Two LOINC codes for one lab-item

Eric Browne eric.browne at montagesystems.com.au
Fri Feb 17 07:34:34 EST 2017


Ian,

I think it is fanciful to suggest that this could be done reliably by a system based purely on LOINC codes/definitions without recourse to manual construction of a list of codes or without knowing what constraints have been imposed on the sources of lab data.

By the way, there is already a LOINC code to cover tests that encompass either mass or molar concentrations of  creatinine  in serum or plasma:-

35203-9 	Creatinine [Mass or Moles/​volume] in Serum or Plasma ( see http://r.details.loinc.org/LOINC/35203-9.html?sections=Comprehensive ).
But despite the fact that its use for lab reporting is discouraged, its very existence almost guarantees that it will be used. The fact that this code is included in HEDIS panels and Value Sets suggest it might have been introduced into LOINC for downstream quality reporting.

A quick look through my LOINC tables shows the following potential codes that might need to be considered:-

 "Creatinine [Mass or Moles/volume] in Serum or Plasma"
 "Creatinine [Mass/volume] (Maximum value during study) in Serum or Plasma"
 "Creatinine [Mass/volume] in Serum or Plasma --1 day post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --1 hour post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --1 hour pre XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --1.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --1.5 hours pre XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --10 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --12 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --16 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --18 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --2 days post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --2 hour specimen"
 "Creatinine [Mass/volume] in Serum or Plasma --2 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --2.25 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --2.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --3 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --3.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --3.75 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --30 minutes post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --30 minutes pre XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --4 days post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --4 hour specimen"
 "Creatinine [Mass/volume] in Serum or Plasma --4 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --4.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --45 minutes post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --45 minutes pre XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --5.25 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --5.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --6 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --6.5 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --7 days post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --8 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --9 hours post XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --baseline"
 "Creatinine [Mass/volume] in Serum or Plasma --post dialysis"
 "Creatinine [Mass/volume] in Serum or Plasma --pre XXX challenge"
 "Creatinine [Mass/volume] in Serum or Plasma --pre contrast"
 "Creatinine [Mass/volume] in Serum or Plasma --pre dialysis"
 "Creatinine [Mass/volume] in Serum or Plasma"

 "Creatinine [Moles/volume] in Serum, Plasma or Blood"
 "Creatinine [Moles/volume] in Serum or Plasma --1 day post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --1 hour post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --1 hour pre XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --1.5 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --1.5 hours pre XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --10 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --12 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --16 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --18 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --2 days post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --2 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --2.5 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --3 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --3.5 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --30 minutes post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --30 minutes pre XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --4 days post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --4 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --45 minutes post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --45 minutes pre XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --5 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --6 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --7 days post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --8 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --9 hours post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --baseline"
 "Creatinine [Moles/volume] in Serum or Plasma --post XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --post dialysis"
 "Creatinine [Moles/volume] in Serum or Plasma --pre XXX challenge"
 "Creatinine [Moles/volume] in Serum or Plasma --pre dialysis"
 "Creatinine [Moles/volume] in Serum or Plasma"

 "Creatinine and Glomerular filtration rate.predicted panel - Serum or Plasma"

There are probably others.

regards,
eric

Eric Browne
eric.browne at montagesystems.com.au
ph 0414 925 845
skype: eric_browne


> On 17 Feb 2017, at 8:28 pm, Ian McNicoll <ian at freshehr.com> wrote:
> 
> Hi Robert,
> 
> Thanks for the input.  This is going to be a universal issue, however and wherever we are trying to aggregate bits of 'clinically identical' lab data as-per your example.
> 
> I am interested in how this is done now, as LOINC is not extensively used in the UK outside individual institutions, and my understanding is that the LOINC terminology carries enough relationship metadata to allow 
> 
> 2160-0 Creatinine [Mass/volume] in Serum or Plasma        Creatinine      Qn         mg/dL
> 14682-9 Creatinine [Moles/volume] in Serum or Plasma      Creatinine     Qn         umol/L  
> 
> to be queried/inferenced as 'Creatinine Serum or Plasma' but this would require a LOINC-aware terminology server.
> 
> or do folk just manually document the sets of terms to be queried?
> 
> Ian
> 
> Dr Ian McNicoll
> mobile +44 (0)775 209 7859
> office +44 (0)1536 414994
> skype: ianmcnicoll
> email: ian at freshehr.com
> twitter: @ianmcnicoll
> 
> 
> Co-Chair, openEHR Foundation ian.mcnicoll at openehr.org
> Director, freshEHR Clinical Informatics Ltd.
> Director, HANDIHealth CIC
> Hon. Senior Research Associate, CHIME, UCL
> 
> On 16 February 2017 at 13:51, Robert Hausam <rrhausam at gmail.com> wrote:
> In recent months I've had some discussions with Dan Vreeman at Regenstrief about the need to be able to group or aggregate "clinically equivalent" LOINC codes (however "clinically equivalent" is defined - mol and mass is one obvious case).  The original impetus for our discussion isn't being pursued on my end at the moment, but Dan did say that Regenstrief is embarking on an effort of their own to develop the capability for doing something like this.  I am sure that they would be interested in hearing about use cases that are being identified that need this capability (and also about anyone with an interest in helping them with getting the work done).
> 
> Rob 
> 
> On Thu, Feb 16, 2017 at 6:23 AM, Wouter Zanen <w.zanen at eurotransplant.org> wrote:
> The use case discussed was our use case. All that has been explained makes perfect sense from a lab perspective (Mol and Mass are different test), however in our use case we do need to aggregate them.
>  
> In our case it is allowed to report have for example createnine in both mg/dl and mmol/l, in the software application it will be one field with a choice for the unit, we receive info from multiple labs in europe). We are also looking for the possibility for electronic exchange of HL7v2 messages in the future. We use the lab test observation (inlcuding specimem details)  and lab test panel to record the test result. We try to bind with both SNOMED and LOINC (being flexible), on a template level I see only two solutions:
>  
> I now see two options:
> 	• Either we don't bind to LOINC and MAP Loinc codes in the mapping software we inevitable are going to need to process the HL7V2 message. Result is one archetype with both mol and mass units.
> 	• Or we invent a testfinding container archetype (Called Creatinine that binds to Snomed) and under that we have two test panel archetypes for  Mol and Mass. This makes building the app more difficult but at least we know the composition is related to Createnine.
> Currently we prefer solution 1.
>  
> Best regards,
> 
> Wouter Zanen
> 
> 
> 
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> >>> Ian McNicoll <ian at freshehr.com> 16/02/2017 11:04 >>>
> Helpful but do rely on having some fairly sophisticated terminology services and available mappings.  
>  
> We should keep this dialogue going as we will be working in a mixed loinc snomed environment in a uk project.  
>  
> Ian 
> On Thu, 16 Feb 2017 at 09:38, Bert Verhees <bert.verhees at rosa.nl> wrote:
> Very well thought out guidelines in the second part. Will be helpful in the discussion
> 
> Thanks
> Bert
> 
> Op do 16 feb. 2017 om 10:07 schreef Ian McNicoll <ian at freshehr.com>:
> This was helpful but still implies that some sort of terminology service is required 
> 
> https://confluence.ihtsdotools.org/download/attachments/12781103/Expo_LOINC_SNOMED_EHR_October_2015_Final.pdf?version=1&modificationDate=1446571187000&api=v2
> 
> 
> 
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