For vendors, LOINC a fast track to the future
Laboratory information systems (PDF document, 233Kb)
Raymond D. Aller, MD
Is your laboratory poised to moveinto the future, or will your laboratory information system hold you hostage in the past?
Does your LIS connect to other hospitals in your community as part of an integrated delivery system or a community-wide cooperative electronic health record endeavor? Can your lab automatically transfer case reports for reportable disease to your local public health authority to facilitate disease control and detect malicious epidemics in their earliest stages? Can you add to your system expert decision support rules that are generated externally? Can you provide result data to managed care and other payers to justify payment for services rendered?
Many of the LIS vendors on the following pages offer such capabilities and should serve as good business partners for years to come. Regrettably, however, some vendors have not kept pace with changes in the medical field. Several factors separate antiquated from adaptive systems, including the features highlighted below.
Standard test identifiers
How would a clinician care for patients if every laboratory reported sodium results with a different numbering system-for example, if one lab used Arabic, another Roman, another octal (base eight), and another hexadecimal (base 16)? This scenario obviously is ridiculous, but so is the common approach of naming tests idiosyncratically, without using a standard test-naming system.
As multi-hospital integrated delivery systems have begun to integrate clinical services, mechanisms to compare and combine results produced by one lab with those from another have begun to rely heavily on common test identifiers. The Logical Observation Identifiers Names and Codes (LOINC) system, built over the past decade by laboratorians and informaticists, is one such comprehensive standard test-naming system. Use of LOINC, however, should not deter laboratories from creating their own internal codes for test results-for example, it might be necessary to use a test code to distinguish glucoses run in the third floor lab from glucoses performed in the main lab. All individual result codes should then be referenced to the appropriate LOINC code. (Three or four internal tests may be referenced to the same LOINC code.)
The federal government demonstrated its support for LOINC earlier this year when it adopted the first phase of the Consolidated Health Informatics initiative. Under the CHI initiative, whenever federal programs build or purchase new systems that exchange laboratory data, they are required to use LOINC codes to describe the tests handled by those systems. Therefore, vendors who hope to do business with a federal agency will need to fully support LOINC and will benefit themselves by complying with the CHI standards as well.
In the private health care arena, laboratories supplying higher volume services to some managed care organizations during the past few years have also been required to provide LOINC codes with those results or, at a minimum, provide a translation table between their internal result codes and LOINC.
Transportable rule sets
An important component of modern clinical information systems is the ability to create and execute rules to interpret and suggest action on results and result combinations. In the past, health care institutions had to laboriously build and test these rules. Today, standard syntaxes for describing the rules, such as the Arden syntax, exist, but these do not yield executable rule sets that can be transported to other systems in their entirety. A consortium of vendors, universities, and health care systems, however, is working to create rules that can be moved from one system to another without re-editing. Such efforts require that test results be defined precisely, which requires use of LOINC codes.
Electronic transmission of results for public health
The standard content and format for electronic transmission of legally reportable laboratory results from a clinical lab to the local public health jurisdiction has recently been updated by the Centers for Disease Control and Prevention (www.cdc.gov/phin). It specifies using a combination of HL7 v. 2.4 and LOINC.
Electronic reporting of public health-relevant laboratory results has been shown to more than double the reporting rate from that achieved with manual lab reporting. Given this benefit, some state public health staffs have proposed that disease-reporting laws be amended to require electronic laboratory reporting.
New York is already making progress in this arena. It receives electronic disease reports from dozens of laboratories.
LIS vendors should not only accommodate the use of LOINC but support and encourage the use of this coding system. Vendors should include LOINC in their starter-set test dictionaries and make LOINC a required field for clients building new test entries.
Despite evidence and incentives that support implementing this coding system for laboratory result names, many labs, and unfortunately some LIS vendors, continue to disregard the growing need to connect to other organizations or comply with legal disease-reporting requirements.
Featured on pages 36-62 are 40 laboratory information systems from 36 vendors. The data presented is based entirely on vendors’ responses to a questionnaire. We urge readers to verify the information provided before purchasing a system, particularly the number of installed sites and claims of offering innovative features.
Ask prospective vendors to provide you with a complete list of contracts. If a vendor will provide only a partial list of clients, are you to assume that they have omitted their dissatisfied customers? If a vendor is not comfortable using any of their installed sites as a reference, you may want to consider another vendor. Recognize, however, that every vendor probably has a few clients who are unhappy, so don’t dismiss a vendor because of one or two negative references.
Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at firstname.lastname@example.org.