, please see Appendix D of the LOINC Users' Guide. You can download the LOINC Users' Guide here.

If you are submitting requests for new laboratory tests or other basic clinical measurements, we think the the tools in RELMA are the easiest way to make a submission. Just look for the "Propose Term" button on the mapping screen or "Propose a new LOINC" choice from the File menu and you'll be on your way. We also accept submissions in Microsoft Excel format or using our online submission form. If you choose to create your submission using Microsoft Excel, you must use one of the template files provided on the LOINC web site. When constructing the submission, please follow the instructions provided. The spreadsheet templates, online submission form and instructions can be found here.

Creating a Submission Using RELMA

The RELMA program can aid you in creating submissions by allowing you to create, manage and store submission terms in a way that is similar to how the program creates, manages and stores local Term Files. With RELMA, you can create terms for submission over time and submit groups of terms in batches. The program will track when the term was created and the date when you submitted the term. The program will help you organize the terms that you create and it will automate the process of creating the individual submission files that are sent to Regenstrief for processing.

Because there are two kinds of requests for additions (requests for an entirely new kind of measurement and requests for variations on observations that are already in the database), there are two methods for creating them. The first method is to start from scratch, typing or choosing from a list each part of the requested term. The second method is to start with an existing LOINC term and modify one (or more) part of that term to create a unique variation not found anywhere else in the LOINC database. We recommend the second method because it will save you time (you won't have to choose each constituent part of the requested term by hand) and it will expedite the process by providing additional information beyond the first six parts of the requested term.

Starting from a Blank Slate

To start from scratch, choose "Propose a new LOINC" from the File menu on the welcome screen. If you are viewing the mapping screen, you can either choose the same menu option from the File menu or click on the "Propose Term" button located above the results grid when the results grid is empty (i.e. there are no LOINC records in the grid).

Starting from an Existing LOINC

To modify an existing LOINC term, you must begin from the mapping screen. After you execute a search, highlight one of the LOINC terms displayed in the results grid. Now you may choose the "Propose a LOINC based on selected term" option from the File menu, click on the "Propose Term" button OR you may right-click your mouse and choose the "Propose a LOINC based on selected term" option from the dropdown menu. See the "Proposing a LOINC using an existing LOINC" section below for more details.

After performing one of the methods described above, you should see a form very similar to the one in the figure below.

Overview of the Propose LOINC Form

After the form displayed in the figure above is loaded, you should edit the parts so they equal the values you wish to exist in the proposed term. Once you have finished creating the proposed LOINC, click the "Save" button. This will save the proposed term to your local computer and make it available for submission later.

Note: The fields highlighted in red are required for all proposed LOINCs as specified in the table above. A requested term cannot be saved for submission unless it contains data in each of the required fields.

To enter another proposed LOINC, click the "New" button. To view other requested terms you have previously created, click the left and right arrow buttons located in the bottom left corner of the form. To close the form, click on the "Exit" button located in the bottom right corner of the form.

Details of the Propose LOINC Form

The following sections describe individual areas of the Propose LOINC form. Each section provides an explanation of the area in question and instructions on how to enter data in that part of the form.

The Local Details Section

The local code section displays the details of a term within a Local Term File that served as the model for the requested term. In the figure above, the user was unable to find a valid LOINC to map the local code of CULT (Culture) in the "SAMPLE" Local Term File, so the user chose to request such a term. When the form opened, the local code information was copied onto the Propose LOINC form, and it will be transmitted along with the proposed LOINC when the user submits the term. Please make sure that when local code data is present it relates to the requested term. The local code information helps the Regenstrief Institute better understand the need for your requested term.

Note: The local code section may contain data if the user opens the Propose LOINC form while viewing the mapping screen and a local code from the current Local Term File is displayed on the screen.

The Similar LOINC Section

The similar LOINC section contains the LOINC number and the shortname of the LOINC term that is the closest match to the proposed LOINC. Because the LOINC database strives to contain a unique collection of concepts, it is important that each proposed LOINC be unique from any existing LOINC term. By providing a similar LOINC, you assist the Regenstrief Institute to ensure the addition you are requesting is unique.

Like the local code section, the similar LOINC section cannot be edited. The section is populated from information on the mapping screen at the time the requested term is created. To make sure this data is copied, make sure an existing LOINC code is highlighted in the results grid before choosing to propose a LOINC. This is shown below in the "Propose a LOINC using an existing LOINC" section.

The Reference Number

In the figure above, to the right of the similar LOINC information you will notice a box labeled "Reference #". In this box you can provide a unique reference identification number for each requested term that you create. These reference numbers will be transmitted along with the proposed LOINCs they reference. The staff at the Institute can then use these numbers in correspondence with you regarding specific terms in your submission, and these numbers will be returned with your requested LOINCs after the submission process has been completed.

The Status Field

Displayed in the figure above is the status field. This field displays information telling the user the term has been submitted and on what date the term was last submitted. It is possible to submit terms multiple times, but this is not recommended.

Note: Once submitted, a term cannot be edited. If you edit a previously submitted term, a new term will be created. This may seem confusing, but this behavior ensures that if a proposed LOINC is submitted twice it can easily be identified as a duplicate of a previously submitted term.

The Assigned LOINC Field

Also highlighted in the figure above is the assigned LOINC field. After submitting terms to Regenstrief, a user typically receives his or her submission file back with comments, edits and assigned LOINC numbers. These assigned LOINC numbers are usually new terms created based on the user's submitted terms. This field allows the user to record these assigned LOINC numbers after the submission file is returned.

Once a user has entered an assigned LOINC number, RELMA will attempt to lookup the shortname for that term. If the shortname can be found, it will be displayed in the field to the right of the assigned LOINC number. It is not uncommon for the program to have difficulty in finding the shortname as users often submit terms throughout the year whereas the LOINC database is updated and released only a few times a year.

Example Answers and Answer Lists

Because additional information helps the staff at Regenstrief better understand the nature of your requests, providing example answers or sample results provides the context and output of your requested test(s). You may include anything from a short description like in the figure above or a long block of text from an HL7 message. Any and all information you can provide will be helpful to those who evaluate your requests.

Note: When including HL7 messages as sample results, please be sure to remove patient identifying information.

Sometimes your tests will have answers that come from answer lists defined in your information systems. Providing the answer for these lists is just as helpful as including HL7 messages as sample results. The form provides a mechanism by which you can define answer lists. To define a list, first click on the round circle labeled "Answer List" shown in the figure below.

This will change the form so it displays a dropdown textbox with a list of available answer lists. Also displayed is a button labeled "New Answer List". Clicking this button will display the form shown in the figure below.

Enter the information for the new answer list then click the "Save/Exit" button. This will return you to the "Propose LOINC" form and the newly defined answer list should be selected for the requested term.

Normal Range

With any test, Normal Range is critical when establishing a baseline. By providing this critical evidence, it can highlight use cases requiring a new LOINC term.

Example Report

When examples of reports (please remove any Private Health Information) can be provided, it provides valuable details of results as well as tests and panels.

Reference Infomation/URL

The process for approving submissions includes detailed investigation and analysis. By providing applicable reference information assists in the process and reduces miscommunication.

Test instrument information/URL

When known, please provide information about the instrument vendor, the instrument used to run the test and/or reagent kit used to perform this test (if applicable).

  • "Test Inst. Vendor" - Enter the manufacturer of the instrument/test kit you use to conduct this test.
  • "Test Inst. Model" - Enter the model name of the test instrument you use to conduct this test.
  • "Test Reagent Kit" - Enter the name of the test kit you use to perform this test. If the test kit does not depend upon the analysis instrument, enter the vender of the test kit rather than of the instrument in the first question.

The Parts of a Proposed LOINC Term

Each LOINC is composed of multiple parts. To propose an addition to the LOINC database, you must specify the parts that compose the new term. The left column labeled "LOINC Part" contains spaces for entering data for the various parts of a LOINC term. A description and examples of these parts are provided by placing the mouse above of the textbox (the rectangular box with an arrow pointing downward on the far right side). Additional description and discussion is provided in the LOINC Users' Guide.

Note: You must enter text into the parts labeled in red. These are required as specified in the table above.

These textboxes appear to be standard Windows dropdown controls, and indeed they behave very similarly to dropdown controls. However, many of these textbox controls contain LOINC hierarchies, so their behavior is slightly different than the standard controls used in RELMA and other Windows applications.

You can switch between textboxes using the TAB key like you do in other Windows applications, but pressing the RETURN (ENTER) button causes a slightly different behavior. Instead of moving to the next textbox, pressing the return (enter) key takes the text you entered in the box and conducts a search for that text. If the text is found, a list of words and phrases containing the text entered is displayed on the screen. This is accomplished by the control "dropping down" or "dropping up" on the screen as shown in the figure below.

Once the control has "dropped down" or "dropped up" you can click using the left mouse button on one of the search results. Clicking in this manner will select one of the search results, and the selected item's LOINC value will be copied into the textbox where you entered your text. You can also click on items in the list or hierarchy without performing a search. The item's LOINC value may differ from the value displayed in the "dropped down" or "dropped up" portion of the textbox control. This behavior is caused by the use of abbreviations and synonyms in the LOINC database.

Note: To search for blood in the system tree, the user could have typed either "bld" or "blood". The system textbox control does not return the exact same set of search results for both strings, but it does return the string "Blood" for each search. Synonyms may not always work, so users may have to try more than one search to find the exact string they wish to use as a part for the requested term they are creating.

Providing Comments

Providing comments is not required but highly recommended. Comments allow the staff at Regenstrief who process submissions to understand why your organization is requesting the term(s) submitted. Comments are especially important when you are requesting new parts (new properties, new systems, etc) because the staff at Regenstrief needs to understand the definition of the new parts and ensure that they are not synonyms of existing parts. If the staff does not understand your request, your submission may take longer as they search for definitions and enter into a dialogue with you to better understand the nature of your request. Please help us process your terms in the most efficient way possible by providing comments.

Attachments and Supplemental Content

  • The following attachment types are suggested when proposing a LOINC
    • Example Answers
    • Reference Information
    • Package Inserts
    • Other

Note: A missing file will prevent the form from being saved. When this occurs, simply remove the existing record and re-add with the correct path.

Proposing a LOINC using an Existing LOINC

To propose a new LOINC term using an existing LOINC as a base from which you may start editing, open the mapping screen. From the mapping screen, conduct a search to find the LOINC that is the closest match to the term you wish to request. Highlight the closest match term by clicking once with the left mouse button and then click the "Propose Term" button, or use the "Propose a LOINC based on selected term" File menu action (or select "Propose a LOINC based on selected term" from the right-click menu). An example is shown below.

Step 1 - Conduct search on mapping screen

Step 2 - Highlight LOINC term that best matches the term you wish to propose

Step 3 - Click the "Propose Term" button to request a term

In the example above, the user has conducted a search to map his local term to a LOINC code and did not find an applicable LOINC. The user selects the nearest match in the results grid then presses the Propose LOINC button. The user next sees the Propose LOINC form shown in the figure below.

After pressing the "Propose Term" button, the Propose LOINC form opens and the information from the mapping screen is copied into the various sections of the form. The user may then edit the part or parts of the existing term in order to create the unique concept he or she wishes to propose.

Reviewing Proposed LOINCs

Once you have entered one or more proposed LOINCs using the methods described above, you may wish to review the terms you've created and prepare them for submission. Choosing the "Review and Submit Proposed LOINCs..." from the File menu on either the welcome or mapping screen will bring up a form similar to the one shown in the figure below.

  • Before you can submit your proposed LOINCs, it is required that you provide your name, organization name, and contact information (phone, fax and email) so that a staff member at Regenstrief may contact you regarding your submission if necessary. Once provided on the form, this information will be saved and loaded each time you run the RELMA program, so it is recommended that you enter this information the first time you view the form.
  • Loaded into the grid in the center of the form are key pieces of the requested terms you have created using the methods described in the previous sections of this users' manual. The column labeled "Send" contains a checkbox that you can use to select groups of proposed LOINCs you desire to submit to Regenstrief. The column labeled "Test Code" represents a local code from your system that this proposed LOINC is based on. Some codes will have the prefix "RELMA". These codes were generated by the RELMA program when no local code information was available (i.e. you started the requested term from scratch or did not have a Local Term File term showing on the mapping screen). The next set of columns in the grid represents the six parts of your proposed LOINC. These fields should help you identify and distinguish between the many terms you might create. The final fields in the grid help you distinguish between those codes you have previously submitted and those you have not yet submitted. Of course, you can filter the grid to display only non-submitted or only submitted terms by choosing a different value for the "View" box in the bottom left-hand corner of the form.
  • To create a new proposed LOINC from scratch, click on the "New" button. To edit a requested term, highlight the term in the grid by clicking on it with the left mouse button then click on the "Edit" button. You can permanently delete one or more proposed LOINCs by first highlighting them using the mouse then clicking the "Delete" button. Clicking on the "Print" button allows you to print the items currently displayed in the grid. See instructions below when using the "Submit" button. The "Exit" button closes the form and returns you to either the welcome or mapping screen.
  • To delete a an entry simply highlight the row by clicking the far left column on the grid. Then click the "Delete" button at the bottom of the screen. Multiple rows can be selected using the Windows standard SHIFT and CTL keys.

Submitting a Submission File Using RELMA

To submit terms created and reviewed using the methods described in the previous sections follow the steps outlined below.

  1. Select the terms you wish to submit by checking the Send column.
    1. To select all terms previously unsent, you may click on the "Select All" button below the grid.
    2. To deselect all terms, you may click on the "Deselect All" button below the grid. **_Note:** Terms previously sent will have a status of "SENT". Be careful when selecting terms because while you are allowed to submit the same term more than once this practice is not recommended. Sending large batches that contain previously requested terms may slow down the submission process._
  2. Click the "Submit" button.
  3. Finalizing a Submission.
    1. This step allows you to provide any additional notes as it pertains to the submission as a whole, review the attachments for all proposed LOINCs and add any additional attachments for the submission. Note: On this form, any attachments that are removed and are associated with a proposed LOINC, cannot be re-added to the proposed LOINC on this form. If you wish to ensure that the attachment remains associated with a given proposed LOINC, return to the Propose a LOINC form and edit the attachments accordingly. Otherwise, any attachments added on this form will be associated to the submission and not a specific proposed LOINC. (See "Submission Finalize" image below.)
  1. A short summary of the number of Proposed LOINCs is included at the top.
  2. Should any of the Proposed LOINCs have been previously submitted to Regenstrief Institute, Inc., a warning will be provided indicated that this is not typical.
  3. Provide any supplemental notes as it pertains to the submission as a whole.
  4. Add any attachments that pertain to the submission as a whole.
  5. Click the "Submit" button Note: When sending your submission through FTP, RELMA does not trasmit your loinc.org password.
  6. RELMA will now package all selected proposed LOINCs, including any associated attachments, and create an archive submission file. Note: This may take a few moments if you have a high number of terms to submit or have large attachments included.
  7. Supported methods for sending submissions: FTP, EMAIL. See User Preferences section for more details.
  8. Sending submission using EMAIL
  • A dialog box will appear notifying you that your default email client will be opened.
  • The email should be pre-addressed to submissions@loinc.org.
  • The subject should be pre-filled with "RELMA Submission {unique id}". Note: The unique id is a system generated GUID that allows Regenstrief to associate an email with a submisssion file.
  • Since Windows does not allow for automatic attaching of files to an email, a note is included in the message body indicating the path of the generated archive file. Using the provided path, attach the file to the email message.
  • Note: It is essential that this file be attached prior to sending the email.
  • Send the EMAIL.
  • FTP Confirmation.

A confirmation will be displayed showing that your submission was succesfully sent.
Note: If you do not receive this confirmation or experience problems during the submission process, visit our FAQ web page for more details.
Note: You may receive communication from Regenstrief with requests for further information if required.

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