A 20-Year Evaluation of LOINC in the United States' Largest Integrated Health System
A 20-Year Evaluation of LOINC in the United States' Largest Integrated Health System
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DOI：
10.5858/arpa.2019-0055-oa
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发表时间：
2020-04-01
影响因子：
4.6
通讯作者：
Hauser, Ronald George
中科院分区：
文献类型：
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作者：
Bhargava, Ankur;Kim, Tae;Hauser, Ronald George
背景。临床实验室有义务实施逻辑观察标识符名称和代码（LOINC），这是一种用于唯一识别实验室检查的信息学标准。实验室在实现这一目标方面的历史进展是未知的。评估临床实验室实施LOINC的情况，注意LOINC的采用，多样性和正确性。我们汇总了退伍军人健康管理局（VA）内的130个设施的数据，该机构是LOINC的早期采用者，在20年期间（1999-2018）。为了评估LOINC的采用情况，我们计算了没有LOINC的测试和结果的年度比例。为了评估LOINC的多样性，我们统计了每年活跃使用的不同LOINC的数量。为了评估LOINC随着时间的推移的正确性，我们将分配的LOINC与每年手动审查的金标准进行了比较。我们共审查了586，000项测试和91.62亿个结果。LOINC的采用，作为测试和结果的比例，随着时间的推移而改善（P < .001）。在回顾的最后一年，85%（202 125例中的172 142例）的实验室检查和99%（551 205 087例中的547 229 066例）的结果具有LOINC。从1999年到2018年，活跃使用的不同LOINC数量从4502增加到12503（P < .001）。正确性普遍提高，但随着测试和时间的推移变化很大。LOINC的采用在过去20年中有所改善。更多样化的LOINC与采用率的增加有关，并且是保持最新的挑战。LOINCs的正确性有所改善，但仍然是一个问题，可能需要对大多数应用程序进行补充审查。
Context.-Clinical laboratories are obligated to implement Logical Observation Identifier Names and Codes (LOINC), an informatics standard used to uniquely identify laboratory tests. The historical progress of laboratories in achieving this goal is unknown.Objective.-To evaluate the implementation of LOINC by clinical laboratories with attention to LOINC's adoption, diversity, and correctness over time.Design.-We aggregated data from 130 facilities within the Veterans Health Administration (VA), an early adopter of LOINC, during a 20-year period (1999-2018). To assess the adoption of LOINC, we calculated the annual proportion of tests and results without a LOINC. To assess the diversity of LOINC, we counted the yearly number of distinct LOINCs in active use. To assess the correctness of LOINC over time, we compared the assigned LOINCs to a manually reviewed gold standard for each year.Results.-We reviewed a total of 586 000 tests and 9.162 billion results. LOINC adoption, measured as a proportion of both tests and results, improved over time (P < .001). In the final year reviewed, 85% (172 142 of 202 125) of laboratory tests and 99% (547 229 066 of 551 205 087) of results had LOINCs. The number of distinct LOINCs in active use from 1999 to 2018 increased 2.78-fold from 4502 to 12 503 (P < .001). Correctness generally improved but varied considerably by test and across time.Conclusions.-The adoption of LOINC has improved during the past 2 decades. More diverse LOINCs were associated with increased adoption and were a challenge to keep up-to-date. The correctness of LOINCs has improved but remains an issue that likely necessitates supplemental review for most applications.