This document summarizes a presentation on using LOINC (Logical Observation Identifiers Names and Codes) to standardize clinical assessments and patient-reported outcomes. It describes how LOINC provides a model for organizing assessments into hierarchical panels and items with specific attributes. A growing number of standardized assessments are available in LOINC, including government forms, clinical screening tools, and patient-reported outcomes. Lessons learned include the need to minimize variation between similar assessments and start from a uniform data model to avoid discrepancies. IP issues also present challenges for widespread adoption.
6. Iterative Refinement
Started almost 10 years ago
Gradually expanded the base panel model
Informing ideas:
Survey instruments have psychometric properties
Question meaning tightly coupled with answers
Many collaborators
esp Tom White, Susan Bakken
CHI Functioning and Disability workgroup
ASPE, AHIMA, CMS, RTI, HL7, HITSP
14. Structured Answer Lists
Answer List Attributes
OID
External Link
Answer Item Attributes
ID (contains “LA” prefix)
String
Sequence
Local code
Score
15. Attributes of Items in a Panel Instance
Display name override
Coding instructions
Cardinality
Local code on that form
Skip logic
Data type in form
Answer sequence override
Consistency/validation checks
Relevance equation
18. Assessments Currently in LOINC
US Government Forms
CARE, MDSv2, MDSv3, OASIS B1, OASIS C, RFC
US Surgeon General’s Family Health Portrait
Brief Interview for Mental Status (BIMS)
Confusion Assessment Method (CAM)
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classification
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
OMAHA
PHQ (9 and 2)
Quality Audit Marker (QAM)
39. MDSv2
• Frequency with which resident complains or shows evidence of
pain (in last 7 days)?
• No pain, Pain less than daily, Pain daily
• How much of the time have you experienced pain or hurting over
MDSv3
the last 5 days?
• Almost constantly, Frequently, Occasionally, Rarely, Unable to
answer
CARE
• Have you had pain or hurting at any time during the last 2 days?
• Yes, no, unable to respond
• Frequency of Pain Interfering with patient's activity or movement
OASIS-B1
• Patient has no pain or pain does not interfere with activity or
movement, Less often than daily, Daily but not constantly, All of
the time
• Frequency of Pain Interfering with patient's activity or movement
OASIS-C
• Patient has no pain, Patient has pain that does not interfere with
activity or movement, Less often than daily, Daily but not
constantly, All of the time
40. Weigh the cost of losing
comparability before
inventing something new
photo via neurmadic aesthetic
42. We usually started from paper forms…
…but some had custom programs and databases
43. Discrepancies and Incongruences
How do you store “Other specified ____________”
Which text is the question and which is help
Storing “unknown” or “unable to determine” as
answers versus flavors of null
Every “check all that apply” stored as a separate
yes/no binary value item
