Release Notes Version 1.0h(2) Released 8/29/96 1. LOINC News In July 1996, the American Clinical Laboratory Association (ACLA) endorsed LOINC and is now recommending that all of its member report laboratory results using LOINC codes. The 40+ members of the ACLA account for approximately 70% of the volume of tests performed in the United States. Also, ICD10 PCS codes for HCFA are being now constructed based on LOINC terms. Finally, Ontario, Canada is very interested in the use of LOINC codes for province- wide laboratory result reporting. 2. Corrections to existing terms 2.1 SUPER Convention Previously we used "LITTLE" in the component/analyte name to indicate that the following alphabetic character is lower case in the official name. In this release we similarly employ the word "SUPER" to indicate that the following character is a superscript according to official nomenclature. 2.2 Blood bank The parentheses included in the names of blood bank antigens were mostly unnecessary. They should not have been included according to our naming rules for specifying lower case alphabetic terms (LITTLE) unless, as in a few cases, the lowercase letter is enclosed by parentheses in the formal name. These have been corrected in this release. 3. Changes to standard report format We have changed the content of the printable (WordPerfect and Word) LOINC reports in the following ways: The ASTM Code, IUPAC Code, MetPath Code, and Comments columns are no longer displayed. They are still maintained in the database, they are just not printed on the word processing reports. Columns representing the Exact Core Component Synonym, Change Reason, IUPAC Analyte Code, and Molar Mass have been added to the report. (The Exact Core Component Synonym, IUPAC Analyte Code, and Molar Mass fields are new to LOINC with Release 1.0h -- see Section 4 for a description.) We stress that this is a change to the printed reports only; we have not and never will change the order of the fields in the database itself (in either the tab-delimited ASCII "LOINDBT1.TXT" or the dBase "LOINC.DBF" formats). The order of the columns on the reports is now: Status Class Loinc Number Map To Analyte/Component Name Type of Property Time Aspect System/Specimen Type of Scale Method Related Names Exact Core Component Synonym Date Last Changed Reason for Change Answer List EUCLIDES Code IUPAC Analyte Code Molar Mass 4. New data fields 3 new fields have been added and populated with data for many observations: Field # Field Name Type Width 33 EXACT_COR_SYN C 254 34 MOLAR_MASS C 13 35 IUPAC_ANLT_CD C 13 Field 33: Exact core component synonym This field contains an exact synonym for the "core component" of the LOINC component name. We have included the mixed case and "superscript" form of blood bank and HLA antigens (e.g., Lua) here to make it easier for automatic matching programs. As there is no ASCII character for superscript letters, we use the hat (^) to signify that the next character is a superscript in these exact synonyms. (E.g., if the core component is represented as L LITTLE U LITTLE SUPER A in the LOINC component/analyte name field, it is represented in the Exact Core Synonym field as Lu^a.) In a future release we will add more exact synonyms for the core components. Field 34: Molecular weights This field contains the molecular weights of many chemical moieties when they are provided to us. Those added in this release were kindly contributed by IUPAC. Field 35: IUPAC analyte code This field contains the Chemical Abstract service number or the Enzyme Nomenclature number for the chemical components for chemicals and/or enzymes. These were also contributed by IUPAC. 5. New observations We have added 1,559 terms in the following areas: 5.1 Susceptibilities based on antibiotic gradient strips (E-tests) We have added observations to represent each of the antibiotics for which susceptibilities can be performed via antibiotic gradient strips. 5.2 Allergen testing: serum IGE and basophil bound antibodies We have significantly enlarged the set of serum IGE allergen tests, and have added a large number of tests for basophil bound antibodies to specific allergens using the leukocyte histamine release method. This test may be more clinically predictive than the serum based IGE allergen tests. Most of these allergen test terms were contributed by Lab Corp and Corning MetPath. We edited the allergen names so that the part of the name that corresponds most closely to the genus comes first, the species comes next, and finer specification comes last. So an IGE AB against Live Oak would be listed as OAK LIVE AB.IGE. The IGE AB against Interior Live Oak would be listed OAK LIVE INTERIOR AB.IGE. If the allergen came from a particular part of the tree (e.g., bark) it would be OAK LIVE INTERIOR BARK AB.IGE. (Of course, common names do not always align well with the corresponding scientific name.) In the future, we will work toward including the Latin scientific name for each of the species represented in these allergen tests in the exact component synonym field. 5.3 Microbiology expansion We have added many terms to the microbiology section to deal with exotic infections, antigens and antibodies against more specific sub species (especially for viruses), and scattered IGM and IGG measures. Some of these additions were made in response to the CDCs communicable disease electronic reporting project, with which we are cooperating. 5.4 Lymphocyte bound CD antigens Corning MetPath contributed approximately 40 new terms for reporting levels and ratios of lymphocyte bound CD antigens. 6. New "Type of Scale" Level We have introduced a new category for Type of Scale. The new category, "SQN," applies to results that can be reported as either QN or SQ scales. 7. Databases As announced for the release of Version 1.0g, we now distributed an indexed dBASE version of the database as well as the tab delimited ASCII file, MS Word and WordPerfect printable versions that we have always made available. Not all of the data fields appear on the printable reports. You have to use the ASCII or dBASE version to access the entire database. We have not yet updated the Users' Guide to reflect all of these changes; this will be done in the very near future. 8. System for requesting new LOINC terms We receive two kinds of requests: (1) The first kind of request deals with (a) an entirely new kind of measurement, e.g., DNA sequencing or (b) the use of LOINC codes in manners that have not been agreed upon by the LOINC committee, e.g., the definition of terms to accommodate the organism 1, organism 2, etc., structures that are present in many laboratory databases. (2) Other requests are variations on observations that are already in the database. E.g., we have a term for a particular test result with serum as the specimen (system) and a user requests an identical term for a specimen of gastric contents. Provided that the requestor followed the rules given below and the number of terms requested at a given time are modest, we will try to respond to these kinds of requests quickly. We will only be able to respond quickly to such requests if the requestor provides us with clear information about the new terms, as detailed in Table 1. Before sending a request, make sure that you have, at a minimum, provided information about items 1 through 5 (and 6 if applicable). The more information you provide to us on items 7-12, the easier it will be for us to determine the correct LOINC name and to ensure that the term is not a duplicate of an existing term, and the better able we are to respond to your requests. Table 1 ------- For each proposed term: Data Field User Guide Explanation 1 Analyte/Component 2.2 Mandatory 2 Kind of Property 2.3 Mandatory -- but we can help if you provide enough details 3 Time Aspect 2.4 Mandatory 4 System/Sample Type 2.5 Mandatory 5 Type of Scale` 2.6 Mandatory 6 Type of Method 2.7 Required 7 Related names: Common names, acronyms or synonyms Strongly recommended 8 Comments Strongly recommended 9 Example results As reported by your lab. Strongly recommended 10 Example units As reported with real results. Strongly recommended 11 Related term(s) which this corrects If applicable. This implies that you think the proposed term should be used instead of the old term, and that use of the old term should be discouraged in favor of this term. 12 Related term(s) to which this term is related If applicable. This implies that the old term is correct, but that this term has substantial similarities. Include LOINC numbers of terms to which you refer. Once for each submission 1 Name of requester 2 Organization making request 3 Contact telephone 4 Contact FAX number 5 Contact email address We cannot guarantee a response for requests that do not include items 9 and 10. This information enables us to verify the property, precision, and method. When a new test is being added to provide a more general reporting class, e.g. if you are requesting a serologic result with no method specified because the database currently includes only terms for this result with the method specified, please indicate this in the comment field. There are some cases where the existing term in the database is close to what you want, but it is actually wrong. For example, a test may be listed as performed on serum when it must be done on plasma. Please indicate the error in the existing observation so we can flag it for non-use. In some cases there is no meaningful difference between the measure performed on one specimen type or another, e.g. the measure is listed with a system of SER or PLAS but can if fact be done on either plasma or serum and there is no clinical difference between the two. If that is the case, please note it in your request, because we would then change the existing term to a system of SER/PLAS. The requestors also need to supply some evidence that they are familiar with the database and that they are sure the term is not already represented in LOINC. The major work these requests generate is the effort to be sure the observation is not already in the database and to design the general style we will use to define this class of terms. We can only give expedited service if the requestors have done this work themselves. Terms should be submitted within an acceptable LOINC database format (Excel or Lotus spreadsheet, dBase, or tab delimited ASCII) and should include at a minimum the 5 or 6 required parts of the term. When a new observation is only a variation on an old one, use an existing LOINC observation as the template; change the part that is different in the new term and highlight that difference in bold (if using a file type that permits this, such as Excel -- see example below) or by appending three asterisks (*) if using a file type such as tab delimited ASCII. Please maintain the field order as outlined in the table above, using whatever delimiter is appropriate to your file format to indicate blank fields. An example submission (which because of space limitations includes columns for only the first eight fields) appears below. Real submissions should have columns for all 12 attributes listed in Table 1. ANALYTE PROP TM SYST PR METHOD CLASS .etc. GLUCOSE^90M POST 50G LACTOSE PO MCNC PT UR*** SQ TEST STRIP CHAL COPROPORPHYRIN 1 ISOMER*** MRAT 24H UR QN CHEM INDICAN MRAT 24H*** UR QN CHEM THYROXINE.FREE MCNC PT SER QN DIALYSIS*** CHEM BRUCELLA ABORTUS AB.IGA*** ACNC PT SER QN MICRO 9. Future plans We expect to further expand the LOINC database terms for mycology, blood bank, and other areas based on contributions from colleagues in Canada who will likely adopt LOINC for an Ontario province-wide laboratory data base. We are working on terms for surgical pathology and IE cyto stains. We have a proposal in hand for defining LOINC codes for order sets such as CHEM12. Work is underway to develop LOINC codes for genetic and DNA testing. We will continue to enrich the database with synonyms and related information as it becomes available.