Enhancing patient care and the bottom line through LOINC / SNOMED CT implementation

September 23rd, 2016 / By Pam Banning

3M HIS has been busy participating in professional healthcare industry meetings during the first half of 2016. This included Clinical Lab Management Association’s ThinkLab, The American Society of Microbiology (ASM) and The American Association for Clinical Chemists (AACC). This blog will summarize the current industry issues and outcomes of these meetings.

At Clinical Lab Management Association’s ThinkLab hosted in Orlando this March, the 3M HIS HDD team presented a poster on the admonitions institutions may face upon NOT updating terminology versions for several years. The poster, entitled “Touring LOINC & SNOMED CT: A Journey through Time and Laboratory Advances,”   reviews the risk of miscommunications if users do not update from the original USA federal mandate of LOINC 2.40 or SCT July 2012. There is a large amount of variation that happens with each terminology release. Specifically, over the last 8 releases, the chemistry and drug/toxicology sections of LOINC have undergone the largest growth. These encoded lab results and values may have the greatest impact on immediate critical patient care. If codes are unrecognized by downstream systems, the lab result message may go into an error log and not post. The vocabulary standards are very dynamic and are under constant development, so end users should examine each release and determine if any new (or retired) LOINC codes apply to their laboratory orders/results catalogue.  These audits can facilitate interoperability and correct codification of patient data.

The ASM, invited us to co-present at a pre-conference workshop for ASM Microbe2016, along with CPT coding reimbursement in Boston this June.  We made a clear distinction in the use case of CPT coding for reimbursement and LOINC/SNOMED CT coding for Meaningful Use adoption and data mining goals. In our demonstration, we presented the finding that the number one CPT lab code by volume usage-venipuncture workload capture (36415), will NEVER be assigned to a LOINC term, because it’s not linked to a patient result.  At the opposite end of the spectrum, there’s only one CPT code for allergy testing, yet there are over 3,400 LOINC terms for each of the allergens and their IgG or IgE components. This means that end users must consider the use case before determining which code system is appropriate to query.

Finally, at AACC this August in Philadelphia, there were round table discussions on the art of maintaining LOINC and SNOMED CT over the years, as well as an afternoon short course on “The Opportunity to Integrate the Laboratory into Patient Care Through Meaningful Use of Electronic Health Record,” with representation from public health and clinical decision support experts. The short course showcased the synergy and impact when LOINC and SNOMED CT adoption are present with clinical decision support rulesets. Millions of dollars were demonstrated in labor and reagent savings from unnecessary laboratory testing, as well as decreased hospital stays.

At both ASM and AACC, the same question was asked: “What happens if we don’t implement LOINC?” The carrot and stick analogy given back in 2011 has migrated from the carrot to the stick for those non-implementers: there will be diminished federal healthcare reimbursement (Medicare), predicted to start in 2017.  This hits multiple operating budgets (bottom line).  From the patient perspective, the inability to receive and readily comprehend coded data from sources that DID implement LOINC affects summary reports and possibly ignores valid, critical information.  Time and money are thrown at additional testing to regain information. This results in both ineffective patient care AND the inefficient spending (bottom line).

3M HIS continues to provide leadership and training in handling laboratory test catalogs and reference terms alongside the appropriate vocabulary standards.  As the Standards Development Organizations update their versions, 3M supports the industry through updated mapping services and active participation in professional societies. This is a seamless push situation that allows organizations to capture their impacted terms. The overall experience of the 3M team servicing clients provides fresh reiteration of best practices and lessons learned for presenting at future industry annual meetings.

Pamela Banning, BS, is a senior healthcare data analyst for 3M Health Information Systems.