Collaboration on data interpretation standards can enhance interoperability, workflows

Easing health information exchange for providers, enabling exchange within workflows is the goal of a collaboration agreement between LOINC and SNOMED CT.

data sharing - EHR
The collaboration between LOINC and SNOMED CT could provide a big step forward toward semantic interoperability.

The developers of the SNOMED CT and LOINC terminology standards used in electronic health records are collaborating on a project designed to make it easier to adopt a unified approach to implementing both standards, with a goal of easing broader health information exchange.

“The purpose of the agreement is to come up with a solution that would allow users who use both standards to implement and interoperate in a simple and efficient manner,” says Don Sweete, CEO of SNOMED International.

LOINC is a worldwide standard for identifying health measurements, observations and documenHL&ts; it enables the exchange and collection of data across health systems. The coding system identifies laboratory tests and other diagnostic procedures that clinicians order.

SNOMED CT is a comprehensive multilingual healthcare terminology; the coding captures the care of individuals in an EHR and facilitates information sharing, decision support and analytics. The codified language for groups of clinical terms can be used, for example, to identify test results.

A significant step

The agreement is an important step in the effort to make these standards interoperable so complete records can be exchanged, says Charles Christian, vice president of technology at Franciscan Health in Indianapolis and a former executive at the Indiana Health Information Exchange.

“Having too many standards can be less helpful than no standards at all,” he points out. “As an industry, we have found that interoperability in the clinical setting is difficult at best. Therefore, the more that we can standardize and harmonize our tools, the better the opportunity we have to get to a place where we can exchange data in a meaningful way, without the need for further interpretation.”

Christian says the announcement from LOINC and SNOMED “is a grand step in this process, and I look forward to what’s next.”

Developing an ‘extension’

Under their new collaborative agreement, SNOMED International and Regenstrief Institute, the developer of LOINC, will work on developing a LOINC “extension” that aligns with the SNOMED CT model.

The developers say the extension will create SNOMED CT and LOINC codes for all concepts that are shared between the terminologies, making it easier for implementers to have a unified approach to implementing both standards and meet clinical and regulatory requirements.

“An easy way to think about how LOINC and SNOMED work together now is that LOINC provides codes that ask a question, and when needed, SNOMED provides codes for the answer,” according to a joint statement from Marjorie Rallins, executive director of LOINC, and Stan Huff, MD, chair of the Clinical LOINC Committee.

“A common interaction between LOINC and SNOMED CT occurs in microbiology. For example, when a culture (the question) is ordered, that order will be coded in LOINC. The result (answer) would be coded in SNOMED CT,” the statement explains.

A SNOMED extension, they note, “is a place where domain-specific codes (like codes for laboratory results, microbiology results or radiology results) can be developed by a community, and then the codes can be shared with other interested users as appropriate.”

Having LOINC and SNOMED together in an extension “provides a structure that links each terminology to broader and enhanced content in the other, which allows for more robust analysis of patient data,” the two LOINC experts say.

The LOINC and SNOMED developers are working on a proof of concept for the extension. “We are hopeful to have the first iteration available to the community in 2023,” SNOMED’s Sweete says.

One goal of the effort is “to come up with a solution that would enable those who use both standards to implement and interoperate in a simple and efficient manner,” Sweete adds.

Health information exchange

Another goal of the collaborative project, the two LOINC executives say, is to promote health information exchange nationally and internationally. The development of the LOINC extension for SNOMED CT is helpful, they say, “because it allows interoperation of records/results across entities and jurisdictions that may have different requirements for numerous standards.”

The new extension also will help support efforts to increase health information exchange that leverages the HL7 FHIR (Fast Healthcare Interoperability Resources) standard, the two LOINC experts say.

“Both LOINC and SNOMED codes are already in use in both HL7 V2.X standards and in HL7 FHIR,” they point out. “This collaboration will make it possible to tightly couple LOINC codes (for questions and observations) to SNOMED codes (for answers and answer lists) in the creation of HL7 Implementation Guides and FHIR profiles. Creating these linkages makes a precise definition of how clinical information should be represented, and that moves the process closer to semantic interoperability.”

Semantic interoperability eases the ability of systems to exchange data with unambiguous, shared meaning.

“Users will be able to use either LOINC or SNOMED IDs in their health records, and the meanings would be semantically equivalent,” SNOMED’s Sweete says.

“The advantage of the agreement is that organizations that do not use LOINC can leverage the LOINC extension, which includes SNOMED CT IDs, so that SNOMED can be used to represent both the ‘question’ and the ‘answer.’ Those organizations that use LOINC could use LOINC IDs to represent the question and SNOMED CT IDs to represent the answer.”

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