2011 08 15 - Clinical LOINC Tutorial - Documents
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Transcript of 2011 08 15 - Clinical LOINC Tutorial - Documents
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LOINC Tutorial Documents
Daniel J. Vreeman, PT, DPT, MSc Assistant Research Professor, Indiana University School of Medicine
Research Scientist, Regenstrief Institute, Inc
Clinical LOINC Meeting
08.15.2011 © 2011 [email protected]
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Overview
photo via Vernio77
1. Origins of a Document Ontology 2. HL7/LOINC Model 3. Evaluation and Ongoing
Development 4. Future Directions
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Origins of a Document Ontology
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Local systems have idiosyncratic names…
…need a common, controlled vocabulary
Outpatient Pain Note
Dr. Smith’s Tues Pain Clinic Note
Chronic Pain Clinic
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06/2000 • Document Ontology
Task Force
09/2003 • First Axis Values and LOINC
Codes 06/2005 • Expanded SMD Domain
10/2007 • Revised Axis
Value Approval
Ongoing • Harmonization Efforts • New Content Creation
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Document Type Codes Provide consistent semantics for names of documents exchanged b/w systems
Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt 1):94-8.
Retrieval
Organization
Display Preparation of Templates
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What is a Document? a collection of information
photo via striatic
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an information collection
Sections Sentences Sentences
Other content
photo via karen horton
Different than a panel enumerated, discrete elements
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Clinical Notes
Formal Document Ontology model and rules apply to clinical notes, but not (yet) to reports.
Clinical Note
A clinical document, produced by clinicians spontaneously or in response to a request for consultation.
Clinical Report
A clinical document, produced in response to an order for a procedure.
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Approach
Empiric analysis of >2000 document names
Mayo, 3M/Intermountain, VA in SLC, VA in Nashville
Find the level of granularity that best meets exchange use case
Photo via Jeffrey Beall
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Ultra-specific local names • Dr. Evil’s Friday Afternoon Pain
Clinic Note
Commonly understood elements • Outpatient Pain Clinic
Note
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Local Codes and Names
Still probably needed
Can send both in HL7 Mapping to a standard enables:
Interoperability
Aggregation
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Document Ontology Model Multi-axial / Poly-hierarchical
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Names are based on
expected information content
NOT document format photo via karen horton
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Names Based on Content
Same LOINC code for…
…if information content is the same
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Not Part of the Name Author Location of service Date of service Status (e.g. signed, unsigned) Security/privacy flags (e.g. protected) Updates or amendments to a document
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Assume that these other important attributes would be sent in different fields of the message
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Model of Document Names
Subject Matter Domain • e.g. Cardiology, Pediatric Cardiology, Physical Therapy
Role • Author training/professional classification (not @ subspecialty) • e.g. Physician, Nursing, Case Manager, Therapist, Patient
Setting • Modest extension of CMS’s definition (not equivalent to location) • E.g. Hospital, Outpatient, Emergency Department
Type of Service • Service or activity provided to patient • Eg. Consultation, History and Physical, Discharge Summary
Kind of Document • General structure of the document • E.g. Note, Letter, Consent
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Rules for Constructing Names
photo via Robert S Donovan
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1. Enumerated List Document names are constructed from enumerated lists of values for each axis.
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2. Document + One Other Document name needs specification of a Kind of Document value and at least one of the other four axes.
• <Type of Service> <Kind of Document> Component
• Find Property
• Pt Time
• <Setting> System
• Doc Scale
• <SMD>.<Role> Method
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3. Combinations Combinations from within an axis are allowed where they make sense (SMD, Service).
Assessment + Plan
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Example LOINC Names Component Prop Time System Scale Method
Group counseling note Find Pt Hospital Doc {Provider}
Evaluation and management note Find Pt Outpatient Doc {Provider}
Evaluation and management note Find Pt {Setting} Doc {Provider}
History and physical note Find Pt {Setting} Doc {Provider}
Initial evaluation note Find Pt {Setting} Doc Physician
{curly braces} notation: send that content as a separate item in the message (field or segment).
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Hierarchy Made a 1st pass Component hierarchy – Based on Type of Service Axis – Ignored Kind of Document
Multi-axial hierarchy is auto-generated – Available as a separate download
Custom hierarchies (e.g. context-specific) ones are easily imagined
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Hierarchy in RELMA
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Evolution, Evaluation We’re not done yet
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Evolution Ongoing evaluation and evolution Exceptional contributions from Columbia University and the VA
More ontology additions from submissions
Expanded original SMD values with ABMS specialty names and iterative discussion
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Iterative Evaluation Case Study NYPH-CUMC
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Case Study
Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
SMD Role Setting Type Service Kind of Doc Overall Distinct Original CDO
26.7% 99.9% 99.9% 43.5% 100% 23.4% (n=894)
7.9%
Expanded CDO
98.6% 100% 100% 99.9% 99.9% 98.5% (n=935)
39.1%
1. Expanded CDO is better 2. Many local documents map to 1 LOINC 3. Inter-rater reliability was good
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Nursing
Hyun S, Shapiro JS, Melton G, Schlegel C, Stetson PD, Johnson SB, Bakken S. Iterative evaluation of the Health Level 7--Logical Observation Identifiers Names and Codes Clinical Document Ontology for representing clinical document names: a case report. J Am Med Inform Assoc. 2009 May-Jun;16(3):395-9.
SMD Role Setting Type Service Kind of Doc Overall Distinct SMD ++ CDO
74% 100% 100% 100% 100% 74.5% (n=94)
33%
In a separate analysis…
Section headings from nursing documents that could be mapped to existing LOINCs Hyun S, Bakken S. Toward the creation of an ontology for nursing document sections: mapping section names to the LOINC semantic model. AMIA Annu Symp Proc. 2006:364-8.
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Case Study German University Hospital
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German University Hospital
86 Document Types (1.2 mil documents)
44%
44%
12% Mapped to LOINC
Not specific enough mapping
No LOINC match
Dugas M, Thun S, Frankewitsch T, Heitmann KU. LOINC codes for hospital information systems documents: a case study. J Am Med Inform Assoc. 2009 May-Jun;16(3):400-3.
Used LOINC v2.24 (original DocOnt terms)
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German University Hospital
LOINC codes that existed for documents in their set (by volume)
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Ongoing Development
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A Work-in-Progress LOINC User’s Guide is definitive source for current policy
Collaboration/discussion Clinical LOINC Meetings HL7 SDTC Online
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The Future Great Scott!
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Future Directions More v1 and v2 axis value harmonization Axis definitions Extension to other Kind of Documents Empiric analysis of document contents
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photo via milos milosevic