2024-03-18 LIDR Meeting Notes

Date

Mar 18, 2024

Attendees

(Bolded indicates presence at meeting)

Agenda and Notes

From Chat:

https://drive.google.com/file/d/1tgXwTWm8iaT9PvrCvb0iwDNnKEE3CNrp/view?usp=drive_link

Recording:

LIDR Meeting 3-20-2024.zip

POST CALL NOTE:

From Andrea: Thanks for another good discussion.

Here's a screenshot from an Apple Health implementation of lab results using FHIR (several years old), but demonstrates how they promoted use of the LOINC Long Name for the test name in their Apple Developer Conference in 2018.  It's from their video/documentation.  Ironically, if you look closely under the LOINC code, it says "No Text," where you'd expect to see the LOINC Long Name.  

As discussed on the call, Apple Health allows patients to populate the app with their health data from their EHR (and of course we know much of the laboratory data originates from the LIS connected to the EHR).  Thus it ties back to having accurate lab test data/information everywhere in the health ecosystem.  The LOINC Committee has also discussed cross-paradigm needs, especially where LOINC is used in apps with mobile devices or generated from smartwatch/other devices.

Another usability issue that might help Apple Health in their design of lab results is the LIDR indicator for different/same lab results.  Currently there are 2 ways Apple Health's app lists lab results, by date (most recent), or alphabetically for the most FHIR items.  There are a number that are not readable and in an "unreadable data" category.  "Interpretations," "Impressions" (for radiology studies) are all under "I" and decoupled from their report/test panel.  (Granted, a lot of this is implementation/usability design.)

~2018, the Lab LOINC Committee had several discussions about use of the LOINC LN as the lab test name as LabCorp and ACLA members reported some EHR implementations using LOINC for this purpose (not as intended and problematic for many reason, one of which is LOINC names are not static, subject to minor changes in a release such as with the recent decision for Semiquantitative results.)  The Lab LOINC Committee indicated (Lori Carey made the point) that the Short name should not be used for the test name in displays and clinical facing systems as it may pose a safety risk.  Indeed, the LOINC User guide indicates these names (other than display name) are used in HL7 messages, back end databases for a human readable LOINC code description, troubleshooting, etc. but aren't to be used in clinical facing systems/uses.  

Curious if Apple read the LOINC User Guide?  They are not alone.  FHIR US Core examples with lab results have used the LLN as well, Synthea datasets with lab results use them for the test order or result name (and also vital, radiology studies, SDOH questions, etc where LOINC is used beyond lab tests), etc.  These examples are all missing what some may call the "local term", that is the performing laboratory's test order or result name (the source of truth description).  

We've had presentations on lab test names, but haven't really discussed if LIDR will have an "official" laboratory test name for each row?  Or just the elements with a unique identifier for a row so we can distinguish each as unique.  We do not have a national lab compendium like in some countries (not sure if it's possible with the market.)  So there will be a need for each performing laboratory to continue to build their lab test names and give them unique identifiers (for that lab/entity/test build) from an informatics perspective and in accord with laboratory regulations.

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