We discussed the unintended consequence of regulations that name a specific LOINC version. The rule-making process requires a specific, named version. So, rule-makers can name the current one, but can’t name a version that doesn’t exist yet. In the Meaningful Use Certification rules, the ONC has built specific provisions that allow updating to the current version. Yet, some (many) companies and institutions incorporate the version required in regulation, but don’t update as new releases come out every 6 months because they aren’t required to do so.

We also discussed several implementation challenges, like the cost of maintenance and the problems that occur when senders and receivers are using different versions of LOINC.

Ultimately, the Committee voted unanimously on the following best practice:

Best Practice

We recommend that users update to the current version of LOINC within 90 days of its publication.

This best practice recommendation will appear in an upcoming publication of the LOINC Users’ Guide.

Upgrade in progress. Photo via Arul Irudayam.

Rationale

There are many reasons why updating to the most recent LOINC release is a good idea that you should build into your vocabulary maintenance practice. Here are a few.

1. The most recent release is always our best release ever. LOINC follows good terminology development principles, which means that LOINC codes are never removed from the database and meaning of a code is never changed over time. So, all of the LOINCs that have ever existed are present in the most recent release. Over time and with each release, we add new terms and accessory content and make revisions where needed. For example, if we notice that we inadvertently have two codes with slightly different names but the exactly the same meaning, we’ll deprecate (retire) one of the codes and add a pointer to the preferred term.
2. The world moves fast. The in vitro diagnostic testing industry is constantly innovating. Since 1994, the FDA has categorized an average of about 2,000 new commercially marketed in vitro test system analyte measures each year. (Source: CLIA Download Data). In the last ten years, each bi-annual LOINC release has averaged about 1,800 new terms. LOINC continues to expand coverage of new clinical domains (Radiology procedures, clinical documents, patient reported outcomes measures, etc) and new laboratory testing areas, like genetics. In order to keep up with current clinical practice, you need a plan for regularly updating your use of standard vocabularies like LOINC.
3. Maximize the potential benefit of standardized data. If you receive data from multiple sources, you’ll miss out on the opportunity for your information systems to effectively process data from any source that is on a more recent version than you. If you are leveraging LOINC codes for quality improvement or decision support purposes, you run the similar risk of getting out of sync with the with value sets or other rules developed by others.

Tips for staying up to date with LOINC releases

There’s no doubt that the ongoing maintenance of mappings to standard vocabularies like LOINC can be a challenge. The complexity of the task depends on many factors, including how large your local dictionary is, the sophistication of your IT tools, subject matter expertise, etc. Here are a couple of quick tips for being sure you’re ready to go each June and December when new LOINC versions comes out.

1. Join the LOINC mailing list. New versions of LOINC are published twice per year (in June and December). Announcements of new LOINC releases are sent to the mailing list as soon as they’re published, so you don’t have to remember to check the website every six months. Or, follow @LOINC on twitter.
2. Go Premium. Especially if you’re a geek, you should consider getting a LOINC premium membership so that you can script (or at least very quickly) download of the latest release. It’s as simple as one short curl command and boom, you’ve got the latest release. A premium membership also gets you an email with the release-to-release change file delivered right to your inbox. Plus, if you’re downloading RELMA, you’ll get our fastest download speeds from the membership site.
3. Use RELMA to find the places where you’ve mapped to a LOINC code that is now deprecated. Each release contains many terms (about 2%, or 1,700 terms on average) that are deprecated. When a term is deprecated, the LOINC team identifies replacement term(s) wherever possible. For cases where users should choose between two possible replacements, we include a description of how to choose between them. If you’ve used RELMA to map your local codes to LOINC codes, you can use it to find local terms mapped to deprecated or discouraged LOINC codes. RELMA’s special screen (“Find Local Terms Mapped to Deprecated LOINCs”) identifies deprecated/discouraged code mappings and shows you options for updating them with replacement terms.

Future directions

At the LOINC Committee meeting, we also discussed whether it would be valuable for Regenstrief to produce a “core” LOINC Table and a “full” LOINC table. The main idea is that the core table would have only the essential defining fields of a LOINC term, whereas the full table would have all of the other accessory “metadata”. Because it has fewer, more stable fields, the core table would be much less likely to change structurally over time. Depending on their use-case, implementers who import the whole LOINC table into their system could simplify that process by using such a “core” file.

If this is of interest to you, be sure to sign up for the LOINC mailing list, where we’ll soon be sending out a survey about what should be in this “core” table.

References