5-张林 HL7Asia2017-英文版-170815-13015-张林 HL7Asia2017-英文版-170815-1301

jingALOINCmappingstudyinChinaResearchonStandardsandSpecificationsRelatedtoRegionalExchangeandSharingofCLinicalLaboratoryInformationsponsoredbytheNationalHealthandFamilyPlanningCommission(NHFPC)WhoamI?•Name:LinZhang•ALOINCVolunteer•HonoraryLifetimeLOINCPremiumMembership•StandingmemberofCHISS•MainlyinterestedinHITstandards,esp.inologies•Andanactivevolunteerinopensourcedomain,chasWikipediaMediawikianditsSMWExtensionetc.•LaboratoryMedicinePractitioner•NuclearMedcineRadiochemistAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing2•Background•LOINCMapping•80/20Rule•AMappingStudyofCommonLabTestsina•Summary•AcknowledgementAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing3•LOINCistheinternationalstandardforidentifyinghmeasurementsobservationsand•Itisdesignedtofacilitateexchangeandsharingofthesehealthdata,includinglabdata•LabLOINCisonemajorpartofthewholeterminology•Tothisend,weneedtomapourlocaltestcodestoLOINCasauniversalstandardthateverysystemcanunderstand.•However,mappingissohardasaresourceintensiveeffort.•Soitneedsguidance,includingrank/frequencyinformationbasedonroutineusagepatternsinalocalcontext.August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing480/20Rule:ParsimoniousMapping•KeyReferences:•VreemanDJ,FinnellJT,OverhageJM.Arationaleforparsimoniouslaboratorytermmappingbyfrequency.AMIAAnnuSympProc.2007Oct11:771-5./pmc/articles/PMC2655785/•Top2000+SI/USVersions(December2016).CommonLOINCbsLaboratorybslaboratoryilizationintheintensivecareanditsimplicationsforlargelectioneffortsJAmMedInformAssoc(2):229-August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing5AMappingStudysinChina•Project:ResearchonStandardsandSpecificationsionalHealthandFamilyPlanningCommissionigatorBaoluoLi•WG6–LOINCWorkingGroup•Subset:LOINCcodesofCommonlabtestsinChina•ToprovidemappingguideandstatisticalevidenceonsuitabilityofLOINCtonationalstakeholders,suchashealthcareorganizations,governmentagenciesandvendors.•Mappinglocalobservations(reportitems)otherthanlocalpanelstoAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing6•Sampledatawereprovidedbyarangeofrepresentativehealthcareorganizationswithinseveralregions/citiesinthiscountry.•Sampledataincludeslocalobservationsandfrequenciesoftheirinstancedataduringthespecifiedsamplingpreiod(in2016).August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing7maryofDataSourcesSampleData•SourceRegions/Cities:5•i.e.,Beijing,Shanghai,Guangzhou,HebeiandSichuanNumber,TypesandSizesofSourceOrganizations:•SourceOrganizations:35communityhospitalsservices7secondaryhospitals;13tertiaryhospitals•includinggeneralhospitals,specializedhospitalsand2large3rd-partyLabs•OutpatientVisits:750to4millions/a•Admissions/Inpatients:2345to100K/a•LicensedBeds:68to2000•SampleData•SamplingPeriod:2016•LocalObservations:9698•InstancesofLocalObservations:193324503August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing8•DataPreparing:MSExcel•32SourceOrganizationsweremergedintoonevirtualgrouptofacilitatethemappingprocess,sothereare4localtermfiles(intotal)tobemapped.•MappingTool:RELMAv6.17(December21,2016)•RELMA=RegenstriefLOINCMappingAssistant•Database:LOINCv2.58&LV=5(SimplifiedChinese)•Importlocalterms(.xlsx)intotheRELMALMOFdatabase•Mappingprocess•Asinglepersonformapping/reviewing•UsingsearchtermsinChineseand/orEnglish•Mostlybasedontheoriginallocalterms•Manuallyentry/modificationasneeded•UsingtheranksinRII’sRELMAtofacilitatecodeselectionAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing9etimelineandresourcesavailablemostofthesampledataareprovidedinaratherlifiedformatratherthantheformatsuitableforanormalLOINCmappingprocess.•NotsufficienttocreateexactmappingstoLOINCfields•SothemappingprocesswasbasedonacombinationequenciesandLOINCranks.August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing10•Onlymappedto945LOINCcodesbecauseofroughlymapping•Likelyupto2000codesorsoifexactmappingabledbysubmissioninaproperformataccordingestionfromLOINCCommittee•Themorefrequentlyatestisused,thebetterthes•SignificantoverlapwithLOINCTop2000+subset.August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing11MappingofSerumSodium(Na+)August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing12rganizationsToBeMappedegeHospitalosticsKingMedCenterforClinicalCoLtdSichuanAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing13tionsnits%)egeHospitalosticsKingMedCenterforClinicalCoLtdSichuanAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing14TheresultingmappingswereexportedintoanExcelworksheetAndtheconentconsistsoffivepartsasdescribedbysubsequentslides.1.LocalpanelsandTests3.LOINCCodesInvolved5.NamesandAbbreviations2.FrequenciesandRanks4.CategoriesofBillables/SevicesAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing15★JJJ(Jing-Jin-Ji)-Beijing-*LaboratoryMutualnitionInitiativeofalsinBeijing45=0.00847)Boththelistsarefullycovered.August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing16enciesandRanks•Instancesofeachobservation(localtest)•SourceOrganizations•Percentageofthesampleinstancedataset•Culmulativepercentage•RanksAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing17hineseandseveralLOINCFieldsClassandClassTypeareprovidedforeachmapping.August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing184.CategoriesofBillables/Sevices•Tofacilitateunderstandingandacceptanceofmappingsthroughgroupingbythefamiliar/officialcategoriesofblessevicesSource:NationalMedicalServicesPricingSpecification(Edition2012)publishedbyNationalDevelopmentandReformCommission,MinistryofHealth,ChineseMedicineAdministrationAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing19IncludingLongCommonNames(Chinese,byformula),ShortNames(Chinese,manually)andAbbreviations(English,manually)AshumanreadablenamesAsdisplaynamesAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing20SizeandCoverageoftheSubset•Size:945LOINCcodes•Coverage:99.012%ofthevalidinstancedata•Allthevalidinstancedatatobemapped:190007765•98.284%oftheOriginaln•Unmapped:1877864•1877864/190007765=0.988%•Mapped:188129901•188129901/190007765=99.012%August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing21CommonboratoryTestsforInteroperability临床检验结果互联互通项目常用代码手册neseHealthInformationTechnologyAlliance(CHIETA)•提出/起草单位：医疗卫生信息互联互通技术联盟August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing22toverlapingbetweenthissubsetandTop0+SI/USVersionswith470%437%Top2000+SI/USVersions(December2016)CommonLOINCLaboratoryObservationCodes—LOINC/usage/obs/August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing23Thissubset(Xaxes)vsTop2000+SI/USVersions(Yaxes)CNvsTopSICNvsTop2000+USAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing24•Futureupdateswouldneedmoredetailsaboutthelocalteststoenablemoreexactmapping•EstimatedsizeofactualsubsetwouldbesimilartoRII’sTop2000+subset(esp.theSIversion)August19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing25•NeedmoreLOINCers,suchaslabprofessionalswithHIT/terminologybackground•Needconsensusandcollaborationamongstakeholders•Mechanism(s)tomanagerequestsforchange,esp.foradditionofnewterms•Balancebetweenstandardizationandcustomization,e.g.,referenceterminologiescannotmeetalltherequirementsAugust19,2017LinZhang.CHIMA2017&HL7Asia2017,Beijing26•Ourusagepatternsarealsosubjecttothe80/20rule.LOINCissuitableforencodinglabtestsinthiscountry.•JustastartersetformappinglocaltestcodestoLOINCrartherthana"one-off"effort.Sofurtherupdateswouldbeneededinthefuture.•Needsintegrationintoamappingtoolforitsintendedfuntionasareal-timeguide.•Butitshouldnotrelpace/avoidmappinglocalcodesinaparticularorganization.•Ina