To Build Nationwide Automated Laboratory Notification System from Clinical
laboratories to Centers for Disease Control in Taiwan
Purpose
To build automated laboratory notification system from clinical laboratories to Centers for
Disease Control (CDC) for real-time disease surveillance in Taiwan.
Background
Since 2013, Taiwan CDC funded 19 medical centers and 10 regional hospitals (Figure 1) to
build automated laboratory notification system (ALNS) in each institution for sending
laboratory results from clinical laboratories to CDC automatically. Taiwan CDC listed 9
bacteria and 11 virus (Table 1) as required conditions; all laboratory tests (positive or negative)
related to above 20 conditions are required to be sent to CDC. Currently there are about 50%
of notifications submitted automatically through ALNS. Use of LOINC code for laboratory
test mapping is recommended in this project.
Figure 1 ALNS distribution in Taiwan
Table 1 ALNS notification conditions
Hepatitis B
Enterovirus
Hepatitis A virus
virus
Adenovirus
Herpes Simplex
Influenza virus
Virus
Rotavirus
Campylobacter
species
Streptococcus
agalactiae
Streptococcus
pneumoniae
Hepatitis C virus
Parainfluenza
virus
Norovirus
Respiratory
syncytial virus
Mycobacterium
tuberculosis complex
Listeria
monocytogenes
Vibrio
Streptococcus pyogenes parahaemolytic
us
Salmonella speci
es
Yersinia
enterocolitica
LOINC mapping issues
1. Specimen
a. Microscopic observation by Acid fast stain.* in: Sputum [create new code]
Disease
Mycobacterium
tuberculosis complex
Mycobacterium
tuberculosis complex
Frequency
(seen in how
many
hospitals/all
hospitals)
Local code
Microscopic
observation
[Presence] in
Sputum by Acid
fast stain
Microscopic
observation
[Presence] in
Sputum by Acid
fast stain.ZiehlNeelsen
Moderate (6/29)
Many (12/29)
Closest LOINC
[72357-7,
Microscopic
observation, Pr, Pt,
XXX, Ord, Acid
fast stain]
[76083-5,
Microscopic
observation, Pr, Pt,
BAL, Ord, Acid
fast stain.ZiehlNeelsen]
Proposed LOINC
[Microscopic
observation, Pr, Pt,
Sputum, Ord, Acid
fast stain]
[Microscopic
observation, Pr, Pt,
Sputum, Ord, Acid
fast stain.ZiehlNeelsen]
b. Influenza virus A+B Ag by EIA.rapid in: Nph, Thrt [create new code]
Disease
Influenza
virus
Influenza
virus
Influenza
virus
Local code
Influenza virus A+B Ag
[Presence] in Nph by Rapid
immunoassay
Influenza virus A+B Ag
[Presence] in Thrt by Rapid
immunoassay
Influenza virus A+B Ag
[Presence] in Unspecified
specimen by Rapid
immunoassay
Frequency
Many (8/29)
Many (7/29)
Few (2/29)
Closest LOINC
[72367-6, Influenza
virus A+B Ag, Pr, Pt,
Nose, Ord, EIA.rapid]
[72367-6, Influenza
virus A+B Ag, Pr, Pt,
Nose, Ord, EIA.rapid]
Proposed LOINC
[Influenza virus A+B
Ag, Pr, Pt, Nph, Ord,
EIA.rapid]
[Influenza virus A+B
Ag, Pr, Pt, Thrt,
Ord, EIA.rapid]
[72367-6, Influenza
virus A+B Ag, Pr, Pt,
Nose, Ord, EIA.rapid]
[Influenza virus A+B
Ag, Pr, Pt, XXX,
Ord, EIA.rapid]
c. Influenza virus A RNA by Probe.amp.tar in: Thrt [create new code]
Disease
Influenza
virus
Local code
Influenza virus A RNA
[Presence] in Thrt by
Probe and target
amplification method
Frequency
Moderate
(5/29)
Closest LOINC
[34487-9, Influenza virus
A RNA, ACnc, Pt, XXX,
Ord, Probe.amp.tar]
Proposed LOINC
[Influenza virus A
RNA, ACnc, Pt, Thrt,
Ord, Probe.amp.tar]
d. RSV Ag by IF in: Sputum, Nph [create new code]
Disease
Local code
Frequency
Respiratory
syncytial virus
Respiratory syncytial virus Ag
[Presence] in Nph by
Immunofluorescence
Respiratory
syncytial virus
Respiratory syncytial virus Ag
[Presence] in Sputum by
Immunofluorescence
Moderate
(5/29)
Few (2/29)
Closest LOINC
[72367-6,
Respiratory
syncytial virus Ag,
ACnc, Pt, Nose,
Ord, IF]
[5877-6,
Respiratory
syncytial virus Ag,
ACnc, Pt, XXX,
Ord, IF]
Proposed LOINC
[77390-3,
Respiratory
syncytial virus Ag,
Pr, Pt, Nph, Ord, IF]
LOINC 2.52
[Respiratory
syncytial virus Ag,
ACnc, Pt, Sputum,
Ord, IF]
e. RSV Ag by EIA.rapid in: Sputum [create new code]
Disease
Respiratory
syncytial virus
Local code
Respiratory syncytial
virus Ag [Presence] in
Sputum by Rapid
immunoassay
Frequency
Few (2/29)
Closest LOINC
[72885-7, Respiratory
syncytial virus Ag, Pr,
Pt, Nph, Ord,
EIA.rapid]
Proposed LOINC
[Respiratory syncytial
virus Ag, Pr, Pt,
Sputum, Ord,
EIA.rapid]
f. Salmonella sp &or Shigella sp identified in: Bld [xxx/stool new for bld]
Disease
Salmonella
species
Local code
Salmonella
sp/Shigella sp
identified in Bld by
Organism specific
culture
Frequency
Closest LOINC
[42255-0, Salmonella sp
&or Shigella sp
identified, Prid, Pt,
XXX, Nom, Organism
specific culture]
Few (2/29)
Proposed LOINC
[Salmonella sp &or
Shigella sp identified,
Prid, Pt, Bld, Nom,
Organism specific
culture]
g. Virus identified in: Rectum [create new code]
Disease
Virus
Culture
Local code
Virus identified in
Rectum by Culture
Frequency
Few (1/29)
Closest LOINC
[6584-7, Virus identified,
Prid, Pt, XXX, Nom,
Culture]
Proposed LOINC
[Virus identified, Prid, Pt,
Rectum, Nom, Culture]
2. Method
a. Hepatitis B virus core Ab.IgG+IgM in Ser by: EIA
Disease
Hepatitis B
virus
Local code
Hepatitis B virus core
IgG+IgM Ab
[Presence] in Serum
by EIA
Frequency
Few (2/29)
Closest LOINC
[51914-0, Hepatitis B
virus core Ab.IgG+IgM,
ACnc, Pt, Ser, Ord, Null]
Proposed LOINC
[Hepatitis B virus core
Ab.IgG+IgM, ACnc, Pt,
Ser, Ord, EIA]
b. Salmonella sp Ab in Ser by: Aggl
Disease
Salmonella
species
Local code
Salmonella sp Ab
[Titer] in Serum by
Aggl
Frequency
Few (3/29)
Closest LOINC
[22527-6, Salmonella
sp Ab, Titr, Pt, Ser, Qn,
Null]
Proposed LOINC
[Salmonella sp Ab,
Titr, Pt, Ser, Qn, Aggl]
c. Streptococcus pneumoniae Ag in Ser by: EIA
Disease
Streptococcus
pneumoniae
Local code
Streptococcus
pneumoniae Ag
[Presence] in Serum
by EIA
Frequency
Few (2/29)
Closest LOINC
[11086-6,
Streptococcus
pneumoniae Ag,
ACnc, Pt, Ser, Ord,
Null]
Proposed LOINC
[Streptococcus
pneumoniae Ag,
ACnc, Pt, Ser, Ord,
EIA]
d. Bacteria identified in Bld by: Anaerobic+Aerobic culture
Disease
Bacteria
Culture
Local code
Bacteria
identified in
Blood by Culture
Frequency
Few (1/29)
Closest LOINC
[600-7, Bacteria
identified, Prid, Pt,
Bld, Nom, Culture]
Proposed LOINC
[Bacteria identified, Prid, Pt, Bld,
Nom, Anaerobic+Aerobic
culture]
e. Streptococcus pneumoniae Ag in Urine by: EIA, LA
Disease
Local code
Streptococcus
pneumoniae
Streptococcus
pneumoniae Ag
[Presence] in Urine
by EIA
Streptococcus
pneumoniae
Streptococcus
pneumoniae Ag
[Presence] in Urine
by LA
Frequency
Closest LOINC
[24027-5,
Streptococcus
pneumoniae Ag,
ACnc, Pt, Urine, Ord,
Null]
[24027-5,
Streptococcus
pneumoniae Ag,
ACnc, Pt, Urine, Ord,
Null]
Few (2/29)
Few (3/29)
Proposed LOINC
[Streptococcus
pneumoniae Ag,
ACnc, Pt, Urine, Ord,
EIA]
[Streptococcus
pneumoniae Ag,
ACnc, Pt, Urine, Ord,
LA]
f. Streptolysin O Ab in Ser by: Aggl
Disease
Streptococcus
pyogenes
Local code
Streptolysin O Ab
[Presence] in Serum
by Aggl
Frequency
Closest LOINC
[9788-1, Streptolysin
O Ab, ACnc, Pt, Ser,
Ord, Null]
Few (1/29)
Proposed LOINC
[Streptolysin O Ab,
ACnc, Pt, Ser, Ord,
Aggl]
g. Influenza virus A+B Ag in Nose by: EIA
Disease
Influenza
virus
Local code
Influenza virus A+B
Ag [Presence] in Nose
by EIA
Frequency
Few (1/29)
Closest LOINC
[44567-6, Influenza virus
A+B Ag, ACnc, Pt, Nose,
Ord, Null]
Proposed LOINC
[Influenza virus A+B
Ag, ACnc, Pt, Nose,
Ord, EIA]
Closest LOINC
[33535-6, Influenza virus
A+B Ag, ACnc, Pt, Nph,
Ord, Null]
Proposed LOINC
[Influenza virus A+B
Ag, ACnc, Pt, Nph,
Ord, IF]
Closest LOINC
[43614-7, Adenovirus
Ag, ACnc, Pt, Nose, Ord,
Null]
Proposed LOINC
h. Influenza virus A+B Ag in Nph by: IF
Disease
Influenza
virus
Local code
Influenza virus A+B
Ag [Presence] in Nph
by IF
Frequency
Few (1/29)
i. Adenovirus Ag in Nose by: EIA
Disease
Adenovirus
Local code
Adenovirus Ag
[Presence] in Nose by
EIA
Frequency
Few (1/29)
[Adenovirus Ag, ACnc,
Pt, Nose, Ord, EIA]
3. Property & Scale
a. Microscopic observation in Sputum by Acid fast stain.Kinyoun: Pr / Ord
Disease
Mycobacterium
tuberculosis complex
Note: [report value: +++]
Pr/Ord suggested from
LOINC Manual
Local code
Microscopic
observation
[Presence] in
Sputum by Acid
fast stain.Kinyoun
Frequency
Few (2/29)
Closest LOINC
[654-4, Microscopic
observation, Prid,
Pt, XXX, Nom,
Acid fast
stain.Kinyoun]
Proposed LOINC
[Microscopic
observation, Pr, Pt,
Sputum, Ord, Acid
fast stain.Kinyoun]
b. Streptococcus agalactiae [Presence] in Cervix by Organism specific culture: Pr / Ord
Disease
Local code
Streptococcus
agalactiae [Presence]
in Cervix by
Organism specific
culture
Streptococcus
agalactiae
Frequency
Few (1/29)
Closest LOINC
Proposed LOINC
[581-9, Streptococcus
agalactiae, ACnc, Pt,
Cvx, Ord, Organism
specific culture]
[Streptococcus
agalactiae, Pr, Pt, Cvx,
Ord, Organism specific
culture]
c. Which LOINC code is correct for Widal test? Widal test is a general test for Salmonella
typhi.
Disease
LOINC
34371-5
Salmonella
species
(style A)
34372-3
32212-3
32213-1
Salmonella
species
(style B)
22527-6
COMPONENT
Salmonella typhi
H Ab
Salmonella typhi
O Ab
Salmonella
paratyphi A Ab
Salmonella
paratyphi B Ab
Salmonella sp
Ab
PROPERTY
TIME
SYSTEM
SCALE
METHOD
Titr
Pt
Ser
Qn
Aggl
Titr
Pt
Ser
Qn
Aggl
Titr
Pt
Ser
Qn
Titr
Pt
Ser
Qn
Titr
Pt
Ser
Qn
d. Similar question to Widal test, HSV simplex virus is for unknown HSV type; HSV 1+2
simplex virus is also for unknown HSV type. Which LOINC is best for unknown HSV
type?
Disease
Herpes
Simplex
Virus
(style B)
Herpes
Simplex
Virus
(style B)
Herpes
Simplex
Virus
(style B)
Herpes
Simplex
Virus
(style B)
LOINC
COMPONENT
PROPERTY
TIME
SYSTEM
SCALE
METHOD
19106-4
Herpes simplex
virus Ab.IgG
ACnc
Pt
Ser
Ord
36921-5
Herpes simplex
virus 1+2
Ab.IgG
ACnc
Pt
Ser
Ord
5013-8
Herpes simplex
virus DNA
ACnc
Pt
CSF
Ord
Probe.amp.tar
32141-4
Herpes simplex
virus 1+2 DNA
ACnc
Pt
CSF
Ord
Probe.amp.tar
The LOINC version migration issue
We did observe several codes affected when LOINC Version migrate from 2.50 to V2.52.
We noticed some axes were changed instead of creating a new LOINC code (then old
codes were deprecated). We want to know that whether update of LOINC axes become
common and whether RELMA would provide tool for dealing LOINC version issue.
We also provided our statistic of laboratory tests affected by LOINC version migration
(2.50 to 2.52)
Ver. LOINC
COMPONENT
PROPERTY TIME SYSTEM SCALE METHOD Frequency
2.50 6556-5 Streptococcus pyogenes Ag
ACnc
Pt
Thrt
Ord
EIA
24
2.52 6556-5 Streptococcus pyogenes Ag
Pr
Pt
Thrt
Ord
EIA
2.50 13953-5 Hepatitis B virus little e Ab
ACnc
Pt
Ser
Ord
EIA
15,591
2.52 13953-5 Hepatitis B virus little e Ab
Threshold
Pt
Ser/Plas
Ord
EIA
1,835
2.50 13954-3 Hepatitis B virus little e Ag
ACnc
Pt
Ser
Ord
EIA
9,955
2.52 13954-3 Hepatitis B virus little e Ag
Threshold
Pt
Ser/Plas
Ord
EIA
1.189
2.50 5193-8 Hepatitis B virus surface Ab
ACnc
Pt
Ser
Qn
EIA
47,012
2.52 5193-8 Hepatitis B virus surface Ab
ACnc
Pt
Ser/Plas
Qn
EIA
346
2.50 51916-5 Herpes simplex virus 1 Ab.IgG ACnc
Pt
Ser
Ord
EIA
411
2.52 51916-5 Herpes simplex virus 1 Ab.IgG Threshold
Pt
Ser/Plas
Ord
EIA
2.50 43180-9 Herpes simplex virus 2 Ab.IgG ACnc
Pt
Ser
Ord
EIA
2.52 43180-9 Herpes simplex virus 2 Ab.IgG Threshold
Pt
Ser/Plas
Ord
EIA
18