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In this Update
Once again we've packed a ton of great stuff into this release. Our content development has done an incredible job extending and enhancing to the LOINC database, while the software development team has added some great new features to RELMA. Here's the outline:
- LOINC content highlights
- Changes to the public LOINC data files in this release
- LOINC Linguistic Variant Updates
- RELMA highlights
Read on for the full details.
Highlights from our best LOINC release yet
LOINC version 2.58 contains 83,377 terms, an increase of 2,509 since the June 2016 version.
This release includes 652 new laboratory, 1,791 new clinical, and 66 new survey terms.
Some of the new content highlights in this version:
- Approximately 140 chemistry terms
- Over 100 serology terms, including new terms for rheumatologic and neurologic autoimmune diseases
- Approximately 75 molecular pathology terms
- Over 45 microbiology terms, including new terms for Zika and other arboviruses and emerging Borrelia species
- Nearly 40 pathology terms, including for colorectal and prostate cancer
- New panels for laboratory terms, including:
- Over 100 new Radiology terms, including XR terms to complete RadLex mappings
- Over 1000 new document ontology codes
- Nearly 50 new codes for cardiac angiography and quantitative nuclear medicine results (82654-5 Nuclear cardiac imaging panel)
- Over 40 terms for CDC case reporting
- New clinical and survey panels, including:
- Asthma Control Test (ACT) (82674-3)
- Adverse Childhood Experiences (ACE) (82813-7)
- Drug Abuse Screening Test (DAST) (82664-4)
- Drug Abuse Screening Test-10 (DAST-10) (82666-9)
- Amyotrophic lateral sclerosis functional rating scale - revised (ALSFRS-R) (82954-9)
- Patient Centered Assessment Method (PCAM) (83331-9)
- PCORnet common data model set - version 3.0 (PCORnet) (85057-8)
- Mood Disorder Questionnaire (MDQ) (85102-2)
- Bipolar Spectrum Diagnostic Scale (BSDS) (85103-0)
- HEDIS 2017 Value Sets (82955-6)
- Version 1.5 of the Top 2000+ Common Lab Results
Edits contained in this release
A total of 2,539 terms have been deprecated. A total of 31 terms were undeprecated (A.K.A. resurrected. Yes, this can really happen to LOINC terms).
About 11,000 terms have been edited. Here are some of the highlights:
- Thirty-one XR calcaneus terms were deprecated in error when we deprecated CT calcaneus terms during previous the LOINC/RadLex CT unification work. All of the calcaneus XR terms were changed back to active status and further updated to include the Region imaged.
- LOINC 23925-1 Penicillin [Susceptibility] by Gradient strip, is now deprecated and mapped to both 7041-7 Penicillin G [Susceptibility] by Gradient strip, and 7042-5 Penicillin V [Susceptibility] by Gradient strip. LOINC 23925-1 was previously in the Top 2000+ file and has been replaced by 7041-7 and 7042-5 in version 1.5.
- About 90 terms in the COAG class with the Method of Imm were updated to have Method of IA to maintain consistency across classes, a change approved by the Laboratory LOINC Committee in December 2016.
- The word 'toxin' in the Component for terms that included 'Clostridium tetani toxin Ab' was updated to 'toxoid' to more accurately represent the antibody target.
- Components for terms related to Escherichia coli Shiga-like toxin were updated so that they all include the words 'Shiga-like toxin'.
- Terms that represent antibiotic susceptibilities with different "breakpoints" depending on the type of infection were updated so that the breakpoint information was moved from the Component to the System (see the LOINC Users' Guide for more details).
- Ongoing work with RSNA to establish a unified model for naming radiology terms resulted in changes for more than 5,000 terms. These changes related to the System across modalities, and to the Component modeling for XR. As part of this work, 31 XR terms with the System of Calcaneus that were incorrectly deprecated when the corresponding Calcaneus CT terms were deprecated were undeprecated (CHNG_TYPE 'UND') and returned to 'ACTIVE' Status.
- Updated more than 1,000 terms that previously had a Method of 'PhenX' to reflect the original source of the content.
- The values in the HL7_ATTACHMENT_STRUCTURE changed from STRUCTURED/UNSTRUCTURED to IG exists/No IG exists, respectively, to more accurately convey the concept that "Structured" was meant to represent - that a CDA implementation guide (IG) exists for reporting data in a structured format with the corresponding document code, but not necessarily that such a structure will always be used.
- Massively redesigned the presentation of the LOINC Users' Guide. Hope you enjoy it!
- Unified the list of fields in the LOINC table whose contents are compared when populating the CHNG_TYPE and VersionLastChanged field. These fields are updated when a change is made in any of the released fields except for:
- Note: We exclude the RelatedNames2 field for two reasons: a) it is not one of the primary fields that defines a LOINC concept and b) it changes frequently.
LOINC/IEEE Medical Device Code Mapping Table
We continue our close collaboration with the HL7/IEEE medical device workgroup and are pleased to have published an updated version of the LOINC/IEEE Medical Device Code Mapping Table. This version contains mappings from IEEE REFID concepts to 550+ LOINC codes. We look forward to expanding these mappings to cover content in the 10101b and 10101c standards in the future.
LOINC/RSNA Radiology Playbook
The updated LOINC/RSNA Radiology Playbook file reflects our ongoing collaborative work with the RSNA to develop a unified model for naming radiology procedures. To date all of the CT, MR, NM, PT, US, and XR terms in the core RSNA Playbook have been mapped to LOINC codes. All of the LOINC terms in these modalities have been updated to the unified model. Going forward, the LOINC representation in the unified model will be the primary source for this content. We expect to complete the unified model representation for the other modalities by the end of 2017.
Notice of of changes to the public LOINC data files in this release
This release includes changes to the structure of the LOINC Table:
Field Name: VersionFirstReleased
Formal Definition: The LOINC version number in which the record was first released. For oldest records where the version released number is not known, this field will be null.
Field Name: ValidHL7AttachmentRequest
Formal Definition: A value of 'Y' in this field indicates that this LOINC code can be sent by a payer as part of an HL7 attachment request for additional information.
Notice of changes to the public LOINC data files for the December 2017 Release
We are proposing a number of changes for the December 2017 release. All of the following proposed changes flow from the same rationale:
The performance improvements for keeping a smaller field size are minor compared with the hassle of changing field size definitions over time. The Laboratory LOINC Committee recommended a one-time increase in field size to accommodate long term content development and evolution needs.
Field Name: PROPERTY
Formal Definition: Second major axis-property observed (e.g., mass vs. substance)
Action: EXPAND field size from 30 to 255
Field Name: TIME_ASPCT
Formal Definition: Third major axis-timing of the measurement (e.g., point in time vs 24 hours)
Action: EXPAND field size from 15 to 255
Field Name: SYSTEM
Formal Definition: Fourth major axis-type of specimen or system (e.g., serum vs urine)
Action: EXPAND field size from 100 to 255
Field Name: SCALE_TYP
Formal Definition: Fifth major axis-scale of measurement (e.g., qualitative vs. quantitative)
Action: EXPAND field size from 30 to 255
Field Name: METHOD_TYP
Formal Definition: Sixth major axis-method of measurement
Action: EXPAND field size from 50 to 255
Field Name: CLASS
Formal Definition: An arbitrary classification of the terms for grouping related observations together.
Action: EXPAND field size from 20 to 255
Field Name: VersionLastChanged
Formal Definition: The LOINC version number in which the record has last changed. For records that have never been updated after their release, this field will contain the same value as the loinc.VersionFirstReleased field.
Action: EXPAND field size from 10 to 255
Field Name: CHNG_TYPE
Formal Definition: Change Type Code: DEL = delete (deprecate); ADD = add; NAM = change to Analyte/Component (field #2); MAJ = change to name field other than #2 (#3 - #7); MIN = change to field other than name; UND = undelete.
Action: EXPAND field size from 3 to 255
Field Names: STATUS
Formal Definition: ACTIVE = Concept is active. Use at will. TRIAL = Concept is experimental in nature. Use with caution as the concept and associated attributes may change. DISCOURAGED = Concept is not recommended for current use. New mappings to this concept are discouraged; although existing may mappings may continue to be valid in context. Wherever possible, the superseding concept is indicated in the MAP_TO field in the MAP_TO table and should be used instead. DEPRECATED = Concept is deprecated. Concept should not be used, but it is retained in LOINC for historical purposes. Wherever possible, the superseding concept is indicated in the MAP_TO field and should be used both for new mappings and updating existing implementations.
Action: EXPAND field size from 11 to 255
Field Name: SHORTNAME
Formal Definition: Introduced in version 2.07, this field contains the short form of the LOINC name and is created via a table-driven algorithmic process. The short name often includes abbreviations and acronyms.
Action: EXPAND field size from 40 to 255
Field Name: VersionFirstReleased
Formal Definition: The LOINC version number in which the record was first released. For oldest records where the version released number is known, this field will be null.
Action: EXPAND field size from 10 to 255
LOINC Linguistic Updates
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. You can also download the translations in the LOINC Linguistic Variants File.
Updated Linguistic Variants in this release:
- Chinese (China)
- French (Canada)
- Italian (Italy)
- Spanish (Spain)
RELMA version 6.17
New RELMA Features
- We have significantly enhanced the HIPAA Attachments screen in collaboration with the HL7 Attachments WG. We have added a new "Valid Attachment Requests" tab that lists those LOINC terms that payers may send when requesting additional information. Many of the labels on the screen have been updated to be more consistent with the current HL7 terminology. We have also updated the listing of LOINC document codes and the corresponding HL7 Implementation Guides that can be used with them on the "Documents with implementation guide" tab. We've also added a detailed and informative help function (just click the ? button or hit F1) on this screen to further explain the content and layout.
- We have added a "Clinical Terms Only" option to the Common Tests search restriction drop down lists on both the search screen and the mapping screen. If you're looking for clinical LOINC content, this is an easy way to filter out lab codes from your search results.
See the RELMA Release notes for more details.