Lab Matters Summer 2022 - Page 24


How to LOINC ® and SNOMED ® in Pandemic Times by Rachel Shepherd , specialist , Informatics

The ability to identify threats , conduct surveillance and report instances of disease are the most quintessential functions of public health . However , in order to do this effectively , all public health entities — laboratories , medical providers , federal agencies — must communicate in the same language . Without the universal usage of agreedupon terminology , all tests conducted , and their associated specimen data , would be disparate and meaningless . There could be no comprehensive review of data , and every interaction between a laboratory and external entity would require lots of human-driven , inefficient guesswork . In short , information would be chaotic and useless in the aggregate .
When a new virus emerges , it immediately needs to be named and codified before any meaningful communication about it can happen . Typically , the name is decided by the World Health Organization ( WHO ). Next , it needs defined data elements for everything surrounding the virus — possible tests , possible results , clinically relevant information — so that medical providers , health informaticians and laboratorians can uniformly enter the agreed upon terminology into their respective electronic health records ( EHR ) and laboratory information management systems ( LIMS ). That is where standards , such as LOINC ® and SNOMED-CT ® , along with their fearless creators and defenders — terminologists — come in . Terminologists submit their codes to the Regenstrief Institute where they are published centrally for widespread use .
Providing a Dictionary
Logical Observation Identifiers Names and Codes ( LOINC ® ) and Systematized Nomenclature of Medicine-Clinical Terms ( SNOMED CT ® ) essentially serve as dictionaries and are consulted to convey critical information . LOINC ® provides the terminology for tests and their results — what type of test is being requested ( e . g ., blood or sputum ), what is being measured ( e . g ., glucose in urine ),
For her contributions in developing this critical shared resource , which has saved laboratories critical amounts of time and ensured interoperability in reporting across health systems , APHL ’ s Lead Terminologist Riki Merrick was awarded the LOINC ® Award for Distinguished Contributions in 2021 .
and what is observed ( e . g ., amount of glucose detected ). On the other hand , SNOMED-CT ® provides the fundamental vocabulary for EHR , including patient symptoms and diagnoses .
Currently , there are over 150 unique potential laboratory tests for COVID-19 involving different specimen types ( e . g ., nasal swab , saliva , serum , etc .) as well as the results and how they are expressed ( e . g ., positive / negative or units / volume ). For public health reporting , there are over 100 demographic fields for the patient to address ( e . g ., age , exposure , travel history , vaccination status , etc .). All these specific scenarios needed to be communicated via unique codes , which needed to be developed quickly .
Language Lessons During a Pandemic
In February 2020 , after the WHO announced SARS-CoV-2 as the official designation for the emerging virus that caused COVID-19 , terminologists spent their time sifting through package inserts and standard operating procedures ( SOPs ) for laboratory-developed tests to codify their specific attributes .
There are more than 200 LOINC ® codes related to SARS-CoV-2 testing . The benefit of so many choices is that public health can communicate very specifically about specimens and testing . On the other hand , so many options made it difficult and tedious for laboratories to select the code that most accurately corresponded to the exact situation for each test conducted . Faced with thousands of samples and backlogs of data , laboratories did not have extra time to scour through all the codes and try and match them , one by one , to the package inserts of each individual test . Each laboratory independently dedicating time and resources to that type of research for every single specimen would have led to thousands of hours lost when there were no minutes to spare .
To combat that inefficient process and to ensure that laboratories could report the data elements required by the US Department of Health & Human Services , APHL developed the LOINC ® In Vitro Diagnostic ( LIVD ) Test Code Mapping for SARS-CoV-2 Tests . This catalog compiles all the LOINC ® codes for test orders , test results , SNOMDED-CT ® test descriptions , specimen sources and device identifiers in one place . This file is updated regularly and published centrally , so that laboratories always have accurate information without having to search across the landscape for new or deactivated tests .
APHL Lead Terminologist Riki Merrick explains that the ultimate goal is to create a repository of information contained in the LIVD files . If fully converted to a repository accessible to systems , mapping would be automated instead of distributed as a spreadsheet , eliminating the need for labs to manually import codes into their individual systems . Test manufacturers could submit their mappings directly to the repository for review and publication and all updates would get pushed out centrally .
This type of work exemplifies what APHL hopes to accomplish — the public health community collaborating to develop and leverage shared resources , tools , and services to improve workflows for all and enhance interoperability across the landscape . n
22 LAB MATTERS Summer 2022
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