(Editor's note: this is the second part of a three-part series on LOINC, SMOMED, and ICD-10. Click here to view part 1. Check back in the coming weeks for part 3.)
The journey down the brick road of reimbursement cannot be complete without the help of three companions; LOINC, SNOMED and ICD. LOINC may be the main stay of diagnostic testing, but it is only one of the three legs supporting laboratory medicine in ARRA HITECH Stages 1 and 2, as well as ACA. Where LOINC can easily define the outcome of a simple test, far more complex tests speak a different language; SNOMED CT. The journey can happen without SNOMED, but it will lack the quality information the patient needs.
What makes SNOMED CT different than LOINC? LOINC is a numeric representation of a test methodology: unit of measure, analyte tested, point in time the specimen was obtained, and the type of specimen. It's great for presenting a creatinine result. However, parts of lab medicine have far more complicated, process driven tests; anatomic pathology and microbiology to name two.
 Here the information is less complex, but the process to create the information is more complex. The point behind interoperability is the ability to share health information electronically in real time. This is where SNOMED enters our journey. It is a clinical terminology which provides clinical content and expressivity for medical documentation and greater granularity than ICD or LOINC. A blood culture result is a very vital piece of clinical information. We work with great focus and attention to detail to ensure that the results we produce are accurate, timely and as precise as possible.
The most sophisticated communication LOINC can offer is the general microbe physical description; Gram negative Cocci. This creates more questions than answers to those caring for the patient. Is it GC? Is it Legionella? Our simple, trusted Scarecrow, LOINC, just doesn't have the brain to answer. This is where the Lion, SNOMED CT shines. LOINC is the question (order) and SNOMED is the answer.
SNOMED has been around for a very long time. Over the years, it has matured and grown. At one time, there were a few different SNOMED families. With the guidance of CAP, it became SNOMED CT. All the families joined to become Clinical Terminology, or CT and our cunning Lion was born. Like all large families, it is a series of hierarchies driving to the specific individual name. SNOMED can take the result of the complex biogram, the organism's name and create the binary code to communicate it to those caring for the patient. Our Gram negative Cocci becomes 24226003, Moraxella (Branhamella) catarrhalis. Now the clinical information has become truly meaningful to the care team: Moraxella (Branhamella) catarrhalis identified by a Blood Culture. Then LOINC can take over and communicate the antimicrobial susceptibility panel's analytes and their numeric or qualitative results.
How difficult is it to do your own SNOMED CT coding? Like many things, that depends on your time, resources, and affinity for the subject matter.
With two of our three companions on this journey by our side, we are closer to home than ever. We have LOINC to communicate the simpler information for orders or observations in clinical lab and SNOMED to tackle the more detailed clinical definitions. We have successfully defined the testing and results, the interoperability coding is almost complete. The remaining question is, "Why did the testing occur?," or in billing terms, "What was the diagnosis/patient presentation?" For that we will need a new companion. The road may now be less lonely and scary, but road continues to stretch before us.
Since the draft of this article and completion of her LOINC/SNOMED CT coding project, Baker has joined BITAC MAP SL as the Head of USA Business Development in addition to her duties as the Laboratory Operations Manager of St Peter's Hospital in Helena, Montana, and her other professional activities. She did so out of a desire to share with others the alternatives to struggling through this process alone.
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