Code system enables providers to achieve interoperability beyond Meaningful Use
By Brian Levy, MD
Most healthcare professionals are familiar with CPT, HCPCS and ICD-9/ICD-10 codes and understand their roles in meeting Meaningful Use and coding requirements. But what about the Logical Observation Identifiers Names and Codes (LOINC)? LOINC is a code system for identifying laboratory and clinical observations that has only recently gained greater visibility in healthcare organizations.
LOINC plays an important role in meeting Meaningful Use requirements. Going forward, it will be the commonly accepted terminology for lab and other test results as providers begin to exchange larger volumes of information across organizational boundaries.
The question, then, is "What do healthcare organizations need to know about LOINC?"
First, the scope of LOINC includes laboratory and other clinical observations. The laboratory portion of the LOINC database contains the usual categories of chemistry, hematology, serology, microbiology and toxicology, while the clinical portion of the database includes entries for vital signs, hemodynamics, intake/output, EKG, obstetric ultrasound, imaging and other observations.
More importantly, LOINC -- like its cohort terminologies mandated by Meaningful Use -- will help expand the interoperability of healthcare data. That means it can be used to improve quality analysis and patient care. Health information management professionals who want to better understand LOINC and its inclusion in Meaningful Use should consider the following five factors:
1. LOINC is free. Over the years, as electronic lab systems expanded, organizations and third-party lab companies created proprietary catalogs of lab result terminologies. As smaller lab vendors consolidated, the larger companies combined these catalogs into terminologies that they owned, charged for and only exchanged with their customers. LOINC, on the other hand, was created in 1994 by the Regenstrief Institute at Indiana University, and is distributed and maintained free of charge.
2. LOINC is intended for reporting lab results more so than order entry. LOINC codes describe in intricate detail how a particular lab test was done. Although LOINC codes include the names of lab tests, the level of granularity often offers more detail than providers need or want for patient care. LOINC codes contain six parts in a specific order, each with a discrete meaning. Those parts are:
- Component: The substance or entity being measured or observed, such as glucose, sodium or lipids.
- Property measured: The characteristic of the analyte, such as mass concentration or enzyme activity.
- Timing: The interval when the test was taken, such as a one-point-in-time result or a result compiled over the course of 24 hours.
- System: The organic origin of the specimen, such as from whole blood, urine or spinal fluid, or from a substance such as the liver or tissue.
- Scale: Quantitative (a true measurement); ordinal (ranked set of options); nominal (responses that do not have a natural ordering, such as names of bacteria); and narrative, (description, such as dictation results from X-rays).
- Method: Where relevant, a LOINC code includes the method used to produce the result.
3. LOINC aids data interoperability. The granularity inherent in LOINC helps ensure an apples-to-apples comparison of data from disparate sources. A LOINC code contains enough detail that it is clear whether multiple results were obtained via the exact same test or not. Take, for example, the scenario of a provider checking on a patient's glucose levels. The provider logs onto a portal and retrieves the results of glucose tests drawn at three different locations. Via a LOINC code, the provider would know if each result used the same units (e.g., mg/dL vs. mmol/L), whether each test was a blood glucose vs. urine glucose, and more. A principal benefit of LOINC is that it provides an interoperable terminology for improving patient care and reducing the costs associated with redundant and duplicative testing.
4. LOINC improves analysis and reporting. Greater interoperability of lab results also means organizations can aggregate larger volumes of data about individual patients, as well as patient populations. Moreover, with identical terminologies, providers can more accurately and reliably measure their patient care performance. For example, organizations can better analyze which interventions for certain conditions are more effective, or which physicians are producing better outcomes. In addition, LOINC codes are now included for many of the clinical quality measures required for Meaningful Use reporting.
5. LOINC links clinical and billing data. The inclusion of LOINC into Meaningful Use requirements is similar to the inclusion of the SNOMED CT terminology. SNOMED CT, required for the electronic exchange of problem lists and other clinical information, provides the clinical details necessary to create an appropriate ICD-9/10 code for billing. Likewise, LOINC codes offer the granularity providers need to create CPT and other codes for reimbursement. There are other synergies between SNOMED CT and LOINC, too, such as with microbiology results. If a provider performs a blood culture (coded in LOINC) and the nominal result is Staphylococcus aureus, Meaningful Use dictates that the result be coded in SNOMED CT. In fact, an initiative by the National Library of Medicine and Regenstrief Institute is currently under way to map LOINC to SNOMED for a closer integration between the two terminologies.
Although still unfamiliar to some, LOINC will soon become a popular discussion topic within organizations intent on achieving Stage 2 Meaningful Use. However, the terminology is more than just another hurdle that must be overcome to earn a Meaningful Use financial incentive. LOINC is a cost-free language for organizations to exchange laboratory and other test results that can be understood by other providers regardless of their affiliations. The ability to aggregate this data in the same language allows providers to more easily and accurately analyze and report their patient care performance. By fostering this kind of interoperability, LOINC can help healthcare organizations achieve better patient care and improved revenue in the years to come.
Brian Levy is the senior vice president and chief medical officer for Health Language Inc., Denver. Levy is also a practicing board-certified internist who has spent years in the field of medical informatics. He has helped develop terminologies, clinical content and the use of the internet by patients and physicians to improve care delivery.
©Copyright 2014 Merion Matters. All rights reserved.