2013 06 06 - Laboratory LOINC and RELMA Workshop
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Transcript of 2013 06 06 - Laboratory LOINC and RELMA Workshop
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UsingRELMAOrInSearchoftheMissingLOINC
JamesT.CaseMS,DVM,PhD,FHL7,FACMIHealthProgramSpecialist,SNOMEDCT
NationalLibraryofMedicine
LaboratoryLOINCMeetingJune2013
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Acknowledgements
LOINCDevelopmentTeam ClemMcDonald,DanVreeman,JamiDeckard,
DavidBaorto,KellyMalo8
RELMADevelopmentTeam JohnHook,AnandhiSowmyan,JamesDennis
LOINCCommi7ee Supporters:NLM,RegenstriefInsEtute,
RegenstriefFoundaEon
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Whatwillwecovertoday?
OverviewofLOINC ReviewingnewRLMAfeatures! InstallingRLMA Sengpersonalpreferences LoadingaLocalObservaEonFile(LMOF)
SearchingforaLOINCTerm PreparingLMOFforMapping ReviewofMapScreenFuncEons SengSearchLimits MappingLocalTermstoLOINC ViewingLOINCTermDetails Proposing/SubmingNewLOINCTerms xporEng/PrinEngMappedTerms MappingyourownLMOFdata
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Whyarewedoingthis?GoalsofHealthInformation
Standards
InteroperabilitytheabilitytoexchangeinformaEonbetweenorganizaEons
Comparabilitytheabilitytoascertaintheequivalenceofdatafromdifferentsources
DataQualitythemeasurementofaccessibility,completeness,accuracyandprecision(andmore)
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LevelsofInteroperability
Basicallowsdatatobeexchangedbetweencomputersystems Wordprocessingdocuments,textmessages
Funconaldescribesthestandardsyntax(format)ofthedata
Documenttemplates,forms,datastructures Messagestandards
Semancrequiresuseofstandardizedcontent(vocabularies)withinthedata
structure
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Comparability
MeaningofthedataisconsistentwhensharedamongdifferentparEes rysipelasHumanskindisease;StreptococcusGrpA rysipelasAnimalSepEcemia/dermaEEs;Erysipelothrixrhusiopathiae
Commonterminologyrequired Shouldworkinthebackground
Wordsarenotenough CodesuniquelyidenEfyterms Vocabularyspecialized,precisetermsthatremove
ambiguity
OntologydescribesnatureofenEEesandtheirrelaEons ClassificaEongroupsrelatedterms
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PotentialUsesofHealthDataare
ConstrainedbyDataQualityFactors
Dataqualityissues Differentforclient/paEentcommunicaEonsvs.
clinicaldecisionsupportvs.epidemiological
analysis O]enconstrainedbyexternalforces
e.g.criteriafordiagnosiso]endiffersfromthecriteriaforreporEng
UnidirecEonaleffectofdataconsolidaEon DetailedGeneral GeneralDetailed
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TheProblemIna8empEngtoarriveatthetruth,Ihaveapplied
everywhereforinformaEon,butinscarcelyan
instancehaveIbeenabletoobtainhospital
recordsfitforanypurposeofcomparison.Iftheycouldbeobtained,theywouldenableusto
decidemanyotherquesEonsTheywouldshow
[subscribershowtheirmoneywasbeingspent
[andwhatamountofgoodwasreallybeingdonewithit
FlorenceNightingale-NotesonaHospital,1873
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Testcomparisons
LabATestName:LymeDiseaseSerology
Measures:B.burgdorferiAbIgG
Method:ELISA
Scale:quantave
e.g.:Titer1:40
LabBTestName:LymeDiseaseAnbody
Measures:B.burgdorferiAbIgM
Method:Immuneblot
Scale:qualitave
e.g.:Posive
LOINC Code = 5062-5 LOINC Code = 6321-4
Whatyouseeintheorderlist
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WhyLOINC?Withinonelaboratory,localjargonterms
maybeusedwhichareusuallywell
understoodbetweencolleagues,but
wouldnotbesufficientlywidelyknownfor
communicaEonwiththeoutsideworld.
U.Forsumetal.,PureAppl.Chem72:555-745,2000 Proper3esandUnitsintheClinical
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LOINC
101EmphasisonLaboratoryLOINC
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5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
5193-8 LOINCCode
HepasBvirussurfaceAb
ACnc
Pt
Ser
Qn
EIA
Component
PropertyMeasured
Timing
System
Scale
Method
TherearesixmajorLOINCaxes
AnatomyofaLOINCTerm
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NOTpartofaLOINCName
Reasonforthetest(whyitwasorderedorthediseaseitdiagnoses)
TesEnginstrument Specificdetailsaboutthespecimen Priority(e.g.STAT) WheretesEngwasdone Whodidthetest
TestinterpretaEon Pricingorcost Anythingnotpartofnamingthetest ThingsfromotherfieldsinanHL7message
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ThesubstanceorenEtythatismeasured,evaluated,orobserved
Component/Analyte
- Sodium
- Glucose- Brucellasp.organism
- InfluenzaAVirusanEgen
CytomegalovirusVirusanEbody Lipids.Total
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
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ComponentStructure
Analyte Name^Challenge^Adjustments
Formal analyte nameSpecify subanalytesMay have subclassesChallengeTwo parts separated by
postAdjustments
CalciumCoronavirus Ag
Calcium.ionized
1H post 100 g Glucose POpost
Adjusted to pH 7.4
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Mass:ObservaEonsreportedwithmass(milligrams,grams,etc.)inthenumeratoroftheirunitsofmeasure Substance:ObservaEonsreportedwithmolesormilliequivalents
inthenumeratoroftheirunitsofmeasure
Catalycacvity:ObservaEonsthatreportenzymaEcacEvity
Arbitrary:Resultsthatreportarbitraryunitsinthenumeratoroftheirunitsofmeasure
Number:Counts
Property
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
ThecharacterisEcora8ributeoftheanalytethatismeasured,evaluated,orobserved
themostdifficultLOINCaxis
MajorCategories
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MCncmassconcentraEon(mass/unitvol;e.g.mg/dL) MCntmasscontent(mass/unitmass;e.g.umol/L) NCncnumberconcentraEon(number/unitvol;e.g.mg/g) TmStpEme CCnccatalyEcconcentraEon(acEvity;e.g.) PridpresenceoridenEty Impimpression/interpretaEon FindsubjecEveorobjecEveobservaEon TypeKind-of
Property
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
themostdifficultLOINCaxis
CombineMajorCategorieswithSubtypesforFull
Property
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CommonPropertyIssues
Fracon=Part/Whole
NFr:%osinophils/leukocytes
SFr:%HGBwhichisA2
Rao=mulEpleanalytesfromsamesystem
MCrto:BUN/CreaEnineinurine
RelaveRao=measuresfromdifferentsystem
RelRto:Albumin.pericardfld/Albumin.SerPl
Fraction versus Ratio
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Pt-atapointinEme 12H-atwelvehourcollecEon 24H-atwentyfourhourcollecEon
Timing*
*non-PtEmingsareusuallyassociatedwithRateProperty
TheintervalofEmeoverwhichtheobservaEonormeasurementwasmade
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
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SystemThe system (context) or specimen type upon
which the observation was made.
Ser
Ser/PlasBld
UrFlu
TissXXX
serum
serum or plasmawhole blood
urinebodyfluid
tissuespecified elsewhere
photo via AlishaV
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
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SystemStructure
SuperSystem PaEentisthedefault Usedtoindicate
bloodproductunit bonemarrowdonor fetus
818-5:A Ag:ACnc:Pt:RBC^BPU:Ord:
54417-1:ABO+Rh group:Type:Pt:Bld^fetus:Nom:
System^Super System
photo via Xurble
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ScaleQn
Ord
Nom
Nar
Quantitativecontinuous numericcan have operators ()OrdinalRanked set (1+, 2+, 3+)Nominalunranked collectionTaxonomy (e.g. bacteria)Narrative
photo via puuikibeach
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
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Scale(Special)
OrdQnOrdinalorQuanEtaEve PrimarilyusedforanEmicrobialobservaEonse.g.
MICreportedasresistant,intermediate,suscepEbleorasthemmdiameteroftheinhibiEonzone
Useisdiscouragedinothercontexts MulEstructuredtextglobs
e.g.chromatographyoutput Useisdiscouraged
DocClinicaldocuments SetClinicala8achments(headers)
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Method
OnlyneededifinterpretaEonaffected Differentnormalranges TestsensiEvity/specificity
Listedatthegenericlevel AggluEnaEon nzymeImmunoassay ProbewithtargetamplificaEon
5193-8:HepatitisBvirussurfaceAb:ACnc:Pt:Ser:Qn:EIA
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HierarchiesLOINCClassOneforeachLOINCaxisMulE-axial
Component|System Separatedownload
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LOINCCOLLECTIONS
Panels,forms,surveys,andotherpaEent
assessments
photo via LuzA
St d di d A t d
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StandardizedAssessmentsand
Collections
Vreeman DJ, McDonald CJ, Huff
SM. Representing patient assessments in LOINC. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095 .
Vreeman DJ, McDonald CJ, HuffSM. LOINC - A Universal Catalog of Individual Clinical Observations and Uniform Representation of EnumeratedCollections. Int J Funct Inform Personal Med. 2010;3(4):273-291.
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IteraEvelyexpandedthe
baselabpanelmodeltoaccommodatemore
complexa8ributes
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HierarchyofaPanelinLOINC
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Assessmentinstrumentsarewidelyused
and not unlike other clinicalobservations
Purpose
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LOINCcouldsupporta
master question file
anduniform representation
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P l /F A il bl
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Panels/FormsAvailableas
SeparateDownload
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LOINC.ORG/USAGE
i l
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AFewTestsGiveMostResults
C
umulative
Labora
tory
O
bserv
ation
V
olume(%)
Vreeman DJ, Finnell JT, Overhage JM. A Rationale for Parsimonious Laboratory Term Mapping by Frequency. AMIA Annu Symp Proc. 2007;:771-775.
loinc org/usage
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loinc.org/usage
Top 2000 Results
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a.k.a. Top 300 Orders
http://loinc.org/downloads/usage/
orders
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a.k.a. Common Units of Measure
http://loinc.org/downloads/usage/units
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M i T
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MappingTermsto
LOINCThingstoRemember
Thethingorderedisnotalwaysthethingmeasured: BloodCultureliveorganism(s)idenEfied VDRLTreponemapallidumAb Urinalysislotsofdifferentthings
ThequesEon(whatamImeasuring?e.g.Glucose)isnottheanswer(e.g.90mg/dl) YouaremappingthequesEon,nottheanswer!
Youmustknowthespecificsofthecomponentbeingtestedfor(whatisthistestactuallymeasuring?)
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WhatisinLOINC?Content
Termstructures Submi8edunits,xampleUCUMunits
aimingtowardpreferredunitssorEng
Synonyms Answerlists(increasingnumber) TextdescripEonslinkstoinfosources
aboutindividualtests Panelstructures ForeignlanguagetranslaEons
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RELMARegenstriefLOINCMappingAssistant
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PurposeofTutorial
liminateneedtoreadtheUsersManual BecomefamiliarwithRLMAfeatures ProvidesomeinsightintomappingEps/pialls Helpbeginthemappingprocessforyour
insEtuEon
Hangwithsomereallycoolfolks
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LOINCfilesandindexes ManualandautomatedmappingfuncEons SamefreeuseasLOINC(seelicense) RLMAtoolstransformlocalwordsinlocalfile
Usercreatesfileoflocalterm/nameandcodes AssignsLOINCtermtolocaltest/ba8erycode Commontestssubsettospeedmapping ContextsensiEvehierarchiesforlocaluse. FlexibleGoogle-likesearchfuncEons
RELMAFunctions
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NewinThisVersion(Rel.6.1) Bugfixes
Fixedaccessibilityissueswherelargetextdidnotdisplaycorrectly.
FixedissuewheretheuserwasnotreturnedtotheMainMenua]erclosingthesearchscreen.
FixedissuewheremulEpleformsweredisplayingwhentheuserselected"ReviewHIPAAA8achments"fromthetop
menu.
Fixedissuewherethe"CommonTests"dropdownlistonthemappingformdidnotshowallfouropEonswithouttheneedforscrolling.
FixedissuewherethesearchresultslanguageheaderdidnotproperlyshowtheRLMAdefinedpreferredlanguage.
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AbilitytodeleteaLocalTermFilefromwithintheformEtled"SelectLocalTermFile".
RLMAwillnotallowtheusertodeletetheprovidedSAMPLfile.
Willnota8empttoconnecttotheinternetifuserhaschosentoNOTshowthelog-inscreen
onRLMAstart-up.
RLMAnowtemporarilydisplaysawarningtextwithinthesearchtextboxwhenasearch
doesnotreturnsearchresults.
NewinThisVersion(Rel.6.1)
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Providesamoreuser-friendlymessageforLMOF3.mdbprivilegeerrormessages.
Provideanexpandedsetofsearchexclusioncriteriaintheformofcheckboxes,whichallows
formulEple-selecEon. moredetailedinformaEonaboutthesenew
restricEonsintheusermanual.
TheOrder/Obsconstraintshavebeenexpandedwithtwonewitems: Includesubset Includeunclassified
NewinThisVersion(Rel.6.1)
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TheLucene"descripEon"fieldhasbeenexpandedtoincludedatafromreferencesources.
ResultsinasubstanEalincreaseintheamountofdiskspaceusedbytheapplicaEon.
The"xportLocalTermFile"screennowsupportsdirectexporttoaMicroso]xcelspreadsheet.
NewinThisVersion(Rel.6.1)
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LOINCWebSite
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Whatsavailabletodownload?
RLMA-mappingandbrowsingtool HL7messageconverter-Makesadatabasesuitablefor
mapping
HL7lint(findsbadmessages) LOINCdatabaseandspreadsheets Accessoryfiles(panels,forms,top2000,etc.) LOINCUserguide;RLMAUserGuide ToolstoassistlanguagetranslaEonsbypart ToolsforbuildingdatabasestomapfromHL7
messages
Newguidancedocumentsformappers
RELMA Hi hli h
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RELMAHighlights Browse-ablehierarchiesofLOINCparts Displaysearchresultsintreeview nhanceddetailsviewofterms/parts
References DescripEons Sampleunits
mpirically-derivedcommontestlist mpirically-derivedcommonorderlist Specialfeaturesforpanels/forms nhancedexport/copy-pasteopEons
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Installing RELMA
Installation Steps
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InstallationSteps
RequiresWindows(orVMonaMac) Makesureyouhaveenoughfreediskspace!
2Gbisrecommended FromCD-StartRun:\RLMA\Setup SpecifyinstallaEondirectory
Lifewillbeeasierifyouacceptthedefault Twodatabasefilesinstalled
RLMA.MDBLOINCTermsDatabase LMOF3.MDBLocalMasterObservaEonFile
Twosamplefilesincluded RunfromStart(All)ProgramsRegenstriefRLMA
Fil L i
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FileLocations
DatabaseandAncillaryFiles WindowsXP=C:\DocumentsandSengs\AllUsers\Documents
\RLMA\
WindowsVista=C:\Users\Public\Documents\RLMA\ Windows7=C:\Users\Public\PublicDocuments\RLMA\
Samplefiles WindowsXP=C:\DocumentsandSengs\AllUsers\Documents
\RLMA\Samples\
WindowsVista=C:\Users\Public\Documents\RLMA\Samples\ Windows7=C:\Users\Public\PublicDocuments\RLMA
\Samples\
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Running RELMAVersion 6.1
Copyright Screen
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CopyrightScreen
New Feature! Join the LOINC
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NewFeature!JointheLOINC
Community
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LOINCcrowdsourcing
M i M /W l S
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MainMenu/WelcomeScreen
Set Preferred Language
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SetPreferredLanguage
ClickFile,SetPreferred
Language
Select Linguistic Variant(s)
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SelectLinguisticVariant(s)
Selectingatranslationmayrequireindexestobebuilt
LOINCTermswithS
panishLinguisticVariant
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p g
AllSpanish!
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SettingUserPreferences
Set User Preferences
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SelectUserPreferences
FromtheFileMenu
SetUserPreferences
...orfromWelcomeScreen
Set User Preference Dialog
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SetUserPreferenceDialog
StartupScreenPreference
NewFileLocations:
(Seepriorslideforlocation)
User Map Screen Preferences
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UserMapScreenPreferences
ClickMapScreenTab
Include/ExcludeBattery
Terms
AddcommentsonMappings
Autocreatesearchterms
User Detail Pages Preferences
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UserDetailPagesPreferences
DownloaddetailpagesfromLOINC.org
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ImportingLocal
TermsintoRELMA
4W L d LMOF Fil
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4WaystoLoadLMOFFiles
DirectentryintoLMOFfromwithinRLMA(painful) Handyforindividualentries/edits
CreateanAccesstablethatmimicstheLMOFstructure(lesspainfulbuttedious)
AppendixA:RLMAManual CreateadelimitedASCIIfilefromyourlocaltest
catalog(goodchoice)
LoaddirectlyfromHL7v2.xmessages PullsdatafromOBRandOBXsegments StoresNTsegmentdata
Constr cting a Local Dataset
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ConstructingaLocalDataset
Createextractofyourtestcatalogwith: Ba8ery/PanelCode Ba8ery/PanelDescripEonorName *LocalCode *TestDescripEonorName
IncludeMethodifImportant Units xampleValues LaboratorySecEon
Creating Delimited ASCII File
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CreatingDelimitedASCIIFile
RLMAcantparsefreetext Needtocreateseparatefields
Canuseanyofthesedelimiters Tab,Semicolon,Comma,Space Candefineyourown
Fieldscanbeinanyorder Minimumrequiredfields
LocalCode LocalDescripEon Units(highlyrecommended)
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EnteringNewLocalTerms
intoRELMA
ManualEnter/Edit
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/
View/Add/EditLocalTerms
EditTermDialo
g
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d t e a og
Edit\Add\DeleteTerms
ExportTerms
PrintPreviewListTextalignmentoption
Export Local Term File
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ExportLocalTermFile
Delimiterssupported:
Tab,comma,bar(|)
New!Directexportto
MicrosoftExcel
AddLocalTerm
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ClicktoAddtoCurrentWorkingFile
MICRO
BUBPLAG
BUBONIC PLAGUE RRT PCR
SearchLocalTermFile
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EnterKeywordfromanyField
Calcium
ReturntoFullList
Print Preview Local Term File
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PrintPreviewLocalTermFile
Onlyprintsselectedrows
Steps to Import Local Terms
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StepstoImportLocalTerms
1. ClickImport Local TermsBu8onfromMainMenua) File>Import Local Terms from Delimited File
2. Locateyourlocaltermstextfile3. NameyourWorkingSet(Mandatory)
a. LMOFdatabasecancontainmulEpleworksets4. DefinedefaultsecEon(OpEonal)5. IdenEfyfiledelimiter6. AssignfieldstoLMOFa8ributes
a. Ignorefieldsyoudontneedb. Combinefieldsifneeded
7. CheckCase-sensiEveifneeded. ClickImport.
ExampleTab-DelimitedFile
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p
ImportingLocalFiles
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SelectImportLocalTerms
fromDelimitedFile
Navigate to File Location
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NavigatetoFileLocation
SelectFileandClickOpenSamplejilesstoredin
RELMADirectory
OpenFileinRELMA
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p
Nameyourworkingset.
RELMAallowsmultiplesetsin
LMOFdatabase
Selectyourdelimiter
ImportButton
FieldsSegregated
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g g
Assign LMOF Attribute
Assignworkingsetname
Workingsetimport
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g p
LOINC Workshop OBR
ReadytoImport
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y
Minimumassignments
Nowyoucanclickthe
Importbutton!
Post-Processing of Local File
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Post ProcessingofLocalFile
A]erimport,RLMASearchesforterms(words)thatitdoesnotrecognize
StoredinafileforfuturereconciliaEon
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LocalTermFileOptions
ChangeLocalTermFile
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SelecttheWorkingSet
Currentmappingstatus
New!Candeletelocalterm
set;nottheactiveone
Alternative Pragmatic Way
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AlternativePragmaticWay
UselargesetofHL7messages AutomaEcallymakedatasetof:
OBRID OBRdescripEon
OBXID OBXdescripEon Sampleofresultswith
Realvalues Units Abnormalflags Normalranges
GenerateLocaltermjilefromHL7messages
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SelectImportTermsfromHL7File
SelectFiletoImport
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SelectHL7File
SpecifyHL7FileNameandSampleSize
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NametheLocalTerm
File(workingset)
Selectwhichcodestostore
Skipimportofsamplevalues
Selectthenumberof
samplevalues
HL7MessagesDataStatistics
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NewTermsaddedtoLMOF
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NewBatteryCode
ClickonEditTermtosee
SampleData
SampleResultsforObservation
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NewTestCode
SampleValuesfrom
Messages
LennyLOINCsays:
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y y
LoadtheSampleFiles
IntoRELMAnow!
Importthetwosamplefilesprovided Import_Sample_OBR.txt
Containsba8erycodeanddescripEon
Import_Sample_OBX.txt Containstestcodeand
descripEon
Create2workingsets Loadyourpersonaldataset
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Cleaningyourdata
PreparingyourDataforMapping
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Improvemappingsuccessby: xpandingabbreviaEons Standardizingcolloquialterms
IgnoringadministraEveterms StandardizingEmereferences
CanbedonepriortoimporEng Be8ertousetoolsbuiltintoRLMA
RELMACleanin
gTools
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g
Usethistooltoedit
unknownterms
ReviewUnknownLocalTerms
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MayRe-ScanFilefor
UnknownTerms
ReplaceLocalTerms
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p
AssignLMOFAttributeReplacementOptions
RELMACleanin
gTools
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g
Usethistooltomake
globalsubstitutions
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TermSubstitution
Savethisglobalsubstitution
foronlythisworkingset
LennyLOINCsays:
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Begintocleanyour
datanow!
UsingtheOBRorOBXsamplefiles,take15-20minutestocleanuptheseunrecognizedterms
Youmayuseyourowndataifyouwish.
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SearchingforLOINCTerms
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ComprehensiveSearch
OnlyTool
SearchWindow
H l Fil
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EnterSearch
Terms Limitto
SpecijicUnits
Usedifferent
logic
HelpFile
RestricttoCommon
Limits
SearchWindow
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CommonTestsselected
CommonTestsrank
RELMASearchHelpjile
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ContextMenu
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Rightclicktobring
upcontextmenu
ChangedsearchfunctionMaxwords
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Largenumberof
results
Keyword
ComponentWordCount
restrictswordcount
Mapping Local Terms
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MappingLocalTerms
MappingLocalTerms
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SelectyourWorkingSettoMap File>Select Local Term File to Process
SelectMap Local Terms to LOINCfromWelcomeScreen
Selectthesubsetoftermstoworkwith: All Mapped Unmapped
SetyourSearch Limits Set Search Limits Bu8on
StandardMappingWindowFeatures
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Customizablegrid ViewdetailsofLOINCterm Sortbycolumn
Clickcolumn CustomSort
Printorexportresultsgrid Spellchecksquigglylinetosignifywords
notknowntoRLMA
MappingScreen
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Vieworeditlocalterm
Quickselectbuttonlist
CustomGridConjiguration
Enterlocaltermnumber
ConjigureGrid
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Reordergridelements
Selectelementstodisplay
ResetDefaultConjiguration
Visuallyresizeelements
Quickchoicebuttons
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ViewingLOINCtermdetail
ViewLocalTermDetails
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Selectlevelofdetailto
displayCanscrollthrough
returnedsubsetofterms
Changetextsize
Canscrolldownasingle
formattedpage
DetailsTextSizeS l t t t i
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Selecttextsize
Selectdetaildisplaylevel
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Selectlevelofdetailto
display
StandardMappingScreen
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Beginasearch
(orhitenter)EEK!WhatllI
do?!
StandardMappingScreen
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Clicktoshowwords
usedin
search
InitialMappingResults
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Useterm
checkbox
NumberofLOINCtermscontaining
keywordBatteryterms
includedin
search
RevisedMappingResults
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Numberof
matching
recordsfound
Re-revisedMappingResults
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Numberof
matching
recordsfoundMatchunits
selected
StandardMappingScreen
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Clearall
inputjields
Enterkeywordshere
CANINE DISTEMPER VIRUS IF
StandardMappingScreen
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Navigatethrough
thelocalterms
TabbedAccesstoFunctions
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NavigatetoFunctions
fromMappingPage
SwitchbetweenGridand
TreeViews
TreeView
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TreeView
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Resultsdisplayedhierarchically DefinedbythemulE-axialhierarchyinsearch
restricEons(coveredlater)
MaptoatermintreebyclickingMapbu8onordoubleclickingterm OnlytorowsthathaveLOINCCodes
TreeView
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Cannotmapto
terms
representing
LOINCparts
Canmaptoterms
withLOINCCodes
TreeNavigation
Buttons
AssigningaLOINCMap
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Highlightcorrect
term
ClickMapButton(ordoubleclick)
AddingMappingComments
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Ifcommentsoptionisselected,
promptappears
Check with Frank in Chemistry
AssigningaLOINCMap
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LOINCTerm
Assigned
ViewPanelChildren
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SelectViewPanelChildren
fromcontextmenu
PanelChildren
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ConjigureExportOptions
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OutputOptions
Include
columnheadersSaveConjiguration
and/orExport
ExcelExportFormat
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MoreonSearching
Search Screen
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SearchScreen
BasicSearchSyntaxSpecial Character(s) Example
Definition
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Influenza virus A Linked terms must appear together
AND Morphine AND Opiates Both terms must appear in the search result term
OR Influenza ORParainfluenza
Either or both terms must appear in the search resultterm
NOT Influenza NOT equine Excludes terms with the word following the NOT.Cannot be used alone.
? Gluc?se(glucose,glucase)
Substitutes a single character in the string. Cannot beused as the first character; cannot be used in
phrases
* Gluc*se(glucose, glucuronidase,
etc.)
Substitute multiple characters in the string. Cannot beused as the first character; cannot be used in
phrases
SearchQualijiers
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IncludesGlucuronidase,Glucosidase,
Glucosylceramidase,etc.
Detailedhelpavailable
Combinin
gSearchTerms
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Reducednumberofterms
ExcludeGlucosidase
AdvancedSearchSyntaxbasedonGoogle-likesearchsyntax
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based o Goog e e sea c sy ta
Parameter Description
+ Term must be included in search
- Term must be excluded from the search
( ) Group terms for subquery (i.e. A OR B; A AND B)
Fieldname: Limit term search to the associated field (e.g. Component: glucose)
Fieldname:() Group multiple terms in a single field
~ Fuzzy search (e.g. Hemofhilus~)
~ Proximity search for multiple terms (e.g. function panel~1)
{}, [] Upper and lower bounds; {} exclusive, [] inclusive
\ Special character escape
Applyingadvancedsearch
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91terms
Applyingadvancedsearch
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33terms
Applyingadvancedsearch
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19terms
Applyingadvancedsearch
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8terms
LimitingSearches
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g
SettingSearchLimits
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NarrowssearchtospecificsubsetofLOINCterms Reducesnumberofcandidateterms Limitscanbeappliedtoallcomponents Componenta8ributecanbefurtherrestrictedbynumberofwords Treestructureallowsforhierarchicalconstraints
GeneralSearchConstraints
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Controlsfeaturesincluding: LimittoLOINCtermscompaEblewithsubmi8edunits Forcedmatchwithanyspecimencontainedinname Method-lesstermsonly
Limittocomponents/analyteswithNorfewerwordsintheirname
PopupsearchEmingstaEsEcsa]ereachsearch Usecarefullyorsearchmaynotbesuccessful
(Noteparallelcontrolswitchesatbo8omofscreen)
SettingSearchLimits
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ClickHierarchy&Search
LimitsTab
Settingsearchlimits
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Canalsosetmostofthembytogglingbu8ons
atthebo8omofthescreen
ToggleButtons
SearchConstraints
Attributetrees
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New!Expanded
predejined,generalsearch
constraints
LimittoLOINCterms
consistentwithlocalunits
TermsConsistentwithUnits
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Onlytermsconsistent
withmmol/Lappear
SettingSearchLimits
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Specimen
constraints
TermsConsistentwithSpecimen
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CSF
Enterdefault
Specimen
TermsConsistentwithSpecimen
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OnlyCSFTerms
arereturned
SettingSearchLimits
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Excludelaterality
Excludelaterality
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Lateralityterms
SettingSearchLimits
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Restrictto
commonorders
Restrictiontocommonorders
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LargenumberofcandidatesCommonorders
rank
SettingSearchLimits
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MethodlessTerms
Restriction
OverrideMethodlessTerms
Restriction
LimittoMethodlessTerms
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Bothmethodand
method-lessterms
LimittoMethodlessTerms
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OnlyMethodless
TermsAppear
MoreonMethodlessTerms
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SomeLOINCcategoriesdonothavemethodlessterms
Checkingmethodlessonlywillremovethesefromviewonresultsgrid
CheckingaddiEonalboxallowsthesetobeseen
MethodlessOnlyUnchecked
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Alltermsreturned
MethodlessOnlyChecked
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OnlyMethodless
termsreturned
Differinoneor
morecomponents
ConditionalMethodless
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Moreterms
returned
Nomethod-less
term;allshown
SettingSearchLimits
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IncludeTrial,Deprecatedor
DiscouragedLOINCCodeswith
ReturnedTerms
IncludeDeprecatedLOINCTerms
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DeprecatedLOINCTermsappearas
StrikethroughTextwithaDoNot
Symbol
YoucannotmaptodeprecatedLOINCterms
Themapbuttonisgrayedoutifoneofthesetermsisselected
DiscouragedLOINCTermsappearasan
invertedtriangle
FavorPropertyRestriction
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Favoronetypeof
propertyoverothers
AllothercomponentsbeingequalMCnc
onlywillbedisplayed
Order/ObservationRestriction
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OrderorObservation
preference
LOINCHierarchiesClassTree
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Threetop-level
branches
TreeNavigation
Buttons
BeforeClassRestriction
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Largenumberof
candidateterms
Manytermshaveclass
ofCHAL
SearchTrees
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Restricteligibletests
tonon-challenge
chemistrytestsonly
FollowingClassRestriction
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OnlyNon-ChallengeChemistrytests
returned
SystemHierarchy
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ComponentHierarchy
Clickondetailsformore
information about the
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ShowtheLOINCCodesassociatedwiththese
components
informationaboutthe
selection
DetailsScreenLOINCPart
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ShowAssociatedLOINCs
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LOINCTermDetailsScreen
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TreeExportTools
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ConjigureExportFormat
Exportaccordingto
Conjiguration
TreeExportConjiguration
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RELMA-TreeFeatures
Alltreesoperatethesameway
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p y
Showstermsspelledout Canexpandandcollapsepartsoralloftree. Treeisstringsearchable Searchcanbebasedononeormorebranchesofatreewithorwithoutother
criteria
UseClearMostLimitsbu8ononMappingScreentoremovealltreeselecEons
LOINCPartSearch
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Samelookastermsearch UsesGoogle-likequerylanguage
xtremelyfast Includeandexcludecriteria ParEalstringmatching(usingwildcards)
Demo Campylobacterfetus,notAb
LOINCAnswerListSearch
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NominalLOINCtermsarenowrequiredtobesubmi8edwithanswerlists.
FindinganswerlistsandtheuseofthemcanbedonewithAnswerListSearchtab
AnswerListSearch
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AnswerListsassociatedwith
LOINCterm
Navigatingthroughthe
Mapping Process
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MappingProcess
Li it ff t t l b E t E d
LOINCMappingTactics
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LimitefforttoonelabsecEonataEmeandfocusexperEse
Chemistryandhematologywillbeeasiest Formanufacturedassays,usepackageinsertas
sourceinformaEon Sampleresultsgivecluetopropertyandscale ConsiderprioriEzingbyfrequencyofuse
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VreemanDJ,FinnellJT,OverhageJM.ARationaleforParsimoniousLaboratoryTerm
MappingbyFrequency.AMIAAnnuSympProc.2007;:771-775.
MoreLOINCMappingTactics
Tryusingmethod-lesstermsfirstS ifi h d b i d i
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Specificmethodscanbetransmi8edin: OBX17(v2.x),ObservaEon.methodCode(v3.0)
xaminelocalunitsorrealresultstoverifycorrectpropertyandscale
ProperEesarerarelydisEnguishableintestnames Youdonthavetodoitallatonesing
UsetheUnmappedfuncEontoreturnwhereyoule]off
Witheveryrelease-UpdatepreviousmappingstoidenEfydeprecatedterms
CommonMappingIssues
Locally Defined Test Name Ambiguity
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LocallyDefinedTestNameAmbiguity Reuseoflocaltestcode
Analyte-freeLocalTestNames (Miscellaneousserology,PCR)
IncongruentValuesets(Scaleambiguity) Resultvs.InterpretaEon AvailableLOINCTermstooSpecific/General Panelvs.DiscreteTest CommoninMicrobiology
UsingyourMappedTerms
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PrintresultsofLOINCMapping xporttoFile
ConjigureExportFormat
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ContextSensitiveExport
Conjiguration
LMOFExportConjiguration
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SelectFieldstoExport
SelectExportFormat
SaveConjigurationand
Export
PrintMappedTermsfromView/Add/EditMenu
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Mayhighlighttermstobe
printed
ClickPrintbuttontoPreview
output
FormattedReportOutput
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ClickPrintbuttontooutput
formattedreport
ExcelExport
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LabAutoMapper
R i b t h d t fi d N l t t
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RuninbatchmodetofindN-closestterms
Canthenusethisoutputtodofinalmapping AgainunitsareVRYimportant Canpickalllimitsavailabletoregularmapping
PickingtheLabAutoMapper
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LabAutoMapperStartScreen
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Maximumnumberofterms
toreturn
Canrestrictsearchto
commontests
LabAutoMapperStartScreen
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Termsusedfor
mapping
Localtestcode
LabAutoMapper-MappingScreen
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ExportingMappedTerms
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ExportTermsto
DelimitedFile
ExportTermsDialog
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CheckFieldsyou
wishtoexport
SelectDelimiter
SelectTermSet
New!Direct
exporttoExcel
Selectjilelocation
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OtherRELMA
Features
Panels,FormsandSurveyReview
ReviewPanels,Formsand
Surveys
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ReviewPanels,FormsandSurveys
LaboratoryPanels
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Expandcategoryto
seepanels
Double-clickpaneltesttosee
components
ExpandedPanelDetail
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GovernmentPanels
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FormCategory
PanelCodes
GovernmentPanelChildren
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ExpandedClinicalPanel
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ClinicalPanels
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Findwhereatermhas
beenused
35089-2, 35090-0
LOINCTermPanelUsage
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OtherSurveyInstruments
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HIPAAAttachments
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ViewVariousHIPAA
Attachments
HIPPAAttachmentTree
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ExpandedAttachmentData
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Cantjindthe
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termyouwant?
SearchHintsandTips
Keywordswithzerofrequencyareignored May need to rephrase use synonym
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Mayneedtorephrase usesynonym Somecausesfornoreturnedterms
Toomanykeywordsinsearchunchecksome Limitsappliedthatdontmakesense
.g.Method-lesstestsplusMethodtreesettoIA DidnotfindandrevisewordsnotinRLMA
LocalunitsnotinRLMA UnitsareGRATdiscriminators Youmayhaveteststhatneedtobeaddedto
LOINC
ProposingNewLOINCTerms
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ProposingNewTerms
Makesurethetermisreallyneeded Thinkofothernamesforthesameconcept
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p
AvoiddetailedmethodsorlocalizaEons IsthedisEncEonreallyimportant?
SupplysufficientannotaEontojusEfythenewterm Packageinserts,samplereports(emailtoRegenstrief) Themorethebe8er!
ConstructnewtermswithinRLMA File>Propose a new LOINC Linkedtothetreestoallowbrowsing
CanreviewandsubmitthemtoLOINCfromwithinRLMA
ProposenewLOINCterms
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SelectProposea
newLOINC
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Requiredjieldsin
red
Navigatethrough
proposedterms
Createnewterm,
savecurrenttermorExitform
Advanced/Simple
toggle
PreviewProposedTerms
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Reviewyournew
terms
ReviewProposedTerms
James T. Case DVM, PhD
NIH/NLM
301-555-1314
301-555-1315
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Allproposedterms
fullyeditable
Choosewhetherto
sendorpostpone
X
X
X
SubmittingNewTerms
Mustsupplyname,organizaEon,phone
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andemailofsubmi8er Mustselectatleastoneproposedtermto
send
Configureexportdoesnotaffectsubmissionoutput
mailresulEngfiletoRegenstrief
UseExistingTermsasTemplate
ClickthePropose
Termbutton
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Selectyourclosest
match
UseExistin
gTermsasTemplate
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Allrequired
componentsjilledin
UsingLOINCandSNOMED
Together
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WheredoLOINCandSNOMEDFit?
Remember:
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LOINCrepresentsthequesEon: IsthereanyBotulismtoxininmyspecimen?
(3370-9)
OrganismsidenEfiedinspecimen?(634-6) SNOMDrepresentstheanswer:
NegaEve(SCTID26035009) E.coliO157:H7(SCTID10342900)
WheredoLOINCandSNOMEDFit?
InanHL7message,LOINCmaybeused:
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InOBR-4(UniversalServiceIdenEfier) InOBX-3(ObservaEonIdenEfier
SNOMDmaybeused: InOBX-5(wherenominalvaluesareneeded) AlmostanyplaceelseinanHL7messagewhere
codedvaluesareneeded
Acodethat
identijiesthe
OBX:WithaCodedValue
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Thecodeis
fromSNOMED
Thecodeis
fromLOINC
OBX-5:Data
AcodeforL.
monocytogenes
datatypeinOBX-5asa
codedelement
OBX-3:Acodethatidentijiesthedatain
OBX-5(Listeriaculture)
OBX||CE|6609-2^Listeria ID^LN||36094007^L. monocytogenes^SCT
HL72.5Example(ER-7format)MSH|^~\&| LABGL1|| DMCRES|| 199812300100|| ORU^ R01|
LABGL1199510221838581| P| 2.3||| NE| NE
PID||| 6910828^ Y^ C8|| Newman^ Alfred^ E|| 19720812| M|| W| 25 Centscheap Ave^^Whatmeworry^ UT^ 85201^^ P||( 555) 777- 6666|( 444) 677- 7777|| M|| 773789090
FirstOrderOBR
(CultureandID)
FirstResultValue
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OBR|| 110801^ LABGL| 387209373^ DMCRES|634-6^Bacteria XXX Aerobe Cult^LN||| 199812292128||||||||Stool| IN2973^ Schadow^ Gunther^^^^ MD^
UPIN|||||||||||||||| CA20837^ Spinosa^ John^^^^ MD^ UPIN
OBX|| CE| 634-6^Bacteria XXX Aerobe Cult^ LN||50136005^Salmonella typhimurium^SCT|||||| F||| 199812292128|| CA20837
OBR|| 110801^ LABGL| 387209373^ DMCRES| 29567-9^Bacterial SusceptibilityPanel^ LN||| 199812300934||||||||Bacterial isolate| IN2973^ Schadow^Gunther^^^^ MD^ UPIN||||||||| Salmonella typhimurium ||||||| CA20837^ Spinosa^John^^^^ MD^ UPIN
OBX|| CE|23631-5^Trimethoprim/Sulfasoxazole^ LN||264841006^Intermediate^SCT|||||| F||| 199812300934|| CA20837OBX|| CE|18967-7^Penicillin^LN||30714006^Resistant^SCT|||||| F||| 199812300934||
CA20837OBX|| CE|18928-2^Gentamicin^ LN||131196009^Susceptible^SCT|||||| F|||
199812300934|| CA20837
FirstResult
(CultureandID)
FirstResult
(CultureandID)
SecondResult(s)
OBXs
(SNOMED)
FirstResultDescription
OBX(LOINC)
SecondOrderOBR
(Susceptibility)
QandASession
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Exercise
Mapyourowndata
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