Indian Health Service Laboratory Modernization LOINC/UCUM Proposed Strategy

1. Indian Health Service Laboratory ModernizationLOINC/UCUM Proposed Strategy Clarence Smiley David Gifford

2. Background • IHS utilizes the VA’s infrastructure • Last major update was in 2005 • Meaningful Use and other incentives make the implementation of LOINC and UCUM imperative

3. 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.

4. 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.

5. Background • Rural hospitals • Rural Clinics • No laboratorian present • Limited knowledge of terminologies

6. 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.

7. 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Methodology Issues • LEDI Specimen codes – are based upon a deprecated table from HL7 V2.x. • IHS Patch 15 LOINC is out of date; need to update IHS master list…..In process • Local panels may not match LOINC definitions: new code submission?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.

8. Some next steps • 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.

9. 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.

10. 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?

11. 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