Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
The Use of LOINC
in the AHRQ “Adding Clinical Data
to Administrative Data” Project
National Association of Health Data Organizations
23rd Annual Conference - October 26 & 27, 2008
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Logical Observation Identifiers Names and Codes

Under the sponsorship of the National Library of
Medicine and other government and private
organizations, the Regenstrief Institute for Health Care
developed the Logical Observation Identifiers Names
and Codes standard (LOINC) and the Regenstrief
LOINC Mapping Assistant (RELMA®).

The User’s guides and relevant documents and files
are available at
http://www.regenstrief.org/loinc

Products are available for use at no cost.
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Why Use LOINC?

Currently, many laboratories use different coding
dictionaries to send laboratory results electronically to
clinical care systems in hospitals.

Receiving medical informatics systems cannot fully
figure out the results.

The LOINC database provides a set of universal
names and ID codes for identifying laboratory and
clinical test results.
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
LOINC Sections

The LOINC database is divided into four
categories:
 Laboratory portion
 Clinical
 Attachments
 Surveys
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
LOINC Sections

Laboratory portion
• Standard test names and codes
• Includes chemistry, hematology, serology,
microbiology (including parasitology and
virology), toxicology
• Drugs and cell counts for blood smears
and cerebrospinal fluids
• Antibiotic susceptibilities
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
LOINC Sections

Clinical portion
• Vitals signs, hemodynamics,
intake/output, ECG, obstetric ultrasound,
cardio echo, urologic imaging, pulmonary
ventilator management, survey
instruments, and others
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Examples of the Lab and Clinical Portions
Abbreviation
Laboratory Term Class
ABXBACT
Antibiotic susceptibility
ALLERGY
Response to antigens
BLDBK
Blood bank
Abbreviation
ART
Clinical Term Class
Antiretroviral Therapy
BDYCRC.ATOM
Body circumference atomic
BDYCRC.MOLEC
Body circumference
molecular
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
LOINC Record Content

Codes are unique and have no meaning.

Each LOINC record corresponds to a single test result
or panel. The record includes fields for specifying:

Component name (analytic)

Property measured

Timing

The type of sample

The type of scale

The method used to produce the result or other
observation
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Major "Parts" of a Test/Observation Name

The fully specified name of a test result or clinical
observation has five or six main parts. Example:
<Analyte/component>:<kind of property of
observation or measurement>:<time
aspect>:<system (sample)>:<scale>:<method>
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Divisions Within The Fields

Component Name can be hierarchically divided into 3
subparts delimited by (^):
1. Name and modifier further subdivided into 3 more
levels of taxonomic specification, separated by dots (.):
<[analyte].[subclass].[sub-subclass]> ^
2. Information about challenge:
<[time delay] post [amount] [substance] [route])> ^
3. Adjustments/corrections:
<adjustment>
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Divisions Within The Fields

Timing and system/sample can be divided into 2
subparts delimited by (^).

Time: 2nd subpart identifies max, min, mean,
etc.

Specimen: 2nd subpart identifies source if not
the patient (e.g. fetus).
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
General Naming Conventions

Place Identifier of substance measured first

Use generic name of drug

Use full taxonomic name of organism or virus

Name vitamins by chemical name

Rules for species and groups of species

Avoid direct, indirect; conjugated, unconjugated

Use platelets not thrombocytes

Use noun form of target of antibody
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Examples of Naming Conventions

total, not tot

fraction, not frac

alpha, not A- etc.

oxygen, not O

dextro, not d-
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
What is Not Part of Name

Instrument used in testing

Fine details about sample or site of collection

Priority of testing (stat or routine)

Who verified result

Size of sample collected

Place of testing
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Broward Health Lab Codes Sample
Clinical Data Elements Abbreviation Low High Units
Aspartate
Aminotransferase
AST
5
40 units/L
Creatine Kinase MB
0
10.4
ng/mL
Potassium Level
Sodium Level
CK MB
Potassium
Lvl
Sodium Lvl
3.6
137
5
145
mmol/L
mmol/L
Troponin-I
pH Capillary
Troponin-I
pH Cap
0
0.4
7.35 7.45
ng/mL
P O2 Arterial
pO2 Art
60
90
NAHDO 23rd Annual Conference - October 26 & 27, 2008
mmHg
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Example of Inbound Extract
Orderable
Test Interface Orderable
Code
Test Name
Result
Interface
Code
Result
Name
BLGAS
BLOOD GAS
ANALYSIS
O2HB
O2HB
SYR
N
%
BLGAS
BLOOD GAS
ANALYSIS
HCO3
HCO3
SYR
N
mEq/L
BLGAS
BLOOD GAS
ANALYSIS
PCO2
PCO2
SYR
N
mmHg
Specimen Result
Type
Type
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Units of
Measure
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Example of Outbound Report
Result
Orderable Test Orderable Test Interface
Interface Code Name
Code
BLGAS
BLOOD GAS
ANALYSIS
BLGAS
BLOOD GAS
ANALYSIS
HCO3
BLGAS
BLOOD GAS
ANALYSIS
PCO2
O2HB
LOINC
Code
LOINC
representation
Oxyhemoglobin/
Hemoglobin.total
2714-4 :MFr:Pt:BldA:Qn:
Bicarbonate:SCn
1963-8
c:Pt:Ser:Qn:
Carbon
dioxide:PPres:Pt
2019-8
:BldA:Qn:
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Summary

The LOINC codes are not intended to transmit
all possible information about a test or
observation.

They are only intended to identify the test result
or clinical observation.
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Summary of LOINC Benefits

Normalizes lab data codes.

In the AHRQ pilot project, Adding Clinical Data
to Administrative Data, the standardization of
lab terminology allows records from different
hospital systems to be grouped into datasets
that span hospitals.

Standardization of lab codes allows for more
comprehensive analyses of the data.
NAHDO 23rd Annual Conference - October 26 & 27, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Christopher B. Sullivan, Ph.D.
Bahia N. Diefenbach, Ph.D.
Agency for Health Care Administration
Florida Center for Health Information
and Policy Analysis
2727 Mahan Drive
Tallahassee, FL 32308
sullivac@ahca.myflorida.com
diefenbb@ahca.myflorida.com
NAHDO 23rd Annual Conference - October 26 & 27, 2008