Abstract
Introduction:
Laboratory test results provide important measurements for clinical and translational research, yet ubiquitous use of coded lab data for multi-site research remains elusive. Logical Observation Identifiers Names and Codes (LOINC) is a mature and nationally recognized standard with promise to harmonize multisite data to a common reference standard for multi-site research. Anecdotal evidence suggests that LOINC is not yet widely or uniformly adopted in most clinical settings. There are many likely reasons, including its magnitude and complexity, implementation and maintenance costs, and limited business case. The lack of a uniform approach to implementing LOINC raises concerns that variation in terminology maintenance and mapping processes result in variability in the assignment of codes. Further, there are no commonly reported metrics to quantify or estimate the completeness or “quality” of LOINC implementation, which limits opportunities for organizations to benchmark or identify sites with “complete” LOINC implementation for guidance. The objective of this poster is to describe the response and early results from a recent survey of CTSA sites on the completeness and approach of LOINC at their institutions.
Methods:
We developed a brief survey to assess various operational dimensions of institutional LOINC implementation, maintenance, and use. The survey was targeted to CTSA informatics leaders and was developed by authors (informaticians from 3 different CTSA sites). Most questions were multiple choice with option for free text comments. We requested one response per institution and encouraged respondents to consult with others at their institution for details as needed. The survey was introduced at a CTSA informatics enterprise committee (iEC) virtual meeting (where most institutional informatics leads attend) on May 3, 2024, with an email later that day inviting participation in the survey. A reminder was sent on May 21, 2024. Results were tabulated in July 2024.
Results:
Among the 64 CTSA-supported hubs, 19 (30%) responded to the survey. Reported institutional uses for LOINC were varied, with most sites reporting use of LOINC for both local and networked research (86%). Other uses include clinical care (47%), quality initiatives (42%), and public health (37%). 15 respondents reported involvement in research networks, including N3C (n=13), PCORnet (n=10), ENACT (n=9), OHDSI (n=9), TriNetX (n=9), Epic Cosmos (n=8), 4CE (n=3), AllOfUs (n=2). Various sources of funding were reported. Only 3 sites felt that their organization provided sufficient funding. (5 sites reported not having enough funding, and 7 sites were unsure.) Sites were asked what percentage of unique lab tests were mapped to LOINC. Four sites were unsure and did not provide an estimate. Among the other 15 sites, estimates ranged from 8% to 97%, with a mean of 74% of unique lab tests mapped. Responses to the questions “How do you allocate resources for routine LOINC mapping updates?” included: “No specific amount, whatever it takes” (47%), “non-CTSA team (e.g., IT operations, clinical lab)” (21%), “routine updates not performed” (16%), “as needed for research requests” (16%), and “effort allocation (FTE) per year”(11%). When asked about formal/documented procedures for mapping LOINC, 3 (16%) report having procedures, 5 (26%) report no procedures, and the majority (11 sites; 58%) report unsure. Further results continued on poster.
