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

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

3. Background IHS “Patch 15” IHS “Patch 15” Developed a methodology that assisted in automating mapping to LOINCDeveloped a methodology that assisted in automating mapping to LOINC Developed in conjunction with the CDCDeveloped in conjunction with the CDC Detailed in a AMIA paper: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. 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. 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). 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 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. 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 hospitals Rural Clinics Rural Clinics No laboratorian present No laboratorian present Limited knowledge of terminologies 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. 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 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? Local panels may not match LOINC definitions: new code submission? This is an interesting point of discussionThis is an interesting point of discussion Need to centralize process as much as possible due to local resource issues. Need to centralize process as much as possible due to local resource issues. Need for LOINC but no laboratorians at some clinics.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. LOINC code look up – link to RELMA from IHS Lab home page. Support desk specialist will be trained and be able to provide guidance. Support desk specialist will be trained and be able to provide guidance. Deployment will include training on LOINC for all levels of end users. Deployment will include training on LOINC for all levels of end users. “Meaningful Use Report” for the clinics. “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. 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 IHS is soliciting comments from the Lab LOINC community on all aspects of the methodology David Gifford, david.gifford@ihs.govDavid Gifford, david.gifford@ihs.govdavid.gifford@ihs.gov Michael Walker,developer,michael.walker@ihs.govMichael Walker,developer,michael.walker@ihs.govmichael.walker@ihs.gov

12. notes Update stats Update stats Compare Patch 15 vs. new methods Compare Patch 15 vs. new methods P value P value LOINC training certification – is there any LOINC training certification – is there any LOINC system accreditation- is this a NIST pathway? LOINC system accreditation- is this a NIST pathway? Panels within panels Panels within panels Local panels that don’t match LOINC panels Local panels that don’t match LOINC panels New code or does the site have to become LOINC compliant New code or does the site have to become LOINC compliant