Daniel J.

Vreeman, PT, DPT, MSc

Associate Research Professor, Indiana University School of Medicine
Associate Director for Terminology Services, Regenstrief Institute, Inc
2014
Panels, Forms, Assessment
Instruments
Clinical LOINC Meeting
2014 09 04
Overview
1. Base model for panels
2. Advanced model of panel attributes
3. LOINC Answers
4. Panel and Answer features in RELMA
5. Sample of the content
6. Key adoptions
7. Lessons learned
photo via Vernio77
Base Model for Panels in
LOINC
Panels in LOINC
Collector terms that contain links to an
enumerated set of discrete child elements

We use the word panel a generic concept
that synonymous with battery, form, data
set, etc in other domains
Panels can themselves be children,
which allows nesting
Define elements as Required,
Optional, or Conditionally Present
Categorizing Panel Elements
Required (R)
Element is always expected to be present

Optional (O)
Element may not be reported with panel depending on policy
or capabilities of reporting institution

Conditional (C)
Element is a key part of the panel, and should be assumed to be
negative or not present if results do not contain it
Null ()
Undeclared. Typically used in convenience panels
Naming Conventions for Panels
Many (most) include panel in the Component

If dened by an authoritative body, we tend to
use the ofcial name

If elements vary on axis values (e.g. Property), the
panel term name uses a dash - in that eld

Timing, Scale, and Method are typically specied
What Denes a Panel?
Or, when can I map my local one to a LOINC one?

With help from the S&I Framework Initiative, we
are developing a revised set of business rules for
panels

The following summarizes the draft rules
Business Rules for Panels
1. Base denitions of Required, Optional,
Conditional still hold.
2. If a panel is dened with methodless
elements, users could substitute any method-
specic code that matched on the other
attributes
1. As a corollary, it is not acceptable to substitute
a qualitative term for a quantitative term
3. If a panel is dened with method-specic
codes, only that method (or equivalent) is
allowed
Business Rules for Panels
4. Elements that are not measured evaluations
(e.g. calculations, derived values, ask at order
entry questions, interpretations, etc) can be
included (or not)
5. LOINC may dene some panels (in rare cases)
where the exact elements are not enumerated
but rather described in text. This will be used
only in rare complex cases (e.g. public health,
lupus anticoagulant panels, etc).
Advanced model of panel
attributes in LOINC
An expansion that grew out of our work to represent
standardized assessment instruments
LOINC could be a

master question le
and
uniform representation
Iterative Renement
Started about 10 years ago

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
Standardized Assessments and 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, Huff SM. LOINC - A Universal Catalog of Individual Clinical Observations and Uniform Representation of Enumerated Collections. Int J Funct Inform
Personal Med. 2010;3(4):273-291.
Assessment Instruments
Widely used







and not unlike other kinds of observations
Item-level Attributes
Question Text
Question Source
External Copyright
Terms of Use
Description/Denition
Units of Measure (UCUM)
Data Types
Item-level Attributes
Question Text
Question Source
External Copyright
Terms of Use
Description/Denition
Units of Measure (UCUM)
Data Types
Approach to this content being revised
Structured Answer Lists
Answer List Attributes
OID
External Link
Answer Item Attributes
ID (contains LA prex)
String
Sequence
Local code
Universal code (SNOMED CT)
Score
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
Images
Panels Available as Separate Download
Look for the Panels and Forms File
LOINC Answers
LOINC Answers
LOINC is focused on questions, but

Sometimes, questions are best understood by
knowing the set of allowed answer choices

Many answer choices are highly specialized
and not present in vocabulary standards
LOINC Answers
Many answer choices are highly specialized
and not present in vocabulary standards

LOINC has a structured representation of
answer lists

Classify them as Example or Normative
Example => Starter set, but you could use more/less
MAPPING CAUTION
Normative => This is it. Dont mess with it!
Panel Features in RELMA
A sample of the LOINC content
US Government Forms
CARE, MDSv2, MDSv3, OASIS B1,
OASIS C, RFC, US Surgeon
Generals Family Health Portrait,
End Stage Renal Disease forms
Borderline Symptom List - 23 Item
Brief Interview for Mental Status (BIMS)
CARE long term care hospital (LTCH)
Confusion Assessment Method (CAM)
Core behavioral health terms (SAMHSA)
Edinburgh Postnatal Depression Scale
FACIT
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classication
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
My Mood Monitor
Neonatal Skin Risk Assessment Scale
Neuro-QOL
NIH Stroke Scale
OMAHA
OPTIMAL
PROMIS
PhenX
PHQ (9 and 2)
Quality Audit Marker (QAM)
VR 12 and 36
US Government Forms
CARE, MDSv2, MDSv3, OASIS B1,
OASIS C, RFC, US Surgeon
Generals Family Health Portrait,
End Stage Renal Disease forms
Borderline Symptom List - 23 Item
Brief Interview for Mental Status (BIMS)
CARE long term care hospital (LTCH)
Confusion Assessment Method (CAM)
Core behavioral health terms (SAMHSA)
Edinburgh Postnatal Depression Scale
FACIT
Geriatric Depression Scale (GDS)
HIV Signs and Symptoms Checklist
Home Health Care Classication
howRU
Living with HIV (LIV-HIV)
Morse Fall Scale
My Mood Monitor
Neonatal Skin Risk Assessment Scale
Neuro-QOL
NIH Stroke Scale
OMAHA
OPTIMAL
PROMIS
PhenX
PHQ (9 and 2)
Quality Audit Marker (QAM)
VR 12 and 36
15,000+ variables
Oh snap!
Find Panels and Forms in RELMA
Find Panels and Forms in RELMA
Hit this!
Lab Panels
Clinical Panels
Survey Instruments
View Panel Children
View Panel Children
Select View Panel Children
from context menu
Panel Children
Find Panels that Contain this Term
Find Panels that Contain this Term
Select Find Panels with All These
LOINCs from context menu
Find Panels that Contain this Term
Also on Comprehensive Details Pages
Also on Comprehensive Details Pages
These panels all contain this Creatinine term
LOINC adoption here is
gaining some traction
Lesson 1
Variation abounds
Despite similarity
in items, much
variatio! exist!
many differences might have been avoided
Original PHQ-9
CARE
MDSv3
Frequencywithwhichresidentcomplainsorshowsevidenceofpain(inlast7days)?
No pain, Pain less than daily, Pain daily
MDSv2
Howmuchofthetimehaveyouexperiencedpainorhurtingoverthelast5days?
Almost constantly, Frequently, Occasionally, Rarely, Unable to answer
MDSv3
Haveyouhadpainorhurtingatanytimeduringthelast2days?
Yes, no, unable to respond
CARE
FrequencyofPainInterferingwithpatient'sactivityormovement
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
OASIS-B1
FrequencyofPainInterferingwithpatient'sactivityormovement
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
OASIS-B2
photo via
Weigh the cost of losing
comparability before inventing
something new
Lesson 2
IP issues present large
challenges
Weigh the cost of losing
comparability before inventing
something new
Lesson 3
Not all use-cases need
everything




Evolve gracefully.
photo via Dawn Huczek
Quality Measures
1. Name of some specic instrument used
2. Total score from a particular instrument
Graceful Evolution
1. Create "panel" codes that represent the
named instrument
2. Create a total score term (as a child) for the
instruments where score is needed
3. When they are needed, fully model the
instrument as a complete set of questions
(with answers where appropriate)
photo via milos milosevic