Download Public Health Test Presentation 09_24_14

aLOINC Order Code Project:
Public Health Test Orders
Ruby M. Phelps
September 24, 2014
Laboratory Practice Standards Branch
Division of Laboratory Programs, Standards, and Services
Background

Agreed-upon Logical Observation Identifiers Names
and Codes (aLOINC) Code Project
 Meaningful use certification requires that laboratories use LOINC®
to transmit laboratory results
 Currently, non-standardized local codes or terminology are used
by laboratories to describe laboratory test orders
 The structured format of laboratory tests and orders should
provide the ability to incorporate LOINC® terminology for both
ordering and reporting lab testing
Purpose
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Identify and standardize LOINC® codes for public
health tests
Develop/create new LOINC® order codes for public
health tests/panels identified as missing from LOINC®
Review current panels applicable to public health
Provide recommendations to incorporate into
Meaningful Use Stage 3 Certification Criteria
 Laboratory orders interface – EHR (Electronic Health Record) must have the
ability to transmit lab orders using the lab order and results interface
guidelines produced by the S & I Framework Initiative
 Receipt of a laboratory test order for some diseases is
reportable, as this is considered suspicion of the disease
Who Orders a Public Health Test?

Licensed or certified health care providers
 Inpatient or Outpatient settings

Laboratories seeking reference or confirmatory testing
Public health laboratories using the services of another
state public health laboratory

CDC laboratory services

 Perform tests requested by public health laboratories and other
federal agencies
• Specimens from private healthcare providers and institutions must be
submitted to the local state health department laboratory for
processing prior to CDC submission
The Challenge:
Test Order Codes – Current Practice

Example: Borrelia burgdorferi Ab
Code
Short
Name
LOINC®
(best fit)
Lab1
Lab2
(best fit) (best fit)
Public
CPT®
Health
Lab (ex.)
CDC
Lab
11006-4*
0050216
223586
92030
86618
CDC-10298
Borrelia
burgdorferi
Abs, Total by
ELISA
Lyme Ab,
Total/IgM
Responses
Lyme
Disease
Serology
Lyme
Disease
Antibody
Borrelia
Burgdorferi
(Lyme disease)
Serology
Borrelia
burgdorferi Ab
[Presence] in
Serum
* There are ~270 LOINC® codes for Lyme Disease
Standard Test Order Codes:
One Small Step Towards
The “Miracle” of Interoperability
Patient
Public Health Laboratories
Public Health Departments
Physician’s Office
Clinic/Ambulatory Care
Test Order Code
Standards for
PH
Lab 1 Lab 2 Lab 3
Data Hub
CDC Laboratory
Commercial Lab
CDC
Reference Lab
EHR System
LIMS
Surveillance Systems
Scope of Review

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Focus was on tests for infectious diseases performed by state
public health laboratories
Started with test requisitions rather than result codes
 Limited
 Start with the ~98% that fit a pattern (not the exceptions)
 The number of result codes is overwhelming

Exclusions from first round (eventually should be done)

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Animal testing
Bird (for WNV)
Blood lead
Drug screen
Environmental
Food
Maternal screening for congenital abnormalities, HCG, AFP, etc.
Metals
Newborn screen
“Standard” laboratory tests offered by some state health depts.
Process
Step 1 – Test categories used from Reportable Conditions Mapping Table (RCMT)
Step 2 – Eight state laboratory test directories and 10 additional state test requisitions matched to list. CPT®
codes were included if provided by at least one state.
Step 3 – List consolidated, tests named and LOINC® coded if possible
Process (continued)
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Any test where an organism was defined to the species
level as described in the test directory was given its
own line
Newer organisms not in the RCMT were added
Taxonomic name of the organism was used rather than
the disease for which the test was performed. This was
for consistency and to eliminate redundancy
While not exactly in scope a test order name was
proposed after creating some naming conventions
A LOINC® order code was proposed if a potential code
was available
 Unspecified specimen source with some exceptions (serum or
stool samples)
 Methodless with some exceptions
Test Order Name Rules


Used state test requisition forms as a guide for terms most commonly
used
Names were created in lower case with capital letters as follows:
 The beginning of the name
 Proper nouns or locations within the name (e.g., West Nile, Saint Louis, etc)
 Acronyms and abbreviations used sparingly and only for accepted usage (e.g., IgG,
IgM, DNA, RNA, Ab, Ag, etc.)
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Ab before IgG or IgM (e.g., Measles virus Ab IgM)
“Virus” included for all viruses
Organism listed first with a few exceptions
Minimal punctuation for ease in electronic use
 No commas or special characters
Limitations
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Non-laboratorian organized and created this list
Could not always determine if tests were single tests or only
available as part of a panel
Method and how results were reported were not always described.
This information was helpful in categorizing the tests
Sometimes unclear whether a test was for Ab or Ag
LOINC® codes for organism identification, subtyping and
serotyping may not be broad enough to be order codes
LOINC® and SNOMED® result coding was not in scope
Every reportable condition does not necessarily have a test listed
in the state public health lab test directory
 Rarely performed – “Other”
 Relies on clinical diagnosis only
Next Steps?
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Much more to be done
Is this approach reasonable? Are we on the right track?
Review and vetting of list with public health partners
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Need to add tests missed during first phase of review
Determine handling of tests that have reflex testing or may be reflex tests
Provide consensus on test naming conventions and possible LOINC® codes
Incorporate decisions on PH tests with the ambulatory test codes list
• Some PH testing is also done in non-public health laboratories
 Review content of panels
 Provide list of tests that can be flagged as “public health” to Regenstrief

Guidance on the best way to implement
Future
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Publish the list
Sustainability – Identification of who would provide
regular review and update of the list
 Includes application for new LOINC® codes
Thank you!
The findings and conclusions in this report are those of the author and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Laboratory Practice Standards Branch
Division of Laboratory Programs, Standards, and Services