After almost two decades of pushing for adoption of a common coding standard for all laboratory procedures, advocates of the Logical Observation Identifiers Names and Codes database are feeling vindicated.
LOINC, an open standard that applies unique identifying codes to laboratory test results and other clinical observations, has grown from about 6,000 terms in 1995 to nearly 75,000 today. But it hasn’t been an easy journey. “Back in the beginning, the LOINC database would fit on a single diskette,” says Raymond Aller, MD, “Newsbytes” editor and liaison between the CAP and the Laboratory LOINC Committee. “I would take the diskettes to trade shows and hand them out to the vendors, telling them, ‘This is where the future is headed.’”
The future is now for approximately 20,000 registered LOINC users spread across at least 147 countries. The database is available in more than a dozen languages and dialects. Nations from France and Germany to Rwanda and Thailand have adopted it as a data standard.
“It has really burgeoned in the last 18 months—every little hospital is calling,” says Clement J. McDonald, MD, director of the Lister Hill National Center for Biomedical Communications, a division of the U.S. National Library of Medicine and National Institutes of Health. For the years he devoted to developing the standard as Regenstrief professor of medical informatics at Indiana University, Dr. McDonald is considered the “father of LOINC.”
Two forces account for much of the new interest in LOINC, says Charles Halfpenny, chief technology officer and founder of Halfpenny Technologies, a provider of health care connectivity and integration solutions with LOINC-based capabilities. One is that health insurers are requiring laboratories to report certain data with test codes normalized to LOINC. The other is the advent of meaningful use regulations under the 2009 HITECH Act. Halfpenny notes that in the final rule pertaining to stage two of meaningful use, issued by the Centers for Medicare and Medicaid Services in August, LOINC was deemed the required standard for how most structured laboratory results should be encoded for integration into the electronic medical record.
“The health plans have been driving demand,” says Halfpenny. “Now the EHR vendors wishing to offer CEHRT [certified EHR technologies] will further increase demand.”
“We believe,” Halfpenny continues, “that moving forward, demand for LOINC coding will shift. It will be driven by the lab’s customer, the practice. When implementing EHR systems, the practice will pressure the lab to provide LOINC-encoded data so the practice can receive meaningful use incentives and avoid potential future penalties under HITECH.”
It’s not so much the jump in the number of LOINC users of late as it is “the amount of real activity by companies and organizations” that is making LOINC a force to be reckoned with, Dr. McDonald adds.
Public health reporting mandates, including those related to bioterrorism surveillance, have also spurred the growth of LOINC, Dr. Aller says. Having a common data set, collected from multiple sources, allows public health agencies to spot disease trends within a population more easily and quickly.
The need for a system like LOINC has been self-evident to its boosters for a long time. “There are so darn many lab tests,” says Dr. McDonald, “and the names are typically so constrained by field limitations that you can’t tell for sure what the names mean. That’s why the codes are so important.”
Why, then, has LOINC taken so long to catch on? Dr. McDonald sums up the situation from a historical perspective.
“Well, it took 50 years to get the interstate highway system finished,” he says. “It took 50 years before color TV was present in 80 percent of households. These things take a while.”
Dr. Aller concurs. “Lab information system vendors will respond to what their laboratory clients are asking them to do,” he explains. “And for many years, the laboratories didn’t ask them to do much about LOINC. But the laboratories and the vendors are coming along.”
Moving forward, Dr. McDonald foresees even more widespread uptake of LOINC. “My hope would be that most lab tests, at least, would always come out with an appropriate LOINC code, so that receiving computers—whether they be hospitals getting results from an office practice or an office practice getting results from a colleague—can automatically pull that data in.”
“Do that,” he adds, “and you reduce the cost of the record system, increase the speed of the data, and make the data more useful.”
The private equity firm Thoma Bravo, LCC, has announced plans to acquire Mediware Information Systems.
Mediware, which markets blood bank and other information systems, finalized its acquisition of the blood-management consulting, education, and solutions provider Strategic Healthcare Group last month. Mediware also purchased in 2012 the stem cell collection and transplantation software vendor Transtem, LLC, as well as the assets of the chemotherapy-management software Cyto Management System from Cobbler ICT Services BV.
Thoma Bravo, which has invested in 14 software and technology companies across multiple industries, expects to complete its purchase of Mediware by the end of the year.
Mediware Information Systems, 888-633-4927
Thoma Bravo, LLC, 312-254-3300
Orchard Software has released Orchard Trellis, an orders and results management software program for passing orders and results between low-volume point-of-care testing analyzers and instruments and the electronic medical record.
Trellis provides an easy-to-use single-window user interface. The application window is divided into three views—home, pending review, and released results.
“For facilities where a centralized lab exists among a network of POCT locations, there are a couple of deployment options,” says Curt Johnson, Orchard’s chief operating officer. “For a laboratory with a legacy LIS, Trellis can provide POC connectivity by linking the POC testing sites directly to the EMR, or Trellis can be used in conjunction with Orchard Harvest LIS to simplify quality control management and make results from POC analyzers easily accessible for analytics or inspection purposes.”
Trellis, he adds, can link the EMR with a few low-volume instruments or multiple POCT testing locations.
Orchard Software, 800-856-1948
NovoPath has entered into a strategic partnership with McKesson under which McKesson will offer the NovoPath anatomic pathology system in conjunction with its laboratory and integrated health information systems.
“This partnership enables NovoPath to provide McKesson customers and the larger market with a tightly integrated anatomic pathology solution,” says Rick Callahan, vice president of sales and marketing for NovoPath. “This integration offers laboratories the best of both worlds—a seamless integration of a best-of-breed with an outstanding enterprise-wide solution.”
AP-Visions, LLC, has introduced a line of specialty-specific anatomic pathology software that includes solutions for urology, gastroenterology, and dermatology practices.
AP-Visions was founded last year to provide software to all sizes of specialty physician office laboratories. Its user-customizable AP-URO, AP-GI, and AP-DERMA software includes dashboard tracking of patient sample status, support for CPT and ICD-9 codes, and electronic medical record interfacing options.
AP-Visions has also released user-deployed tool kits for laboratory connectivity and middleware.
“Our mission,” says AP-Visions managing director Neal Flora, “is to make laboratory results flow effectively and cheaply to where the health care provider needs them to be.”
AP-Visions, LLC, 714-306-0996
Data Innovations has launched EP Evaluator, release 10.1.
This latest version of the method-evaluation software provides updates to the product’s hematology method comparison and simple precision modules.
The HMC module now includes a user-defined interpretive comments section in HMC reports that allows users to enter study-specific comments that will be displayed in the printed report. A flag comparison report compares positive morphology flags for all specimens across all methods.
With the enhanced simple precision module, the user can define a target mean and a target standard deviation goal. A histogram can display the range of observed data relative to the observed or target mean. A new preference option allows users to change pass/fail reporting to pass/fail/uncertain.
Data Innovations, 802-658-2850
Dr. Aller is director of informatics in the Department of Pathology, University of Southern California, Los Angeles. He can be reached at email@example.com. Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at firstname.lastname@example.org.