Laboratory Terminology for eHR

John MokHealth Informatician

eHR Information Standards Office

Outline

• Some background of laboratory terminology standards

• Standardization of laboratory data in HA

• Planning of laboratory terminology for eHR

Laboratory Terminology Standards

• The Laboratory – Pioneering informatics Standards

1960s 1970s 1980s 1990s 2000s - Present

SNOP

SNOMED 1&2

SNOMED 3.x

SNOMED CT

LOINC

Evolving Laboratory Business

PastFu

ture

Lab test setup Specimen flow Lab report

Lab A

Lab A Hosp A

Knowledge base

Where are we today?

eHR Information Standard Domain Group on Laboratory Records - Membership

Laboratory Informatics Standards Working Group in HA

Pathology IT Steering Group

ChemicalPathology

Immunology HaematologyAnatomicalPathology

Microbiology

HI support

AHN

CMC

GH

KWH

NDH

PMH

PWH

PYN

QEH

QMH

RH

TKO

TMH

TRL

UCH

YCH

AHN

CMC

GH

KWH

NDH

PMH

PWH

PYN

QEH

QMH

RH

TKO

TMH

UCH

YCH

AHN

CMC

KWH

NDH

PMH

PWH

PYN

QEH

QMH

TKO

TMH

UCH

AHN

KWH

PMH

PWH

PYN

QEH

QMH

TKO

TMH

UCH

PHLC

QMH PWH

PHLC

CPLC

CPLC

Dr CC Shek Dr Eric Chan Dr Raymond Chu Dr KC Lee Dr TL Que

Progress

Type Area Terminology Status

Micro-organisms HA and DH SNOMED CT Completed initial mapping

Specimen type HA and DH SNOMED CT Completed initial mapping

Antibiotics HA and DH LOINC Completed initial mapping

Microbiology tests HA and DH LOINC In progress

Biochemistry tests (common) HA and DH LOINC Completed initial mapping

Haematology tests (common) HA and DH LOINC Completed initial mapping

Immunology tests HA and DH LOINC In progress

Anatomical Pathology (Diagnosis code)

HA and DH SNOMED CT In progress

Molecular/Esoteric tests HA and DH LOINC Pending

Test request name eHR SNOMED CT Pending

• Laboratory data standardization/mapping progress

Challenges – Maintenance and Quality Assurance

Lab data Terminology Adoption

SNOMED CT

Like a Question –Urine Culture?

Like an Answer –Escherichia coli

Both LOINC and SNOMED CT being used

Terminology -A brief introduction of LOINC

LOINC - Background

• Logical Observation Identifiers Names and Codes

• LOINC system was initiated in 1994 by the Regenstrief Institute, a non-profit medical research organization associated with Indiana University.

• Developed for data exchange of lab results among different institutions

• Free to use

Why LOINC

• To facilitate the exchange and pooling of results, for clinical care, outcomes management, and research.

• Most widely adopted reference terminology for Laboratory

• Over 44,000 laboratory terms

An example of a LOINC code

LOINC code

• Component

• Property

• Timing

• System

• Scale

• Method

Sodium [Moles/volume] in Serum or Plasma

2951-2

• Sodium

• SCnc

• Pt

• Ser/Plas

• Qn

Six-axis

Laboratory results interface between DH and HA

HL7DH LISTerm and code Set

LOIN

C m

app

ing

DH Lab

HKCVT

HA

LIS Tran

sform

ation

HA doctor

ePR

Laboratory data standards for eHR

References

Structured report model - Microbiology

Request

Specimen type

Anatomical site

Test profile

Test

Culture

Organism

Antibiotics

SNOMED

SNOMED

LOINC

LOINC

SNOMED

LOINC

Terminology

Refer to

Structured report model - Clinical Pathology

Request

Specimen type

Test profile

Test

Test

Specimen type

Test profile

Test

Test

SNOMED

LOINC

LOINC

SNOMED

LOINC

LOINC

TerminologyRefer to

Structured report model - Anatomical Pathology

Request

Specimen type

Anatomical site

Test profile

Test

Diagnosis

SNOMED

SNOMED

LOINC

SNOMED

Terminology

Refer to

Recap - Terminology to be used

• Chemical Path / Haematology / ImmunologyTests -> LOINC

• Microbiology / VirologyTests -> LOINCOrganisms -> SNOMED CTAntibiotics -> LOINCSpecimen type -> SNOMED CT

• Anatomical PathologyTests -> LOINCDiagnosis -> SNOMED CT

Laboratory Standards RoadmapTest

Specimen type

Diagnosis

Culture

Organism

Antibiotic

LOINC

SNOMED

Lab Data

HL7 messageStructured report withTerminology reference

Test Mapping List

HKCTT Lab test mapping

Editorial policy

Editorial policy for

Lab data

Interchange Format

Specification

Lab data Interchange

FormatSpecification

Lab records

eHR

Thank You