LOINC - LOINC Version 2.52 and RELMA Version 6.10 Available

Current versions of LOINC and RELMA released June 29, 2015.

In this Update

Wow, have we got a great release for you this time! We’ve packed in a ton of new content, our first ever downloadable version of the Linguistic Variants, some great new RELMA features, integration with the LForms widget, and a LOINC FHIR vocabulary service!

LOINC release highlights
New LOINC Linguistic Variants File now available
RELMA release highlights
LOINC FHIR Vocabulary Service (pilot)

Read on for the full details.

Highlights from our best LOINC release yet

New content

LOINC version 2.52 contains 76,266 terms, an increase of 1,666 since the December 2014 version. Approximately 7,688 terms have been edited. A total of 2,308 terms have been deprecated.

This release includes 681 laboratory, 640 clinical, and 345 new survey terms.

Some of the new content highlights in this version:

Over 160 new molecular pathology terms, including more than 120 gene mutation analysis terms
140 microbiology terms, including 40 new terms for microbial gene testing in ENT and wound specimens, approximately 10 new terms for viral RNA/DNA testing, and a term for Influenza virus A H5 icA RNA (77605-4)
116 new chemistry terms
Over 70 new clinical document-related codes, including over 50 terms added to the Document Ontology
New panels for laboratory tests, including:
- Mitochondrial respiratory chain enzyme analysis panel (77381-2)
- Salivary gland protein 1 & Carbonic anhydrase 6 & Parotid secretory protein Ab.IgA & IgG & IgM panel (77217-8)
- HTLV I and II Ab Panel (77742-5)
- Wound microorganism gene identification panel (76585-9)
- Respiratory DNA and RNA virus panels (76091-8, 76771-5, 77029-7)
- ENT microorganism gene identification panel (76586-7)
- Antipsychotics drug panel – Urine by Screen method (75815-1)
- 10-year breast cancer distant recurrence risk panel (76546-1)
APTA Physical Therapy Outcomes Registry panel (76464-7), which includes about 70 new terms and 25 existing terms. The registry is currently in beta, set to go live in January 2016.
52 new radiology terms, most related to our collaboration with the RSNA (See also Section “Edits contained in this release”)
Over 65 new cardiology terms
Terms in support of the Meaningful Use program, including sexual orientation (76690-7), gender identity (76691-5), sex assigned at birth (76689-9), and weight-for-length per age and gender (77606-2)
Nearly 400 terms created for PROMIS, including item banks, short forms, and questions
Over 100 terms created for the Nursing Management Minimum Data Set (NMMDS), including nursing demographics panel, clinical knowledge, decision making & mental workload panel, nursing staff job positions, quantity, turnover, and retention panel, and client accessibility panel. These new terms complete the modeling for this revision of NMMDS.
85 terms created for the following survey/assessments: ADVAULT, AmNART, BPI, HARK, HWS, NHCS, NHANES, and OPTIMAL

Other edits contained in this release:

LOINC 49543-2, Calcidiol+Calciferol [Mass/volume] in Serum or Plasma, is now deprecated and mapped to 62292-8, 25-Hydroxyvitamin D2+25-Hydroxyvitamin D3 [Mass/volume] in Serum or Plasma. LOINC 49543-2 was previously in the Top 2000 file and has been replaced by 62292-8 in the current version.
For CSF specimen collection, changed the Challenge part description of “<number> specimen” to “<number> tube” (e.g. see 46087-3)
For Urine tests with Time XXX, changed the Long Common Name from “…in unspecified time Urine…” to “…in Urine collected for unspecified duration”
Ongoing changes for ACnc/Ord terms to Pr/Ord or Threshold/Ord, including molecular pathology terms for identifying specific variants
Updated the values in the UnitsAndRange field to be consistent with UCUM, and standardized the formatting of the ranges
Updated the ORDER_OBS field from “Observation” to “Both” for several terms based on recommended content changes included in the S&I Framework’s aLOINC Order Code Scope Statement (Appendix B, Item 3)
For ultrasound (US) Methods, separated the US imaging modality from the calculation method. For example, US.2D.Teichholz changed to US.2D+Calculated by Teichholz method
Based on Clinical LOINC Committee approval at the February 2015 meeting, terms that specify a look-back period will have timing changed from ‘Pt’ to the specific time stated by the question. For example, timing changed from ‘Pt’ to ‘1W’ for terms that specify a look-back period of 7 days. The component did not change and continues to specify the look-back period as well. This work is in progress.
Corrected the Method of several terms that were labeled as “PhenX” but whose provenance was really another source (as stated in the PhenX Toolkit). The Method of these terms was changed to the source name (e.g. NHANES) to clarify the origin of the concept.
Through our ongoing collaboration with RSNA, we are establishing a unified model for radiology procedure names. Based on this model, we have implemented several changes to the names of CT terms. A detailed description of the unified naming model will appear in a future version of the LOINC Users’ Guide. Over 700 existing radiology terms were edited. Examples of the edits include:
- Changed route of administration to use abbreviations from the HL7 routes of administration. For example: “inhaled” became “IH”, “intrasynovial” became “IS”, and “intracervical (uterus)” became “ICV”.
- Revised all uses of “W & WO” to “WO & W” to better reflect the sequence in which they are performed (first without contrast, then with).
- The specification of anatomic sites in the System now reflects a model that can identify both the body region imaged and the imaging focus. (For example: Abdomen+Pelvis>Urinary bladder)

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

This release includes one change to the structure of the LOINC Table:

Field Name: MOLAR_MASS

Formal Definition: Not actively maintained. Molecular weights: This field contains the molecular weights of some chemical moieties

Action: Deleted

Field Name: ACSSYM

Formal Definition: Chemical name synonyms, alternative name synonyms, and chemical formulae supplied with permission from the Chemical Abstract Society.

Action: Deleted

Field Name: BASE_NAME

Formal Definition: Chemical base name from CAS

Action: Deleted

Field Name: NAACCR_ID

Formal Definition: Maps to North American Association of Central Cancer Registries Identification Number.

Action: Deleted, moved data to SURVEY_QUEST_SRC

Field Name: CODE_TABLE

Formal Definition: Examples on CR0050 Cancer Registry.

Action: Deleted

Field Name: HL7_V2_DATATYPE

Formal Definition: HL7 version 2.x data type that is compatible with this LOINC code

Action: Deleted

Field Name: HL7_V3_DATATYPE

Formal Definition: HL7 version 3.0 data type that is compatible with this LOINC code

Action: Deleted

Field Name: CURATED_RANGE_AND_UNITS

Formal Definition: Units of measure (expressed using UCUM units) and normal ranges for physical quantities and survey scores. Intended as tailorable starter sets for applications that use LOINC forms as a way to capture data. Units are separated from normal ranges by a colon (:) and sets of unit:normal range pairs are separated by a semi-colon (;). Syntax for the normal range includes square brackets, which mean that the number adjacent to the bracket is included, and parentheses, which means that the number itself is not included. For example, [2,4] means “two to four”, while [2,4) means “two to less than four” and (2,4) means “between two and four but does not include two and four”.

Action: Renamed to UnitsAndRange

Field Name: COMMENTS

Formal Definition: Narrative text that describes the LOINC term taken as a whole (i.e., taking all of the parts of the term together) or relays information specific to the term, such as the context in which the term was requested or its clinical utility.

Action: Renamed to DefinitionDescription

Field Name: PanelType

Formal Definition: Describes a panel as a “Convenience group”, “Organizer”, or “Panel”. A “Panel” is an enumerated set of terms that are used together in direct clinical care. The package would typically be thought of as a single orderable item that contains a set of reported observations. A “Convenience group” is an enumerated set of terms used for a common purpose, but not typically orderable as a single unit. An “Organizer” is a subpanel (i.e. a child) within another panel that is only used to group together a set of terms, but is not an independently used entity. They often represent a header in a form, or serve as a navigation concept.

Action: Added

Field Name: AskAtOrderEntry

Formal Definition: A multivalued field, semicolon delimited list of LOINC codes that represent optional Ask at Order Entry (AOE) observations for a clinical observation or laboratory test. A LOINC term in this field may represent a single AOE observation or a panel containing several AOE observations.

Action: Added

Field Name: AssociatedObservations

Formal Definition: A multi-valued field, semicolon delimited list of LOINC codes that represent optional associated observation(s) for a clinical observation or laboratory test. A LOINC term in this field may represent a single associated observation or panel containing several associated observations.

Action: Added

This release includes several changes to the structure of the FORMS tab of the LOINC Panels and Forms File:

Field Name: SkipLogicTarget

Formal Definition:

Action: Deleted

Field Name: SkipLogicTargetAnswer

Formal Definition:

Action: Deleted

Field Name: AnswerRequired

Formal Definition:

Action: Deleted, replaced by AnswerCardinality

Field Name: MaxNumberOfAnswers

Formal Definition:

Action: Deleted, replaced by AnswerCardinality

Notice of discontinuation of separate Panels and Forms files

As we announced previously, this release discontinues publication of all the various subsets of LOINC panels and forms for separate download. May they rest in peace. The are survived by the LOINC Panels and Forms File that contains all of that content wrapped up into one file. Also, you may not know that since version 6.0 RELMA has had the ability to create these exports on the fly for any individual panel or collection of panels you wish.

Notice of of changes to the public LOINC data files for the June 2016 release

Field Name: LOINC.SOURCE

Formal Definition: This is for our internal use and should be ignored by database users.

Action: Remove

Discussion: This field was always intended for internal use per the field definition and is an unnecessary complexity with our new internal processes.

LOINC Users’ Guide Updates

Each release we make a number of updates to the LOINC User’s Guide. This time around is no exception, but in particular, we want to draw your attention to the important enhancements we made to the sections explaining LOINC panels. We’ve significantly expanded our discussion of our rules for creating panels in Section 8, and added a new section on Business Rules for mapping local panels to LOINC panels in Section 13. These enhancements were spurred by the good discussions by the LOINC Committee and the S&I Framework aLOINC Orders Initiative.

New LOINC Linguistic Variants File Now Available for download

We are very pleased to announce the availability of our newest addition to the LOINC release files: an export of the LOINC Linguistic Variants. 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. Now, for the first time you can download a file with these translations. The LOINC Linguistic Variants File contains:

A set of linguistic variants in CSV text format with each record on a separate line (terminated by CR/LF) and each field delimited by a comma character. Each linguistic variant file is identified by its ISO language and country codes.
The LinguisticVariants table that lists the available linguistic variants in CSV text format
The LOINC License in a text file format.

As noted in the LOINC License, the translations are subject to the same license rights and restrictions as the main LOINC distribution.

Updated Linguistic Variants in this release:

Chinese (China)
French (Canada)
Portuguese (Brazil)
Spanish (Spain)
Italian (Italy)
Russian (Russian Federation)

RELMA version 6.10

New integration with the NLM/RI LForms Widget software

We’ve built tight integration in RELMA and search.loinc.org with LForms, an open source Javascript widget that creates data input forms based on LOINC’s rich content model for panels, forms, and survey instruments. Developed by NLM in collaboration with the Regenstrief Institute, LForms supports detailed form attributes, including: data type, cardinality, default value, units of measure (if numeric), answer lists (if multiple choice), relationship (in a hierarchy) to other questions, validation checks, skip logic and help messages.

You can now get quickly from a LOINC panel term to an example data entry form hosted on the loinc.org website in all of these places:

Panels, Forms & Surveys screen in RELMA
Search result grids and details pages in RELMA
Search result grids and details pages in search.loinc.org (coming in June release)

We’ve added many new search restrictions

In our efforts to continually enhance the richness of the LOINC content, we’ve added some new metadata attributes of LOINC terms and built the corresponding search restrictions in RELMA. Here are some of the highlights:

Panel Type. This restriction allows you to limit search results by one of the panel type categories.
Forms. This true/false restriction indicates if a LOINC code is available for viewing in the LForms data widget tool.
AssociatedObservations. This field links a particular LOINC code to one or more other LOINC codes that represent additional, optional observations for a clinical observation or laboratory test. A LOINC term in the AssociatedObservations field may represent a single associated observation or panel containing several associated observations. We have built a similar field for AskAtOrderEntry questions, but have not yet created any underlying linkages. You can expect further content development work on this in future releases.

Along these lines, we have started to add the ability to search for the existence or non-existence of a value in many fields. This feature is currently implemented in most of the basic searchable LOINC fields. We hope to continue expanding this feature in future releases.

Be sure to check out the “Advanced Search Syntax” section of the RELMA Manual for additional details on how to use these new search restrictions.

New features to enhance your use of LOINC panels

We’ve made a few key updates to help you use LOINC panels. We already mentioned our integration with the LForms widget to highlight how LOINC panels can be turned into data capture screens.

We also completely restructured the Panels, Forms & Surveys screen in RELMA. We believe the layout is much more intuitive and hope you find it useful too.

Last, we have now deployed the “Export full panel structure to Excel” on the search result grids (both the Search tab grid and the grid on the Mapping tab). This feature lets you create on-demand exports of the rich LOINC panel structure for any panel term that comes back in your searches. (Previously this feature was only available on the Panels, Forms & Surveys screen).

One last improvement: support for internet proxies

RELMA now supports access to our internet resource through proxies. If your company uses a proxy, simply configure it in the Windows Internet Options applet. RELMA will use these setting when communicating over the internet.

Adiós Windows XP

Microsoft support for the Windows XP operating system ended in April of 2014. Without support from Microsoft it is impossible for us to continue supporting RELMA on this platform. Therefore, beginning with this release, we are no longer testing RELMA on Windows XP. This does not mean that RELMA won’t run on XP but it is no longer officially supported. Furthermore, our development plans for the December 2015 release include upgrading RELMA to use version 4.5 of the Microsoft .Net framework. Since Microsoft has not made this version of the framework available for XP, this will be a breaking change and means that the next version of RELMA will not run on Windows XP.

Announcing our pilot version of a LOINC FHIR Vocabulary Service

The HL7 FHIR standard is developing a really nice set of specifications around vocabulary services. We are very pleased to announce that we are piloting the ability to make key LOINC value sets available via an API as a FHIR service. These are meant to be computer-consumable interactions – you get either JSON or XML back. Right now, the only function available is to retrieve the complete value set.

This is definitely still a work-in-progress, and we have plans to implement a much richer collection of the value set functionality. Comments and feedback are welcome!