Indian Health Service
Laboratory Modernization
LOINC/UCUM Proposed
Strategy
Clarence Smiley
David Gifford
Background

IHS utilizes the VA’s infrastructure
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Last major update was in 2005
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Meaningful Use and other incentives
make the implementation of LOINC
and UCUM imperative
Background

IHS “Patch 15”
• Developed a methodology that assisted in
automating mapping to LOINC
• Developed in conjunction with the CDC
• Detailed in a AMIA paper:
Standardizing Laboratory Data by Mapping to
LOINC
Agha N. Khan, MD, MPH, Stanley P. Griffith, MD,
Catherine Moore, Dorothy Russell, Arnulfo C. Rosario,
Jr., MD, MPH, and Jeanne Bertolli, PhD, J Am Med
Inform Assoc. 2006 May–Jun; 13(3): 353–355.
doi: 10.1197/jamia.M1935.
Background



Pilot project to standardize local laboratory data
at five Indian Health Service (IHS) medical
facilities by mapping laboratory test names to
Logical Observation Identifier Names and Codes
(LOINC).
An automated mapping tool was developed to
assign LOINC codes. At these sites, they were
able to map from 63% to 76% of the local active
laboratory tests to LOINC
Eleven percent to 27% of the tests were mapped
manually. They could not assign LOINC codes to
6% to 19% of the laboratory tests due to
incomplete or incorrect information about these
tests.
Background
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Rural hospitals
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Rural Clinics
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No laboratorian present
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Limited knowledge of terminologies
Proposed Updated Methodology
Using VA’s Laboratory Electronic Data Interchange
specimen codes associate local codes to specimen.
Produce candidate matches of local unit codes to
UCUM.
Finally, using a IHS master LOINC file, auto-map local
codes to the Common Lab Orders LOINC Value Set
Version 1.1.
Those codes that are not automatically mapped, will be
put into a file and submitted to OIT for further
investigation and possible matching through the
Regenstrief’s RELMA tool.
Proposed Methodology Issues

LEDI Specimen codes – are based upon a
deprecated table from HL7 V2.x.

IHS Patch 15 LOINC is out of date; need
to update IHS master list…..In process

Local panels may not match LOINC
definitions: new code submission?
• This is an interesting point of discussion

Need to centralize process as much as
possible due to local resource issues.
• Need for LOINC but no laboratorians at some clinics.
Some next steps

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LOINC code look up – link to RELMA
from IHS Lab home page.
Support desk specialist will be
trained and be able to provide
guidance.
Deployment will include training on
LOINC for all levels of end users.
“Meaningful Use Report” for the
clinics.
Continuous improvement

As we deploy, the master list gets
better. The process is refined until it
will be highly accurate. This will allow
us to have a “Gold” standard for
future deployments.
Continuous improvement
Additional outcome is a study of the
C80 top % compared to the Indian
Health Population.
Currently working on the design of
experiment
Will they be the same?
Will our top 99% be the same as
the general population?
Seeking Feedback

IHS is soliciting comments from the
Lab LOINC community on all aspects
of the methodology
• David Gifford, david.gifford@ihs.gov
• Michael Walker,developer,michael.walker@ihs.gov