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Mapping Local Clinical Chemistry code with LOINC Wanchana Ponthongmak, et al. Mapping local clinical chemistry code with LOINC
Wanchana Ponthongmak, Boonchai Kijsanayotin, Areerat Rattanapradit, Win Min Thit Thai Health Information Standards Development Center (THIS), Nonthaburi, Thailand AbstractBackground: The present time, the Health Information local clinical chemistry test is necessary to help decision Exchange (HIE) is very important and is needed in making for LOINC adoption. every health organization. The usefulness of HIE include; Objective: To evaluate the coverage of LOINC to improving the quality of care, medical reimbursement, Thai clinical chemistry test in three hospitals. epidemiological report, resource and human management, Method: The clinical laboratory data were obtained management in health insurance, financial management from three different locations; 1) Ramathibodi hospital, and etc. Health data standard is a major component 2) Siriraj hospital and 3) Chulalongkorn hospital. which has ability to enable the exchanging of data The Regenstrief LOINC Mapping Assistant (RELMA) between health organizations. Thailand needs to adopt was used to map international standard code with the standard for laboratory in national level that local tests by medical technologist. has potential to allow the semantic interoperability. Results: Local clinical chemistry test data are able to Thai Health Information Standard Development Center map with LOINC code more than 95% of which, (THIS) is under Health System Research Institute 46.92% is one to one mapping and 48.43% is one (HSRI) reviewed international standard for laboratory to many mapping. and suggested to use Logical Observation Identifier Conclusions and discussions: International standard Name and Codes (LOINC). LOINC is a universal for medical laboratory (LOINC) has covered clinical coding system for identifying laboratory and clinical chemistry laboratory in all 3 major hospitals. The results observations. It was developed and was maintained showed that more than 95% are able to map. by Regenstrief Institute of USA. LOINC covered almost This conclude that LOINC is suitable and practical all the medical laboratory tests and is widely used for clinical chemistry laboratory in Thailand.
in many countries and will be use continues to grow Keywords: health data standard, interoperability, Clinical chemistry test is commonly ordered by LOINC, medical laboratory, RELMA.
physician when patient is needed clinical diagnosis. As a result, studying the scope between LOINC and Received 3 April 2015; Accepted 29 May 2015 HIE is the transmission of health information between The need of health data usage is increasing over the health organizations at all level. It is one of important past decade, this is not only for healthcare provider components that can improve the quality of care.1 but patient and consumer as well. The benefit of HIE also include pooling data for research study, planning Correspondence: Wanchana Ponthongmak, Thai Health health policy, especially continuity of care and patient Information Standards Development Center (THIS), safety. Nonthaburi, Thailand (Tel.: +66-2832-9595; E-mail address: Health data standard is a back bone of HIE which facilitate the different systems to communicate, Journal of the Thai Medical Informatics Association, 1, 38-43, 2015 Wanchana Ponthongmak, et al. Mapping Local Clinical Chemistry code with LOINC share and exchange data with full understand In Thailand, the university hospitals are defined as in order to achieve the seamless system with semantic hospital in tertiary level of care. As tertiary hospitals, they provide complex laboratory tests as well as simple In 2009, Thai experts met and evaluated eHealth laboratory tests performed in hospitals in primary and situation in country and provided five recommendations secondary level of care. Consequently, the university hospital are expected to cover almost entire laboratory 1. Thailand needed authority organization who provide tests available. leadership and direction of eHealth The Regenstrief LOINC Mapping Assistant (RELMA) 2. Thailand needed eHealth strategy in ICT framework version 6.2 which contains LOINC version 2.44 was 3. Thailand needed health information legislations to used as a mapping tool. The study consisted of 6 steps 4. Thailand needed national health data standard to enable interoperable healthcare services 1) Preparing the clinical chemistry test list
5. Thailand needed mechanism for capacity building The clinical chemistry test lists from three university of eHealth people.5 hospitals were imported to spreadsheet form. As mention before, one of the recommendations Since the test lists from Ramathibodi hospital and was the health data standards were needed. Currently, Siriraj hospital used the same LIS application named Thailand has a few health data standards such as HCLAB, developed by Sysmex (Thailand) Co. LTD, ICD-9, ICD-10 are used for coding clinical procedures and it caused in duplication of data structure for storage diagnosis, the 12 files and 18 files are used for storing of laboratory term. These two hospitals contained five health data. Unfortunately, the standard for laboratory data fields in data structure which had similar relationship is not existed.
to six major axes of LOINC. These are the following, Thai Health Information Standard Development Center ■ Test name, related to LOINC component (THIS) reviewed the international standards for laboratory ■ Unit, related to LOINC property data and suggested LOINC as a national laboratory ■ Specimen, related to LOINC system standard as LOINC is coverage, nimble, flexible, and easy ■ Data type, related to LOINC scale ■ Method, related to LOINC method Logical Observation Identifiers Names and Codes Moreover, the data structure for laboratory test of (LOINC) is a terminology standard that was developed by Chulalongkorn hospital contained only two fields which The Regenstrief Institute, Indianapolis, United States of related to LOINC including test name, and specimen type. America. It is a universal names and codes system The clinical chemistry test lists of three hospitals which used for encoding clinical observation and medical were merged into single spreadsheet. The test names laboratory with uniqueness. The adoption of LOINC is which contains Thai alphabet were translated into English growing globally due to the coverage and flexible. by medical experts as the RELMA cannot recognize Currently, more than 150 countries used LOINC in Laboratory Information System (LIS).7-8 2) Importing the clinical chemistry test list
Materials and methods After the translation process was done, the combined The laboratory test data in this study were collected from spreadsheet was imported into RELMA. There are three large university hospitals in Thailand, such as four ways to imported local tests into RELMA including; ■ Ramathibodi hospital ■ Direct entry of local terms into Local Master ■ Siriraj hospital Observation File (LMOF) of LOINC database ■ Chulalongkorn hospital Journal of the Thai Medical Informatics Association, 1, 38-43, 2015 Mapping Local Clinical Chemistry code with LOINC Wanchana Ponthongmak, et al. ■ Create an access table of local terms, which is shown in Figure 1 and the mapping results were
mimic the LMOF structure classified into three types; ■ Create a delimited ASCII file of local terms ■ one-to-one mapping: one clinical chemistry ■ Load local terms from Health Level 7 (HL7) test code could be mapped with one LOINC The best way for importing is loading local tests ■ one-to-many mapping: one clinical chemistry from HL7; a massaging standard that used together test code could be mapped with more than with LOINC code facilitating exchange and pooling of health data in clinical care.7 Unfortunately, Thailand does ■ unmapped: no appropriate LOINC code for the not apply HL7 in its healthcare system. In this study, clinical chemistry test the clinical chemistry test list was saved in the text format (.txt) with tab delimiter.
5) Exporting mapping result
The mapping results were not done in RELMA 3) Verifying the error
because it only provides one-to-one mapping RELMA provides 2 verification tools for verifying result but not for one to many. As a result, after RELMA unreadable terms, the term verification, and search the appropriated LOINC code for local the unit verification. The clinical chemistry test list was terms, LOINC codes were exported from RELMA performed by both tools.
to spreadsheet file and mapped to that local 4) Mapping
The RELMA provides mapping interface which 6) Auditing the mapping result
showed the one local test at one time and the The mapping results were checked the mismatch terms mapper can search and select the most appropriated by a medical technologist and a medical doctor in order LOINC codes for that local test. The mapping algorithm to reduce the wrong mapping.
Figure 1: the mapping algorithm9
Journal of the Thai Medical Informatics Association, 1, 38-43, 2015 Wanchana Ponthongmak, et al. Mapping Local Clinical Chemistry code with LOINC This study collected 744 local clinical chemistry tests 2) 222 tests from laboratory information system of which derived from three university hospitals; Siriraj hospital, and 1) 432 tests from laboratory information system of 3) 90 tests from laboratory order list of Chulalongkorn Ramathibodi hospital, hospital. As shown in Table 1.
Table 1 The number clinical chemistry test used classified by data sources
Data sources
Clinical chemistry test
Ramathibodi hospital Siriraj hospital Chulalongkorn hospital The mapping result of clinical chemistry test list to LOINC was almost 95% of which, almost 55% was one-to-one mapping and almost 40% was one-to-many mapping as show in Table 2.
Table 2 mapping results of clinical chemistry test classified by hospitals
Data sources
one-to-one one-to-many unmapped Total
Ramathibodi hospital Siriraj hospital Chulalongkorn hospital For the local test from Ramathibodi hospital, 96.30% Discussions and conclusions could be assigned by LOINC code of which, 62.73% In 2006, AgHa Khan et al standardized laboratory tests was one-to-one mapping and 33.57% was one-to-many from five Indian Health Services (IHS) by mapping the mapping. The unmapped was occurred 3.70% local tests to LOINC codes. The results were 81% to For the local test from Siriraj hospital, 88.29% could 94% of local tests could be mapped to LOINC.10 be mapped to LOINC. 51.35% was one-to-one mapping And in 2009, Martin Dugas and his colleagues mapped and 36.94% was one-to-many mapping and 11.71% local laboratory of hospital in Germany which was could not be assigned by LOINC code.
ordered more than ten times annually. The result was For the local test from Chulalongkorn hospital, more than 93% of local tests could be mapped to all test could be assigned by LOINC code of which, LOINC.11 Moreover in 2012, Thai researchers of 25.56% was one-to-one and 74.44% was one-to-many Thai Health Information Standard Development center (THIS) evaluated the coverage of LOINC to local Journal of the Thai Medical Informatics Association, 1, 38-43, 2015 Mapping Local Clinical Chemistry code with LOINC Wanchana Ponthongmak, et al. laboratory test of reimbursement list in their country high granularity than the laboratory of reimbursement and provided the result as almost 95% of laboratory list. There were five data elements of six LOINC axes in the reimbursement list could be mapped to LOINC.9 which can identify laboratory test uniquely. However, As the previous studies, LOINC has potential to be the tests from Chulalongkorn hospital are mapped to the national standard for laboratory tests in global LOINC with more one-to-many due to data collection site. The study was collected laboratory test data from This study focus on only clinical chemistry discipline Ramathibodi hospital and Siriraj hospital via the LIS because it is a most common and easy for standard- directly which contained every laboratory detail. On the izing at the beginning.7 The result of mapping in three other hand, the laboratory tests from Chulalongkorn largest university hospitals in country was almost 95% were collected from the laboratory order list which indicated that Thai clinical chemistry tests are contains only necessary information for helping the compatible with LOINC standard.
physician order laboratory test easily. Again, there were Once compare to previous study in Thailand local other reasons that lead the mapping to one-to-many. laboratory tests,9 the one-to-one mapping results were For example, the differential of specimen types which increased significantly from 23% to 55%. The reason the university hospitals in Thailand collected data less is the university hospital's laboratory test data have details than LOINC standard as show in Table 3.
Table 3 the example of local specimen type compare to LOINC system
Local specimen
LOINC system
Blood - Mixed Venous Blood - peripheral Blood filter paper Moreover, some of local specimen type determined tests as used in healthcare services in as "other" which mean any specimen type that lead each hospital. These lab profiles cannot to map with many LOINC codes as well. map to LOINC code due to differential The unmapped 42 tests could be classified in of local tests inside themselves. For four groups include; example, the "OGTT 3 tubes" test ■ No appropriated LOINC code which contains three glucose tests The no appropriated LOINC code has two type including includes; glucose 1 hour, glucose 2 hour 1) Local lab profile: some local test is a and glucose point in time do not exist laboratory panel which contains many local Journal of the Thai Medical Informatics Association, 1, 38-43, 2015 Wanchana Ponthongmak, et al. Mapping Local Clinical Chemistry code with LOINC 2) High granularity local test: some local test 2. Hoyt RE. Medical Informatics practical guide for the has more details than LOINC. For instance, healthcare professional. 3rd ed: Lulu.com; 2006 the "Challenge test of Estradiol in 20, 90 3. Public Health Data Standards. USA: Minnesota and 120 minutes" which LOINC only Department of Health; 2006 [updated August 2006; provides code for the challenge test of cited 5 December 2011]; Available from: www.health.
Estradiol in 30 and 60 minutes.
■ Procedure code 4. Cormont S, Vandenbussche PY, Buemi A, Delahousse The local test list also has some procedure tests J, Lepage E, Charlet J. Implementation of a platform which were performed in clinical chemistry department dedicated to the biomedical analysis terminologies of three university hospitals such as "DNA Extraction", management. AMIA Annual Symposium proceedings/ "PCR 1 Fragment" and "Sequencing with Dye 1 Rxn" AMIA Symposium AMIA Symposium. 2011;2011: 5. Kijsanayotin B, Kasitipradith N, Pannarunothai S. There were the tests that performed in drug eHealth in Thailand: the current status. Studies specimen such as "steroid testing in drug" and in health technology and informatics. 2010;160 "Bioanalysis in drug". These tests are not found in (Pt 1):376-80.
6. Kijsanayotin B, Sinthuvanit D. LOINC coding standard ■ Non laboratory test and health information system in Thailand. Health Some local tests were used for commenting other System Research Institute: Health System Research laboratory tests which could not be assigned by any Institute; 2012.
7. McDonald C, Huff S, Mercer K, Hernandez JA, In the future, if LOINC is to be implemented, Vreeman DJ. Logical Observation Identifiers Names there might be different opinions for mapping and Codes (LOINC®) Users' Guide2011. the same laboratory test to LOINC by laboratory 8. McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle experts, who have different background from various D, Aller R, et al. LOINC, a universal standard for healthcare facilities. As a result, the introduction identifying laboratory observations: a 5-year update. on LOINC standard is recommended to minimize the Clinical chemistry. 2003;49(4):624-33.
9. Pontongmak W, Kijsanayotina B, editors. Mapping This project studied the coverage of LOINC for Thai Local Laboratory Codes with LOINC : the clinical chemistry test in Thailand and the coverage preliminary report. Proceedings of the National was almost 95% of three largest university hospitals. Conference on Medical Informatics; 2012: Thai The percentage indicated LOINC is an appropriated Medical Informatics; 2012 standard for chemistry laboratory in Thailand, 10. Khan AN, Griffith SP, Moore C, Russell D, Rosario with potential to use as national standard. However, AC, Jr., Bertolli J. Standardizing laboratory data the study of the LOINC coverage for others laboratory by mapping to LOINC. J Am Med Inform Assoc. disciplines also need in order to prove the coverage 2006 May-Jun;13(3):353-5 of LOINC for laboratory in healthcare service system 11. Dugas M, Thun S, Frankewitsch T, Heitmann KU. in Thailand.
LOINC codes for hospital information systems documents: a case study. J Am Med Inform Assoc. 1. Shortliffe EH. Biomedical Informatics : Computer Applications in Health Care and Biomedicine 3rd ed: Springer Science+Business Media; 2009 Journal of the Thai Medical Informatics Association, 1, 38-43, 2015

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