Taiwan hospital laboratory LOINC code code and the corresponding auxiliary system

Taiwan hospital laboratory LOINC code code and the corresponding auxiliary system

A Collaboration Framework for Mapping Taiwan Hospital Clinic Laboratory Codes into Logical Observation Identifier Names and

Codes

Li Ding Yang a

a. Institute of Medical Informatics, Taipei Medical University m110091010@tmu.edu.tw, ctliu@tmu.edu.tw

Summary

Inspection data processing has been an extremely important part of the hospital one. With the ever-changing information technology, test data storage and transmission has entered the era of information technology. With the hospital's LIS (Libratory Information system) system more complete, the hospital electronic increasingly accelerated pace, as yet, for most of the hospital or testing center have reached the electronic targets. ^.

Under the existing framework, the hospital reported to health insurance, have their own set up their own hospitals and health care use of hospital codes corresponding code list. However, many hospitals use when making inspection of the hospital to formulate their own code system to be tested. Although this approach is not in its implementation is not flawed, but when the need for exchange of information, when hospitals between different coding standards in addition to communication difficulties caused by data, but also enable the hospital clinical diagnosis and test results of the comparison create enormous difficulties, which the whole is a waste of manpower and material resources in many situations.

View of domestic conditions, health insurance IC card has been formally

implemented, however, the exchange of test data lines are still in the hospital

under the state of its affairs. How to structure an exchange mechanism so that

the test information among hospitals to establish a standard, then the information

can be exchanged, it became one of the most important issues.

The purpose of this study, is not to construct an alternative to the current existing RELMA foreign system, but to construct a test for the medical institutes and centers use conversion platform, enabling hospitals to more familiar in their own environment to test code conversion work. Construction of the new system because it takes a lot of manpower and material resources, thus able to directly use the existing test code into LOINC code as the standard, will be the better choice. View of the current domestic situation, in order to make the domestic inter-hospital transfer of information to each other to construct a standard conversion program is also imperative to work. ^If LOINC through international standards to be converted, through the hospital compound code and

corresponding LOINC codes to construct a Web-based online secondary conversion system, medical institutions and through the use of test center personnel and information accumulated finished to provide the hospital compound is converted to LOINC code code standards

table, while collecting hospital hospital code, health care codes and LOINC codes for commonly used words, check the inspectors to facilitate query. Records of completed conversion table, not only as a domestic information exchange used in hospitals, even with foreign hospitals as a benchmark for encoding conversion.

To the hospital through the exchange of test code to reach a different test system can communicate with each other, exchange and analysis purposes, thereby enabling health care to achieve cost savings objectives.

Keywords

Commonly used words, LOINC, Laboratory Information Systems Preface

National Institutes of Health medical research in the health care system, the

report said: after the implementation of national health insurance system, the

number of laboratory tests also increased significantly in the global budget

payment system implemented, the clinical examination of the problem is that

physicians face the test items of the reduced billing crisis. Therefore, the

construction of a standardized test of information systems, will help to reduce

duplication of tests between the various medical institutions caused by the loss of

medical resources.

Department of Health hospitals in the island over the implementation of

electronic medical records pilot project, completed the first phase of a trial, in the second phase project: nine years of the Department of Health hospitals plan to promote electronic medical records, Transfer contents of test report has been transmitted obstacles. Transmission of electronic medical record agreement has generally been in accordance with HL-7 of the Agreement for transmission, and clinical examination of the events from HL-7 Agreement "OBX" to transfer [9].

However, the internal project name has not been tested a set of standards to follow. To solve this problem the Department of Health has commissioned the Taiwan Health Information Exchange Level Seven bodies to introduce LOINC (Logical Observation Identifier Names and Codes) as the standard clinical examination item code, LOINC's description of the test items, this can be very complete. ^However,

as China and the U.S. clinical laboratory medicine education must be a little different, the initial introduction is bound to have some problems. Furthermore, the hospital is not yet set a common name used in testing, so the introduction of LOINC can be said to be a difficult task.

Logical Observation Identifier Names and Codes (abbreviated as LOINC) in 1995 by the American Regenstrief Institute and Pathology (the College of American Pathologists)

Information Committee began a collection of seven major begin testing laboratory coding system developed jointly formed [5 , 6]. The main purpose is to provide a unified generic name and code to identify test (laboratory test) and clinical

observation (clinical observation) report the results to facilitate the exchange of information.

LOINC used in foreign countries, the corresponding system is called the RELMA system. RELMA organizations by the U.S. Regenstrief Institute provides a window for the user interface with (Windows-base) of the aids program called RELAM

(Regenstrief LOINC Mapping Assistant), this utility can be http://www.loinc.org website the current version RELMA3.11, released February 9, 2004 [8]. ^Although RELMA is a good conversion tool, but for the country's medical institutions, to correspond directly with RELMA not an easy task to do. RELAM Although you can assist hospitals and hospital tests for each test code to LOINC codes, but also has its shortcomings:

... This corresponds to what is an extraordinary need to have a good

understanding of the LOINC, because there are many information needs of the

corresponding document, a corresponding amount, and so there RELAM LOINC

using the corresponding tools, time and human remains will be a lot of

consumption. In addition, the artificial variables will lead to inconsistent results and the corresponding error ... [3,6]

Therefore, how can a more convenient form, providing the medical institutions to test the conversion code corresponds to reducing the amount of time required for the cost of standardization is the main issue. National Health Insurance, the Central Health Insurance Bureau compiled lists health insurance payment for a unified national health insurance Payment Standards [2], covering the National Health Insurance program code inspection. But the insurance code to valuation as a starting point in determining the principles of test items classified when they are focusing on cost considerations, in Shizuo Cheng will no longer be under the similar segment, therefore, difficult to identify health care coding samples, and Collection of Specimens time or test methods, no reference ranges for test results and so on, so health care can not meet the coding needs of clinical practice [5].

However, universal health insurance to pay medical expenses is the standard maximum Di Hao Chu national unity, in the "health care, medical consultations and LOINC Bian Ma Jian Yan conversion Zhi research" Ti Dao: Yinweijianbao code is Guonei unique production is a foreign Meiyou things thus using resources to conduct this study was to all medical institutions LOINC Standard Code for Information Systems and a combination of least cost and most efficient way. [3]

Therefore, health insurance code as an intermediary so that all hospitals be able to convert their code to use the hospital as an international standard of LOINC codes, in addition to savings required to re-develop the new standard cost of manpower and resources, health care facilities can still use the existing system without having to make drastic changes, can be converted through the system, you can convert existing hospital code to LOINC code, and then test data as the main basis of the exchange.

LOINC to conduct the conversion, to convert the current implementation only RELMA work RELMA mentioned before, the possible conversion problems, this research work aims to 透过 T-LOINC the establishment of the National Health Insurance yards, LOINC yards corresponding data libraries, health care facilities through health insurance code features are used to provide a test for use by the Web-based hospital codes, LOINC code corresponding to the system check, and then to convert the hospital to test code purposes.

Research Materials and Methods

System was mainly built by Mr. Lv Xinjie T-LOINC mapping table basis. T-LOINC mainly by the "health care treatment program and LOINC test code conversion of the paper" follow-up to build the conversion data in the main, T-LOINC provides codes corresponding to the current health care needs of LOINC Code Mapping Table. Through the Table, the user can significantly reduce the need to select information. In the current NHI-LOINC database, in addition to the corresponding table contains in addition, LOINC code contains information and health insurance to pay the standard chapter-specific treatment Specific Diagnosisand Treatment

Inspection Laboratory Examinatio in the first section contains information on health insurance test code also included. LOINC database where each record represents a sum of individual test results, test kits have been set for the completion, the following were most important to distinguish test items shows the first 2-7 field a total of six fields, namely: examination Project (Component), test unit (Property), test attributes (Time), specimen type (System), measurement type (Scale), testing method (Method) [6]. The composition of the six field only one kind of test items, and given a unique code.

Code section in the hospitals, the system will be recognized when the user logs in accordance with the hospital to record another hospital to provide hospital code and test code name, if users enter the compound commonly used code words, then be recorded until after the completion of the establishment and the corresponding health care LOINC code and the link between code.

To provide more convenient ways to search and help health care facilities required to complete each LOINC code table, build a query structure is the most important part. In the query process, the hospital code, health insurance have their own codes and LOINC code available to use the usual word, the word is commonly used to replace the system generally used for the purpose referred to Keyword. The general, keyword "keyword" is the brief description of the object you want to find some relevant properties of words, which allows users to quickly associate words to the object. In the test system, the general has its own scientific name used in scientific names, or short, but the hospital is sometimes because of some restrictions on internal use of abbreviations will be used to replace, in order to facilitate the use of the system also provides the name of the input of these new test items at the same time, induction into the database for later use, allowing users to try to operate under a familiar environment. ^And

because these terms are commonly used by the inspectors general terms,

therefore, it is referred to as dominant characters. Usual word is intended to

provide users with another way to complete the corresponding query. ^{When used}

in the collection of commonly used code words hospital after the completion of the corresponding code will be his, and health care, LOINC code to associate, so that users can follow up the information accumulated through the system, check to complete the corresponding information. The basis of the current system provides only the corresponding function, follow-up part of the continued addition and modification.

LOINC code check code corresponding to hospital system

System uses the platform is Windows operating system, IIS and Apache need PWDS or support, the system database is used Mysql, VB writing system primarily aims to build a Web-based conversion system, to a more convenient way for users.

System mainly consists of the hospital compound code, health care codes and LOINC codes NHI-LOINC database as well as the corresponding database.

System architecture of NHI-LOINC database is based on T-LOINC based on the conversion data structure, the database mainly contains the health care codes and LOINC codes corresponding information. This section is mainly in

accordance with T-LOINC Mapping Table, while the usual combination of LOINC constructed by word counterpart. The main purpose of the system is to help users search code corresponding to the hospital insurance code, and then through a T-LOINC database to obtain the corresponding information for the user to select the last corresponding LOINC codes. If the Medical Center to provide all hospital codes, insurance codes correspond to the information, but because of reporting problems, users may have to re-select the correct corresponding insurance code.

System will provide health insurance code corresponding to re-process, and then through the T-LOINC database select the appropriate corresponding LOINC codes and save. If the hospital provided information is correct, the user just to confirm, you can directly correspond to parts of LOINC.

Hospitals during data input, the system will provide the code to import hospital - health insurance code corresponding to function, through the provision of the information into the system specifications, you can directly correspond to work.

Figure 1 corresponds to the flow chart

First, the system queries flow chart diagram, the entire process from the user enter the new code and test name of the hospital began to enter the query process, users can use the usual code words or health care classification means narrow your search query, the search for the right health insurance code Providing a possible LOINC code for users to select and record. Later, the system will provide follow-up inquiry recorded the same information for the insurance code or idiomatic words refer to the user ease the burden.

Hospital code in the input data, the system will first check whether the data has been completed insurance code or the corresponding LOINC codes, if there is direct access to health care have been corresponding LOINC code code display screen or direct correspondence through the LOINC code, or enter Insurance Code Unknown query process. At this point you can choose to query classification health insurance code or idiomatic words to search. System consists mainly of compound commonly used code words commonly used words, health care full- text search and LOINC code code commonly used words. This part will be described later. Users get the correct insurance code, you can choose to enter part of the LOINC code, the system will be selected through the corresponding Component, Property, Time, System, Scale, Method and other parameters than the latter, providing the user select the desired information corresponds to the

completion of the corresponding data record.

Figure 2 are known to code hospital - health insurance code corresponding to the query graph

Figure 2 is a known compound code - health insurance status code

corresponding to the query, the system re-enter the hospital code corresponding insurance code also found, indicating that the health insurance code of the

Component, Property, Time, System, Scale, Method, etc. for users inquiries, while the health

insurance code for the past other hospitals had been corresponding corresponding

status, if the test items with the same user query, users can select the user than

the corresponding enantiomers as a result. If some different persons, or directly

after the corresponding changes. Or self-selected by the user to query the

conditions required for comparison, choose a suitable completion of the

corresponding LOINC codes.

Figure 3 unknown compound code - health care insurance category code corresponding query graph

Figure 3 for the unknown compound code - health insurance code classification code corresponding to use of health insurance status of the inquiry, the system re-enter the hospital code, tips to choose health care classification code.

Selection list Component, Property, Time, System, Scale, Method, etc. for users to query, find the corresponding code of health insurance. At this point the system with the detection of corresponding insurance code, the attributes selected by the insurance code to provide the default choice of the LOINC code information for the user to directly select or change the conditions of screening. Provide health insurance code was the last of the corresponding query over the status of other hospitals, if the test items with the same user query, users can select the user than the mapping of query results as a. If some different persons, may direct the modified query, the final completion of the corresponding store.

Figure 4 flow chart of commonly used query words

System, enter the new hospital in the user code, test name and the usual word, the word commonly used to provide users to search for hospitals to make any relevant correspondence on the list. If so, the system will list the

corresponding insurance code for the user to select if the data meet user needs, access to health care is the corresponding code-LOINC process. If not found, then the usual words and non-hospital health care the same code into the search process. School code here can be commonly used code word search, such as the commonly used word lists have been related information for users to choose the correct insurance code. If the user does not institute the usual word for query, the system will enter the NHI NHI code check process, depending on whether the hospital within the hospital system code - health care code information has different treatment decisions.

Figure 5: LOINC Panel Query

Figure 6: Insurance Code Query Panel

Figure 7: Health Insurance code a single item query

Figure 6, 7, 8 shows the health insurance code LOINC code inquiry screen.

Through the T-LOINC Mapping Table data to provide users with direct access to health care code information related to the corresponding LOINC codes to facilitate the necessary inquiries, the information related to the corresponding user can directly access the required information.

Conclusion

Standardized testing is a trend, both in Taiwan and other parts of the world.

Used in the United States has most of the hospital LOINC agencies accept the use of, and used around the world there are many. In Taiwan, health insurance is the only payment system, standardization of health insurance is a very important issue. The results of the current fragmentation of hospitals, in addition to

increasing health insurance costs, the future of electronic medical records will also be promoting a certain problem. Therefore, in considering changes to the

hospital system and the difficulties of re-development of standards under the general through the National Health Insurance in Taiwan to convert code into a more easy way.

In the "National Health Insurance program and LOINC test code conversion treatment study" mentioned: from the research group found that non-nested test items in the LOINC database always contains the code of the clinic health care program, while, LOINC major institutions and consolidation of the American Medical institutions of the test project, has through Europe and the United States and Japan and other countries use by the Regenstrief Institute is responsible for maintaining the United States. [3] Thus, the use LOINC as the test actually contains the international use of the test, and through the national universal health insurance code allows the hospital to more easily access all their LOINC code used to test standard purpose. At present, the corresponding system LOINC abroad, mainly RELMA.

RELAM provides two kinds of online and stand-alone mode of operation, stand-

alone operation offers the user query using Local Word and Attribute function

corresponding LOINC codes also provide users with their own Mapping Local Word to the desired function of LOINC codes. The online version of RELAM only provide access to the features, Mapping part of the action is entirely not included, the user would cause a lot of inconvenience. Meanwhile, although the online version of RELMA through the Browser to start the action, but still need to install the Citrix © client software to connect the software to the action, this software support systems include Microsoft Windows, Mac OS 9.x/10, and Unix / Linux and other platforms using a standard browser such as:

Microsoft Internet Explorer, Netscape Navigator, Mozilla and Konqueror, etc., while other systems may be supported subject to the degree to which support for Citrix [8]. The above information shows that RELMA itself is a powerful system, however, domestic medical institutions and test centers, he is still some shortcomings:

1. RELMA the Mapping feature is only available stand-alone operation, can not do some online resources to share. Test coding system corresponding to manually selected as some of the action required, such as online collaboration platform to build the light of the cumulative control data of each hospital, determine the selection of the correct information will be of great help.

2. RELMA only provide access to the online version of the function and need to install Citrix in order to perform are essentially is either a Web start of the program, the program is the main Rengran RELMA itself, to users, online database Huiyou more fast update information for inquiry, but because of the online version does not provide Mapping function, so users can only query the online version of the action, recording the part of the Zexu itself.

RELMA as the domestic difficulties of conversion tools to use are as follows:

1. National health care facilities require the commitment of dedicated staff (medical examination, medical, computer experts) to learn the use of tools RELMA suit the degree of difficulty higher.

2. Because of the different operators enter a different keyword (Keyword) search and corresponding results are different, thereby affecting the accuracy of the information corresponds.

3. Domestic commonly used common words, abbreviations, terms and international use to describe different, thereby affecting the number of corresponding data and results.

Can see from the above description, RELAM though is a powerful system, but

internal testing personnel, the use of still many inconveniences. Structure of the

system in this study relative to RELAM, there are several aspects of a more convenient:

1. In this study, the system uses Web-based architecture, as long as the browser, operating system support, can be in different systems use this system. RELAM used APPLICATION form, while providing the operating system version support, but the complicated installation procedures, the online version of the more necessary to install additional connection program, and provide access to functionality only to test the corresponding information can not be compared and delivery.

2. In this study, the hospital system to enter a new code, while providing users to enter commonly used words used in the hospital, in the collection of various homes after the next inspection personnel to provide more convenient forms of inquiry. RELAM are unable to provide additional internal data collection.

3. The research system to provide health insurance code as the basis of the query data suggest that function, users can query by the results of other users to access their own inquiries required information, or by some other query information to change attributes of a new query, and do not need to re-check each time, RELAM only one way to re-check.

Discussion of overseas documents to provide the corresponding form of multi- use automated testing project name (Component), the measurement units of property (Property), testing time (Time), samples system (System), method (Method) and other test results column bit and LOINC database fields directly related to

"field on the field" (Attribute to Attribute) of the corresponding practices. ^{On the}

domestic situation, the hospital code inspection data format is not uniform, and Component, Property, System, Method, Time, Scale and other fields are not available, the same name is also unfinished. Therefore, as an intermediary with insurance codes to find the corresponding insurance code supplemented by field after the search form on the field will be more suitable for domestic use in medical institutions.

Construction of this system are not intended to replace the foreign adopted RELAM system, but against the use of inspection personnel in Taiwan. ^Therefore,

the system is designed to assist users to a more familiar environment in the

corresponding data obtained, rather than replace the corresponding RELAM to be

the best system. Provided by T-LOINC corresponding knowledge base, the

system can be combined with health insurance code to be tested code

conversion. To the domestic environment, health care only to use code to allow homes to have a consistent conversion medium. Mr. Lv Xinjie through the institution by the T-LOINC mapping table, the system architecture to a complete record of the process of conversion. Meanwhile, in a network platform to provide shared, the Court does not need to establish their corresponding systems, just entering the system through a browser link to the corresponding, corresponding to completion of follow-up data can also help users to more quickly complete the corresponding work. On the above, structures a code-centric health care Web- based online secondary conversion system for the inspection personnel on Taiwan should be more convenient and more affinity selection. Hope that the future will continue to strengthen the system of additional features, integration RELAM part for domestic use and inspection personnel with the necessary additional

functionality, to construct a true test for Taiwan to use the standard conversion system.

References

[A] National Health Insurance Law, Taipei, Taiwan on July 17 President of the Chinese word meaning the total for a No. 09100142270 by the Order No. 21, 27, 29, 32, 55, 87-1, 87-2 provisions; and addition of 22 -1 clause.

[2] Bureau of National Health Insurance, "National Health Insurance Payment Standards (Volume)", Taipei: National Health Insurance Bureau, 2002.

[3] Lvxin Jie, Luo Wenci, Luwei Hui, Chien-Tsai: health insurance program coding and testing clinic study LOINC transcoding Proceedings of The 2nd Asia-Pacific and Cross- Strait HL7 Conference on Healthcare Information Standard. Pages 123-133.August 21-23,2003.

[4] Chia University Associate Professor Zhu Hai International Trade City, Da-Yeh University, Assistant Professor Chen Zexiong Information Engineering, South China University of Information Management, Chien Shou-dimensional, forward- looking medical information systems to electronic health record ─ ─ example, http://www .itis.org.tw/forum/content3/01if28c.htm .

[5] Institute of Medical Informatics, Taipei Medical University, master's thesis;

Graduate: Lu Weihui essays; Building Knowledge bases and Mapping Framework for Taiwan

LOINC. June, 2002.

[6] Logical Observation Identifier Names and Codes (LOINC

(2002). Users' Guide Updated.

Regenstrief Institute and the Logical Observation Identifiers Names and Codes Committee.p.1-70.

[7] Lau, LM, Johnson, K., Monson, K., Lam, SH, & Huff, SM (2000). A method for the automated mapping of laboratory results to LOINC. Journal of Proceedings / AMIA Annual Symposium. P. 472-6

[8] RELMATM Regenstrief LOINC ® Mapping Assistant Version 3.8 Users' Manual

[9] McDonald CJ, Huff SM, Suico JG, Hill G, Leavelle D, Aller R, Forrey A, Mercer K, DeMoor G,

Hook J, Williams W, Case J, Maloney P. LOINC, a universal standard for identifying laboratory

observations: a 5-year update. Clin Chem. 2003 Apr; 49 (4) :624-33.