Guest post by Liz Amos, MLIS, Operations Analyst in the Office of the Director, NLM.
This year, the biomedical research community is commemorating the 30th anniversary of the Logical Observation Identifiers Names and Codes (LOINC®), a pioneering terminology standard comprising a set of codes that are important for ordering medical tests and reporting clinical research results. This “global lingua franca” (common language) has revolutionized how clinical and laboratory data are documented and shared across healthcare systems. LOINC was established in 1994 by the Regenstrief Institute, a nonprofit medical research organization, in response to the growing demand for a standardized, electronic clinical care and management terminology database. LOINC aids the electronic exchange and gathering of clinical results such as laboratory tests, clinical observations, outcomes management, and research for easy exchange of information.
NLM recognizes LOINC as a vital terminology standard and for the benefits it brings to hospitals, physicians’ offices, laboratories, and more. To support LOINC’s formation, in 1994, NLM funded efforts to test the use of LOINC in a metropolitan health network that linked multiple hospitals, laboratories, clinics, and public health facilities. This was the first information exchange between separate facilities that demonstrated the feasibility of the information exchange model and the use of LOINC in both healthcare and research. Since then, NLM has continued to provide long-term funding and support for LOINC’s ongoing maintenance, development, and distribution. NLM support also ensures LOINC resources are freely available and part of NLM’s Unified Medical Language System (UMLS) Metathesaurus.
To celebrate this significant anniversary, I sat down with Dr. Clem McDonald, the creator of LOINC and a Senior Investigator at NLM, to learn more about its history and accomplishments.
Clem, tell us how LOINC came to be. What problem does it solve?
LOINC came to be because we needed identifiers for observations that you can test for—or measure—in a patient. It started out with laboratory tests and then extended to all clinical measurements. A major purpose of the LOINC code was to identify tests and measurements in Health Level Seven International (HL7) messages, which help clinical researchers report results in a standard way around the world. HL7 messages provide the structure, and the LOINC code provides the meaning of the observation. It enables you to repeat the same measurement over time so you can detect trends. Using standard codes also assures that other users from around the world can understand what you’re saying.
In 1983, you wrote a short editorial called “Grocers, Physicians, and Electronic Data Processing,” which described the foresight grocers had to develop the Universal Product Code (UPC) standard. You thought that healthcare should have similar standards, which later led to the creation of LOINC. What made you look at the grocery industry?
Very early on, grocers were putting standard codes on bottles and cans and everything, even before they had widespread barcode readers. It was very forward-thinking, and we thought this could be transferrable to healthcare. In the healthcare industry, no one was thinking about standardization at all. In fact, at the time, journal reviewers were saying that computers wouldn’t be part of healthcare, so we faced problems even getting the article published.
What are the main achievements of LOINC over the past 30 years?
LOINC’s main achievement is that it’s become widely adopted. As of June 2024, LOINC has over 216,000 registered users from nearly 200 countries and territories. LOINC is also an important part of federal health IT requirements, including the United States Core Data for Interoperability (USCDI), which the Office of the National Coordinator uses to define data elements and associated terminology standards to support patient care and facilitate patient access using health IT.
How have the collaboration and input from various stakeholders shaped the development and expansion of LOINC?
Collaboration and input have made LOINC better. Commercial laboratory test companies, public health departments, and others who produce medical tests are usually the ones who request a LOINC code, but anyone can request a code. We started out with just laboratory tests, and now we have clinical measurements and assessments within LOINC because users requested them.
What are some of your fondest memories creating and developing LOINC?
I have many fond memories of working with the enthusiastic colleagues who helped with its development. It has also been great meeting international adopters and seeing how LOINC is implemented around the world.
Is there anything else people should know about LOINC?
LOINC is available and free for everyone to download!
Interested in learning more about this important LOINC anniversary? Check out how LOINC is celebrating 30 years!
Liz Amos, MLIS
Operations Analyst, Office of the Director, NLMMs. Amos serves as Technical Information Specialist supporting NLM Operations in the Office of the Director. Prior to this role, she was Special Assistant to Dr. Clem McDonald, where she supported the coordination of NLM resources in the advancement of exchange, integration, sharing, and retrieval of electronic health information. She continues to provide technical expertise and support for the FHIR® interoperability standard and vocabularies specific to clinical care, including LOINC, SNOMED CT, and RxNorm. Ms. Amos holds a Master of Library Information Studies from the University of Oklahoma.