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Use of the LOINC Document Ontology
with the DoD Military Health System
Ms. Nancy Orvis MHS Director Business Architecture, Standards, and Interoperability
Mr. Russell Ott
Deloitte Consulting
September 3, 2014
“Medically Ready Force…Ready Medical Force”
What is the Health Artifact and Image
Management Solution (HAIMS)?
Provides Department of Defense (DoD) and Department of Veterans Affairs (VA)
health care providers global visibility and access to artifacts and images (A&I)
generated during the health care delivery process
Integrates with DoD’s current electronic health record (EHR) and supports the
exchange of A&I with the Department of Veterans Health Administration (VHA)
– As of 2 Dec 2013, HAIMS/VHA interface had shared over 26,345 A&I
Designated as the system of record to store the digitized Service Treatment Record
(STR) upon service member separation, and make it electronically retrievable by
the Veterans Benefits Administration (VBA)
– As of June 2014, 60,000 STRs made available to the VA via HAIMS repository
MHS has 9.6M beneficiaries potentially served by HAIMS
– All Active Duty and recently separated Active Duty personnel will have their legal health
record stored in HAIMS
“Medically Ready Force…Ready Medical Force”
HAIMS DocTypes: Current State
• HAIMS is an aggregator of information and hub for data
– Some content is locally stored within HAIMS
– Some content is stored as a metadata reference to other systems (e.g.,
• Strategic direction is to attempt to standardize our Document
Type framework using the LOINC Document Ontology and
encourage other provider organizations to do the same.
• HAIMS Document Type schema:
– 98 total current Document Types
• 56 Codes from LOINC Document Ontology
• 32 LOINC codes not in the Ontology
• 10 DoD-specific codes
“Medically Ready Force…Ready Medical Force”
Addition of Reserve documents
• The Army Reserve has its own documentation repository
• Recently we performed a mapping effort to the LOINC
Document Ontology with the following results:
• Started with 150 unique forms
• Mapped down to 37 Document Types
25 Codes from LOINC Document Ontology
10 LOINC codes not in the Ontology
2 Concepts where LOINC codes need to be requested
0 MHS-specific codes (with examples)
“Medically Ready Force…Ready Medical Force”
Requests for LOINC Clinical Committee
• Add new LOINC codes
HAIMS Description
Summary - Profile
Encounter Note - E&M of Tuberculosis
• Add specified LOINC codes into the Document Ontology
HAIMS Description
LOINC Long Description
Dental - X-ray
Encounter Note - Immunization
Encounter Note - Occupational Exposure
Encounter Note - Transfusions
Procedure Note - EEG
Procedure Note - EKG
Procedure Note - Gynecologic Cytology
Procedure Note - Laboratory
Procedure Note - Pathology
Procedure Note - Spirometry
Dental X-rays and other images (not DICOM)
History of immunization Narrative
History of occupational exposure Narrative
History of blood transfusion Narrative
EEG study
EKG study
Cytology Cervical or vaginal smear or scraping study
Laboratory report
Pathology Procedure Note
Spirometry study
“Medically Ready Force…Ready Medical Force”
Next Steps
• DoD is planning to perform a full review of LOINC codes in use
within HAIMS and present additional requests at the next
Clinical Committee Meeting
– Specific focus is the 32 LOINC codes not in the Ontology and the 10
DoD-specific codes
“Medically Ready Force…Ready Medical Force”
Nancy Orvis
Russell Ott
[email protected]
[email protected]
“Medically Ready Force…Ready Medical Force”

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