I am new to the LOINC standard. I am part of a digital healthcare company who provides diagnostic results based on requests from AP pathology labs.
Would it be fair to request that a AP lab provide us the appropriate LOINC code for an analysis request so that we can understand what type of test/order that lab wants to perform and then once we have the results, submit the results back with associated LOINC code?
I am very confident that the latter use case is what is intended for LOINC. I am not as clear if requesting an AP lab provide us the LOINC code for analysis request is standard.
It is nice to meet you. I’m the volunteer chairperson for the Lab LOINC Committee and one of the monitors for the Forum.
Do your services include both technical and professional services? Do you offer unique workups for specific clients; perhaps items contractually added to be done everytime they order an ‘xzy’?
Are you electronically interfaced to each of your clients for the sending of orders and results? If so, how is your interface messaging constructed?
I can say that not everyone is using LOINC for ordering; if you use search.loinc.org for “pathology” (without the quotation marks), you’ll see an array of discrete portions of a report as well as a few generic report codes.
Let’s discuss further. I look forward to your reply.
It is nice to meet you. I’m the volunteer chairperson for the Lab LOINC Committee and one of the monitors for the Forum.
Do your services include both technical and professional services? Do you offer unique workups for specific clients; perhaps items contractually added to be done everytime they order an ‘xzy’?
Are you electronically interfaced to each of your clients for the sending of orders and results? If so, how is your interface messaging constructed?
I can say that not everyone is using LOINC for ordering; if you use search.loinc.org for “pathology” (without the quotation marks), you’ll see an array of discrete portions of a report as well as a few generic report codes.
Let’s discuss further. I look forward to your reply.
To answer some of your questions. Our services primarily are technical services, but could include professional services in the future. We do offer unique workups to be done every time an AP lab orders a specific test.
We are working to be electronically interfaced with each of our clients to receive order request and send results.
I can say that it looks like LOINC is definitely used to send results back. But I am still unclear if I can rely on labs to provide a LOINC code with their order so that we can use as a standard way to understand which order they are requesting and determine which technical process needs to be run based on the LOINC code.
It seems like based on your response, it is very hit or miss whether a client sends LOINC codes for order requests? If an institution already has LOINC codes mapped, would it just be an update to their HL7 template that they interface with us?
Entering the URL search.loinc.org the keywords PDL tissue , ten LOINC terms were retrieved. There are two for PDL-1 28-8
83055-4 PD-L1 by clone 28-8 [Presence] in Tissue by Immune stain has an ordinal scale and PresenceThreshold property. Example intent would be a request to perform the staining or a simple interpretation of Detected/Not Detected.
83056-2 PD-L1 by clone 28-8 [Interpretation] in Tissue by Immune stain Narrative would ask for a Narration or multiple sentences of an answer.
In the most simplistic form, 83055-4 could be an order for the staining to be performed and return the processed slide(s) to your facility. This is my idea of a technical piece.
83056-2 could be the professional counterpart, where your facility performs the staining and provides a pathology reading.
Please exercise caution in this endeavor, as
I cannot confirm there’s a pairing of LOINC terms for every immune stain. Thus a gap would existing in the operational extent of this until new LOINC terms were available.
I could also envision the mistake of the site ordering just the technical piece and precious time is wasted when they were expecting a pathology reading. There’s burden on your clients to know LOINC and send in the correct order. Current business practices have an offered compendium list of assays by reference lab test names (that may have a LOINC term associated, but do not process their work by LOINC terms). There was a pilot done in the 1990’s of a reference lab using LOINC for their order codes. It became apparent with multiple customization features for clients (pricing, processing etc) that the LIS/LIMS systems couldn’t perform the contracted agreements from a single point of LOINC. As you may be aware, labs may create mirror image tests for clients that get discounts or different pricing, yet operate the same at the backend workstations.
For your third assay, HER2 4B5, there are only two HER2 terms by immune stain. Neither contain the 4B5 parameter you’ve given. Perhaps a new LOINC code submission would be needed here.
I hope this reply has given ideas to consider. Let us know how else to help.
I believe it does. The first question I wanted to make sure of is that we will receive a LOINC code in the HL7 order request and that LOINC codes are not exclusively used for reporting results. I believe you have confirmed this.
What is the process to go about getting LOINC codes created?
Click on the LOINC term to navigate to the term description. I take it to be the reporting of the assay. Possibly from the EMR. Examining the attributes revealed a doc scale and property of finding. I would envision this to be in a note describing the laboratory results. Document (doc) being a note.
Click on the LOINC term to navigate to the term description. I take it to be the reporting of the assay. Possibly from the EMR. Examining the attributes revealed a doc scale and property of finding. I would envision this to be in a note describing the laboratory results. Document (doc) being a note.
Click on the LOINC term to navigate to the term description. I take it to be the reporting of the assay. Possibly from the EMR. Examining the attributes revealed a doc scale and property of finding. I would envision this to be in a note describing the laboratory results. Document (doc) being a note.
Sorry about the multiple posts of one reply. Having internet issues. As for your earlier question on submissions, please see the Knowledge Database at loinc.org
There was also a tutorial given at the October LOINC Conference in France. Recordings are now available at https://loinc.org/conference/france-2022/ scroll down on Monday’s at 15:30 CEST to watch.
Are your orders/test requests and results are discretely captured to encode them with LOINC or more or a text blob or pdf approach? If latter, may only be able to attach a single document level LOINC to say a pdf report (depends on your information system capabilities too).
Regarding the question of using LOINC for ordering and resulting. LOINC should not be used solely for representing the order (order request) or result name/item alone. Rather, there is the name of the specific lab test order of the performing lab communicated to them upon request by a provider. This order name is then mapped to the LOINC code representing the order. Similarly, there is a test result name which is mapped to LOINC in the back end/message.
There are many reasons not to use the LOINC itself to order or result (as indicated in the User Guide). One is the code descriptions are dynamic and may be updated each release, whereas a test order or result is static/set in a data dictionary and used in information systems. Another is the test name may have details not reflected in the LOINC naming conventions.
Where are your implementations occurring? Country regulatory requirements may apply too around the ordering and resulting process. In the US, CLIA regulations apply impacting data that are required with orders and test reports. CLIA would require the performing lab, such as yours, to establish a test menu of what is offered. Said menu and specimen collection/order requirements are communicated to all places of ordering/specimen collection via the CLIA Speicmen Collection Manual (also know as a lab compendium). Often it includes test order numbers and names for specific tests on your menu that your customers would request (e.g a specific genetic marker or panel). It should be clear to you what is being requested.
Regarding mapping LOINCs to orders, there are 3 different types of LOINCs for orders and results (observations). One is Both, it can be used for a single orderable (order) and resultable (result/observation). The second is Order only, which is used for only orders, typically panels. The third is observation only, used for results only. Examples include calculated results like ratios or interpretations.
