LOINC and Medical Coding

LOINC stands for Logical Observation Identifiers Names and Codes. LOINC is a universal standard for identifying laboratory observations that was developed by the internationally-recognized non-profit medical research organization, Regenstrief Institute, Inc. LOINC was created in 1994 as a response to the demand for an electronic database for clinical care and management. It is accessible to anyone for free and both the American Clinical Laboratory Association and the College of American Pathologist have endorsed it. The actual purpose of the LOINC database is the exchange and pooling of different results from blood investigations (chemistry, hematology, serology, microbiology (including parasitology and virology), and toxicology; as well as categories for drugs and the cell counts), scanning reports, vital signs (ECG etc) outcomes management, and also for research.

LOINC is likely to become a HIPAA (Health Insurance Portability and Accountability Act ) standard for some segments of the Claims Attachment transaction. LOINC applies universal code names and identifiers to medical terms related to the Electronic health record. What are the different databases that are promoted and have been included in it? They include,

  • Medical code names
  • Laboratory names
  • Nursing diagnosis
  • Nursing interventions
  • Outcomes classification
  • Patient data set

Each database currently has over 41,000 observation terms. Each database record includes six fields for the unique specification of each identified single test, observation, or measurement.

  • The measured /observed component
  • Property like length, mass, volume etc
  • Time interval of observation
  • System- context
  • Type of scale (quantitative, ordinal, nominal /narrative )
  • Type of method/ procedure)

The resulting benefits of adopting LOINC include reduced errors, improved communication in integrated healthcare delivery networks, improved EHR (electronic health records), automatic transfer to public health authorities of case reports for reportable diseases, and improved transfer of payment information.

Heart Disease, Natural Health and Understanding Inflammation Factors

In a recent study, researchers of heart health conducted tests and documented the development of heart failure in an ethnically diverse group of nearly 7,000 men and women, age 45 to 84. This tracking began in 2000.

In this group, 79 developed congestive heart failure. 35 from this sub-group (44 percent) were physically obese. These people have a body mass index, or BMI, of 30 or more. And on average, participants who were obese, were found to have higher levels of several key immune system proteins involved in inflammation in their blood, than non-obese adults.

One specific key immune system protein, interleukin 6, showed double of average levels. The elevated level of this protein alone accounted for an 84 percent greater risk of developing heart failure in the study members.

Research groups from several universities in the US have found connections between inflammation and a high risk mix of heart disease factors labeled the ‘metabolic syndrome’. This syndrome, or collection of risk factors for heart disease and diabetes – high blood pressure, elevated blood glucose levels, excess abdominal fat and abnormal cholesterol levels, but, particularly obesity – double a person’s chances of developing heart failure.

Add exercise as a possible lifestyle change:

“Researchers at Emory University School of Medicine in Atlanta who measured the effects of an eight-week yoga regimen on 19 heart failure patients found the exercise routine reduced markers of inflammation associated with heart failure while also improving exercise tolerance and quality of life.Patients who did yoga saw a 26 percent decrease in symptoms on a standard assessment that measures quality of life in heart failure patients, compared to a 3 percent decrease for the patients on medical therapy alone.

“Yoga is aerobic. It is not surprising, in terms of its effects on the inflammatory markers,” said Dr. Nieca Goldberg, who prescribes both yoga and tai chi, a Chinese martial art, to her heart failure and heart attack patients.”

Ebola – An African Epidemic – Health and Medical Issues

In the year 1976, Ebola climbed out of its unknown hiding place, and caused the
death of 340 people. Fear gripped the victims’ faces, and uncertainty tortured
their minds. The people of Zaire waited outside clinics, churches and in their
homes for a treatment of the horrible disease, but there was no cure. They were
forced to watch people die, hoping that they would be saved from the violent
death of the Ebola virus. From the year of 1976 to the present date of 1996,
researchers have searched for origin and cure of the virus. Scientist have
carried out numerous studies and investigations, but no one has been able to
find the right explanations. Prevention of a world wide outbreak lies within the
education of what the virus is capable of doing, how Ebola victims can be
properly treated, and by performing prompt action to isolate the virus before it
has dispersed.

The Ebola virus is a member of a family of RNA viruses know as filoviruses.
Marburg virus and four Ebola viruses: Ebola Zaire, Sudan, Reston and Tai are the
five different viruses that have been known to cause disease in humans, while
Ebola Reston only causes disease within monkeys. Filoviruses are the viruses
responsible for causing viral hemorrhagic fevers. All forms of virus of viral
hemorrhagic fever begin with fever and muscle aches. Ebola Zaire attacks every
organ and tissue in the human body except skeletal muscle and bone. It is a
perfect parasite because it transforms virtually every part of the body into a
digested slime of virus particles. The seven mysterious proteins that,
assembled together, make up the Ebola-virus particle work as a relentless
machine, a molecular shark, and they consume the body as the virus makes copies
of itself. Your skin develops blood clots under the skin. Your organs turn to
mush and the underlayers of your skin die and liquefy. The !
skin bubbles up to form a blood rash. Your mouth bleeds, and you bleed around
your teeth, and you may have hemorrhages from the salivary glands. Every
opening in your body, no matter how small, excretes blood. The surface of the
tongue turns brilliant red and then falls off. It is swallowed or spat out when
you vomit up blood. Your heart bleeds in itself and you are not dead. Blood
gets into your eyelids and you weep blood. Before you finally die your body
twitches considerably from grand mal seizures.

Health, Wellness and Medical Science – 2007 Top Ten Trends

The Aspen Health Forum just gathered an impressive group of around 250 people to discuss the most pressing issues in Health and Medical Science.

1- Global health problems require the attention of the scientific community. Richard Klausner encouraged the scientific community to focus on Global Problems: maternal mortality rates, HIV/ AIDS, clean water, cancer…

2- “Let’s get real…Ideology kills”. Mary Robinson, former President of Ireland, on what it takes to stop HIV/ AIDS: “I am from Ireland, a Catholic country. And I am Catholic. But I can see how ideology kills..we need more empathy with reality, and to work with local women in those countries.” This session included a fascinating exchange where Bill Frist rose from the audience to defend the role of US aid, explaining how 60% of retroviral drugs in African countries have been funded by the American taxpayer. Which made Nobel Prize Laureate Peter Agre, also in the audience, stand up and encourage the US to really step up to the plate and devote 1% of the GDP to aid, as a number of European countries do, instead of 0.1%.

3- Where is the new “Sputnik”?: Many of the speakers had been inspired by the Sputnik and the Apollo missions to become scientists. Two Nobel Prize Laureates talked about their lives and careers trying to demystify what it takes to be a scientist and to win a Nobel Prize. Both are grateful to the taxpayers dollars that funded their research, and insist we must do a better job at explaining the scientific process to society at large. Both are proud of having attended small liberal arts colleges, and having evolved from there, fueled by their great curiosity and unpredictable, serendipitous paths, into launching new scientific and medical fields.

4- We need a true Health Care Culture: Mark Ganz summarized it best by explaining how his health provider group improved care when they redefined themselves from “we are 7,000 employees” to “we are a 3 million strong community”, moving from being a cost controller with a paternalistic attitude to a health facilitator, looking underneath symptoms to identify and deal with underlying patterns.

5- You can’t manage what you can’t measure. We heard many times how defining and measuring outcomes, so common in the private sector, is critical to ensuring a good allocation of resources in the health and scientific fields, that use so much taxpayer money. For example. NIH funding grew from $9B in 1994 to $29B in 2007, yet the results are not clear. The same happened with health care as a whole, a sector that now consumes 16% of the US GDP with health outcomes (infant mortality, patient deaths in hospitals) worse than other countries that invest far less.

6- The rising role of public-private partnerships: There are multiple initiatives launched to bridge the increasing gap between academia and industry. The Foundation for the NIH has facilitated key conversation between the FDA and pharma companies. The Gates and Clinton Foundations have launched innovative partnership models to tackle global health problems.

7- From Lifespan to Health-span. Population distribution in developed countries is shifting from a “population pyramid” to a “population rectangle”. The point of much ongoing research is not “how to spend more time on the nursing home” but how to slow down the process of aging, so we can live healthier longer.

8- Patient-advocacy groups are having an impact. We heard many examples on how small groups of motivated individuals have built large patient advocate movements that influence public policy. Michael Milken talked about the Cancer March, that helped increase NIH funding from $1.5B to 5$B. Hala Moddelmog, from the Susan G. Komen for the Cure, explained how they have 1 million people engaged in promoting cancer research and prevention. Robert Klein, key advocate of the California Proposition 71 (that will provide $6B for stem cell research through long-term bonds) explained how the proposition was passed, including engaging over 80 patient-advocacy groups.

9- There’s a new emphasis on understanding “how systems work” instead of “how isolated genes make things happen on their own”: Genomics is starting to help predict susceptibility to disease and to therapies. Now, we must keep in mind the role of our experience and environment in turning some genes on or off.

10- The importance of our Lifestyle-Each of us owns our own health. 70% of heathcare costs derive from lifestyle-related diseases (such as smoking-induced cancer). We heard several calls to action for insurance companies to incentivize behavior modification to promote good lifestyle habits that improve quality of life and can delay disease symptoms, resulting in billions of dollars of cost savings.