Stage 2 Meaningful Use

The Center for Medicare and Medicaid Services (CMS) has announced the final ruling for Stage Two of Meaningful Use.¹ Stage Two requires that at least 55% of lab results in the Electronic Health Record (EHR) are structured data using Logical Observation Identifiers Names and Codes (LOINC) codes.

LOINC is a data content standard that was created to map lab orders and results to universal codes. This was a critical step for electronic transmission of lab data.² Correct LOINC code mapping is essential for HL7 segments. This free standard is administered by http://www.regenstrief.org/loinc.³ The website http://search.loinc.org is useful for mapping individual codes.

Lab-Speak

Learning LOINC (rhymes with oink, like a pig) is not difficult and laboratorians can map their own lab test dictionary. A brief translation of LOINC table column headers to ‘Lab-speak’ is helpful.

LOINC Column Header	What We Call It in the Lab	Comments
Component	Panel or test name	Shortest version of lab test name
Property	Scon= Substance Concentration Acon= Arbitrary Concentration Mcon=Mass Concentration	There are other LOINC columns which clearly define the Unit of Measure (UOM) per testing method.
Pt	A point in time	Spot
System	Specimen Source: blood/ser/plasma and urine are common. XXX-means an unspecified source.	Some reference labs and the Public Health Lab Interoperability Project (PHLIP)⁴tend to use the XXX generic source for microbiology.
exUCUMunits and exUnits	Unit of measure (UOM)	Map to the UOM noted in the procedure manuals.
Scale	QN=Quantitative Ord=1+,2+,etc Nar= Text Narrative
Class	Tables where various LOINC codes are found.	Example: HIV is in MICRO and Electrolytes are in PANEL.CHEM. Susceptibilities are in ABXBACT.
OrderObs	A panel order will have one LOINC code while the individual results (Observations) have different LOINC codes.	Sometimes the same LOINC is used for both Order and Observation for single tests.

LOINC syntax for long names can use up to six components, listed sequentially:
(component):(property):(time aspect):(system):(scale):(method)

Note: PHLIP prefers to see the Long Test Name in the HL7 message for Influenza reporting.

Step-by-step: Map Lab Tests to LOINC

1. Obtain an Excel spreadsheet of active tests at your lab. Both panel and result names are needed. Add a column for LOINC.
2. Locate procedure manuals to determine methodology (IF versus EIA, etc.), specimen type and UOM.
3. Hints for mapping tests to LOINC:
a. To search for individual LOINC codes by panel or test, go to http://search.loinc.org/
b. If the LOINC database (v2.40) has been downloaded from http://www.regenstrief.org/loinc, then search there, using the RELMA tool.
c. There is also a free table of the top 300 Common Lab Tests at http://loinc.org/usage/orders, which can be downloaded as an Excel spreadsheet. Use Control F to search for tests.
d. Reference lab may provide a spreadsheet of LOINC codes already mapped in their system. Before using their LOINC, check in http://search.loinc.org/ to ensure that your test matches the method, UOM, etc.

Use Your New LOINC Mapping

1. In Meditech 6.0, LOINC codes can be inserted into the Lab Test Dictionary on page 6 for T-Tests and Profiles.
2. In STARLIMS 10, LOINC is inserted in both Test Manager and in Micro Component.

Successful LOINC mapping is needed to comply with Stage Two Meaningful Use. Mapping can be done by laboratory staff, using procedure manuals and local familiarity with methods. Once entered into the Laboratory Information System, correct HL7 mapping can occur.

Allison Fiddler is a medical technologist with the NV State Public Health Lab. She has implemented both STARLIMS and Meditech 6.0 software LIS modules and mapped LOINC codes.

References
1. Centers for Medicare and Medicaid Services. Stage 1 vs. Stage 2 Comparison Table for Eligible Hospitals and CAHs, retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforHospitals.pdf on August 26, 2012.

2. Agha, G et al. Standardizing Laboratory Data by Mapping to LOINC, J Am Med Inform Assoc. 2006 May-Jun; 13(3): 353-355.

3. McDonald et al. LOINC, a Universal Standard for Identifying Laboratory Observations: A 5- Year Update. Clinical Chemistry. April 2003 vol. 49 no. 4 624-633.

4. Center for Disease Control, MESSAGING GUIDE FOR INFLUENZA TEST RESULT REPORTING BY PUBLIC HEALTH LABORATORIES. Retrieved from http://www.aphl.org/aphlprograms/informatics/collaborations/phlip/pages/default.aspx on August 26 , 2012