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LOINC
LOINC
LOINC
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Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations. First developed in 1994, it was created and is maintained by the Regenstrief Institute, a US nonprofit medical research organization. LOINC was created in response to the demand for an electronic clinical care and management database and is publicly available at no cost.

It is endorsed by the American Clinical Laboratory Association. Since its inception, the database has expanded to include not just medical laboratory code names but also nursing diagnosis, nursing interventions, outcomes classification, and patient care data sets.

Function

[edit]

LOINC applies universal code names and identifiers to medical terminology related to electronic health records. The purpose is to assist in the electronic exchange and gathering of clinical results (such as laboratory tests, clinical observations, outcomes management and research). LOINC has two main parts: laboratory LOINC and clinical LOINC. Clinical LOINC contains a subdomain of Document Ontology which captures types of clinical reports and documents.[1][2]

Several standards, such as IHE or HL7, use LOINC to electronically transfer results from different reporting systems to the appropriate healthcare networks[citation needed]. However, the health information enclosed is identified by a multiplicity of code values that may vary according to the entity producing those results. This has obvious disadvantages to the healthcare network that may need to adopt different codes to access and manage information coming from multiple sources. Managed care providers, for example, often have negotiated contracts that reimburse episodes of care and unique coding to trigger automated claim payment. Mapping each entity-specific code to its corresponding universal code can represent a significant investment of both human and financial capital.

A universal code system will enable facilities and departments across the world to receive and send results from their areas for comparison and consultation and may contribute toward a larger public health initiative of improving clinical outcomes and quality of care.

LOINC is one of the standards used in U.S. Federal Government systems for the electronic exchange of clinical health information. In 1999, it was identified by the HL7 Standards Development Organization as a preferred code set for laboratory test names in transactions between health care facilities, laboratories, laboratory testing devices, and public health authorities.[3]

Content

[edit]

LOINC terminology has two main parts:[4]

  • Laboratory LOINC: It covers laboratory tests, microbiology tests (including antibiotic susceptibilities)
  • Clinical LOINC: It covers a variety of non-lab concepts (ECG concepts, cardiac echo, obstetric ultrasound). Within clinical LOINC, there are also sup-parts for
    • Clinical documents: concepts for various types of clinical reports (e.g., discharge summary, well-child visit note)
    • Survey instruments: concepts for standardized surveys (e.g., Glasgow Coma Score, PHQ-9 depression scale)

Format

[edit]

A formal, distinct, and unique 6-part name is given to each term for test or observation identity.[5] The database currently has over 71,000 observation terms that can be accessed and understood universally. Each database record includes six fields for the unique specification of each identified single test, observation, or measurement:

  1. Component- what is measured, evaluated, or observed (example: urea,...)
  2. Kind of property- characteristics of what is measured, such as length, mass, volume, time stamp and so on
  3. Time aspect- interval of time over which the observation or measurement was made
  4. System- context or specimen type within which the observation was made (example: blood, urine,...)
  5. Type of scale- the scale of measure. The scale may be quantitative, ordinal, nominal, or narrative
  6. Type of method- procedure used to make the measurement or observation

A unique code (format: nnnnn-n) is assigned to each entry upon registration. Other database fields include status and mapping information for database change management, synonyms, related terms, substance information (e.g. molar mass, CAS registry number), choices of answers for nominal scales, translations.

Uses

[edit]

Some of the advantages resulting from adopting LOINC may include improved communication in integrated healthcare delivery networks, improved community wide electronic health records, the automatic transfer to public health authorities of case reports for reportable diseases (e.g. for disease control or detection of epidemics), improved transfer of payment information for services rendered and a significant improvement in the overall quality of health care by reducing errors in the system.

The fact that universal standards are being promoted (if not adopted by national organizations and agencies) is an indication that the dialogue will continue regarding the development, structure, financing, monitoring, enforcement, and integration of standards within the broader health care system.

International interest in LOINC continues to grow. A number of efforts have been undertaken to translate the LOINC documents and terms into various languages, such as Simplified Chinese, German, Spanish. As of January, 2009, the software RELMA (Regenstrief LOINC Mapping Assistant) is available in separate downloads that contain an additional word index in Spanish, Simplified Chinese, or Korean, which allows searching in these languages in addition to English.[6] Harmonization efforts between LOINC and SNOMED CT were initiated in 2012.

See also

[edit]
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References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

LOINC

View on Grokipedia
from Grokipedia
LOINC, which stands for Logical Observation Identifiers Names and Codes, is a universal standard for identifying measurements, , and documents in clinical settings. Developed and maintained by the Regenstrief Institute, it serves as a common language—a set of unique codes, names, and descriptors—for tests, , clinical assessments, surveys, and document types, enabling standardized electronic data exchange across healthcare systems, , providers, researchers, and agencies worldwide. First initiated in by Clem McDonald, a Regenstrief investigator, LOINC addresses the challenge of proprietary or idiosyncratic coding in healthcare by providing a free, openly accessible database that promotes and . As of August 2025, it is the world's most widely used for these purposes, supporting integration with standards like HL7 and , and containing 108,249 terms that cover everything from blood glucose levels to reports and patient questionnaires. Its core structure assigns a unique six-part code to each , incorporating components such as the measured, property observed, and units of measure, which ensures precise identification without ambiguity in diverse contexts like clinical care, outcomes management, and research. LOINC's adoption has been driven by regulatory requirements for electronic records and reporting, making it essential for global data harmonization, particularly in areas like result transmission and vital statistics collection.

Background

History

LOINC was initiated in by Clem McDonald, an investigator at the Regenstrief Institute, a nonprofit medical research organization affiliated with , to address the growing need for a standardized to facilitate electronic reporting of laboratory and clinical observations across healthcare systems. This effort arose from challenges in exchanging data via standards like HL7, where proprietary or idiosyncratic codes hindered . The founding meetings, held at Regenstrief starting February 16, , involved key figures including Stan Huff, John Baenziger, and others to establish a public code system for observations. Initial development occurred under sponsorship from the National Library of Medicine (NLM) and other government and private entities, with NLM providing funding in 1994 to test LOINC in a metropolitan health network. The , organized by Regenstrief, guided the creation of universal names and codes, focusing on tests initially. During preliminary stages, the naming model evolved rapidly as the gained experience in capturing the nuances of clinical observations, refining components like , , and time aspects to ensure clinical distinctiveness. The first release, LOINC 1.0, occurred on April 24, 1995, containing more than 6,000 terms for observations. Key milestones marked LOINC's growth and integration. In 1999, (HL7) designated LOINC as a preferred code set for laboratory test names in transactions between healthcare facilities and laboratories, embedding it into broader messaging standards. By the early 2000s, international adoption accelerated, with translations into multiple languages enabling use in over 20 countries and supporting global data exchange initiatives. Regenstrief, as a nonprofit, has maintained LOINC since its inception, ensuring free access and ongoing development through committee oversight and NLM contracts, such as the initial support agreement in 1999. By 2020, the database had expanded to nearly 95,000 terms, reflecting its evolution from lab-focused codes to include clinical measurements, surveys, and documents.

Purpose

LOINC serves as a universal standard for providing names and ID codes to identify and clinical observations, measurements, and documents, enabling the creation of portable and understandable that can be shared across diverse computer systems, laboratories, providers, and international stakeholders. By establishing a common language for these elements, LOINC acts as a global that facilitates the electronic exchange of clinical results without the need for extensive custom mappings. A key challenge LOINC addresses is the inconsistency in how laboratory results and observations are named and coded across different healthcare systems, which previously hindered the aggregation of data for purposes such as , quality improvement measures, and . Without standardized identifiers, electronic data exchange often required labor-intensive translations between proprietary codes, leading to errors and inefficiencies in pooling information from multiple sources. LOINC mitigates these issues by assigning unique codes that represent the semantic "question" being asked in each test or measurement, ensuring consistent interpretation regardless of the originating system. In broader terms, LOINC supports seamless integration into electronic health records (EHRs) by allowing systems to automatically recognize and file incoming results, thereby reducing mapping errors and enhancing data accuracy for care. It also promotes the reuse of across domains, including outcomes management, secondary analysis for research, and policy development, by enabling with messaging standards like HL7 and fostering global data harmonization.

Terminology Structure

LOINC Codes

LOINC codes function as permanent, unique identifiers for laboratory and clinical observations, ensuring consistent identification across healthcare systems worldwide. These codes are numeric strings consisting of digits and a , ranging from 3 to 8 characters in length, formatted as a sequence of digits followed by a hyphen and a single digit, such as 718-7. The structure of a LOINC code consists of a sequence number assigned sequentially and a mod-10 appended for validation, with no semantic meaning embedded in the numeric components themselves. This design prioritizes simplicity and reliability, allowing the code to serve solely as a non-descriptive tag for the associated observation. New LOINC codes are generated sequentially by the Regenstrief Institute following approval of proposed terms by the LOINC Committee, a process that includes internal and pre-release publication for feedback. Once assigned, codes are never deleted, reused, or altered, maintaining in all subsequent LOINC releases through persistent inclusion in the database even if terms are deprecated. In practice, LOINC codes are integrated into electronic health information exchange standards, such as HL7 version 2.x messages, where they populate the OBX-3 (Observation Identifier) field of OBX segments to specify without ambiguity. This usage facilitates interoperable transmission of test results and clinical data across disparate systems. Each code is paired with a Fully Specified Name for descriptive context.

Names and Attributes

The Fully Specified Name (FSN) in LOINC serves as the primary human-readable descriptor for a term, combining the unique LOINC code with a structured phrase organized along six axes to provide precise semantic context. These axes include the Component, which identifies the analyte or substance observed (e.g., "Hemoglobin"); the Property, denoting the measured attribute (e.g., "Mass concentration"); the Time Aspect, specifying the timing of the observation (e.g., "Point in time"); the System, indicating the specimen or sample type (e.g., "Blood"); the Scale Type, describing the measurement scale (e.g., "Quantitative"); and the Method, outlining the technique used (e.g., "Automated count"), which is optional but allows for clinically significant variations. This axis-based structure ensures that the FSN captures the essential details of laboratory and clinical observations in a standardized, machine-readable format. Complementing the FSN are additional attributes that enhance usability and maintenance. The Short Name is a concise version of the FSN using common abbreviations and acronyms for quick reference (e.g., "Hgb Bld-mCnc" for in blood; "MCH RBC Qn Auto" for by automated count). The Long Common Name provides a clinician-friendly, description (e.g., "Hemoglobin [Mass/volume] in Blood"). Terms also include a Status attribute, which indicates their lifecycle stage—such as ACTIVE for fully vetted and recommended use, for experimental terms, DISCOURAGED for outdated but still valid options, or DEPRECATED for retired concepts—guiding implementers on appropriate selection. Related terms, stored as synonyms or mappings, link equivalent names like brand-specific variants or panel components to the core LOINC term, supporting across systems. LOINC terms are hierarchically organized into classes, which group related concepts for easier navigation and curation (e.g., the CHEM class encompasses chemistry-related observations like electrolyte assays). This classification, defined in Appendix B of the LOINC documentation, allows users to sort and filter terms by domain, such as laboratory or clinical, without altering the underlying structure. The naming system's flexibility accommodates method-specific variants—such as distinguishing immunoassay from enzymatic methods—while preserving the universality of the core axes, enabling broad applicability in diverse healthcare settings without proliferation of unique codes. This balance supports both granular reporting and standardized data exchange.

Content

Scope and Categories

The LOINC database comprises over 108,000 terms as of its version 2.81 release in August 2025, providing standardized codes for a broad spectrum of healthcare observations to support interoperable data exchange worldwide. These terms primarily encompass laboratory tests, such as those in chemistry (e.g., serum potassium levels) and hematology (e.g., blood hemoglobin concentration); clinical measurements, including vital signs (e.g., blood pressure) and anthropometrics (e.g., body height); survey instruments for patient-reported outcomes, such as PROMIS scales for physical function; and document types, like discharge summaries or radiology reports (e.g., zygomatic arch x-ray reports). LOINC organizes its terms into more than 20 broad classes to facilitate grouping and retrieval, with the class being the largest and covering domains like , , and . Other key classes include CLINICAL for and specialty assessments (e.g., , ); , often under for genetic variant analyses and ; and , which addresses patient occupational, , and environmental factors as part of history and physical examinations. Emerging areas within these classes now incorporate (e.g., stability assessments) and allergens (e.g., and environmental triggers), reflecting evolving healthcare needs. Inclusion in LOINC is limited to terms representing identifiable, clinically meaningful observations in healthcare settings, such as test results or measurements that require universal identification for exchange, while excluding diagnoses, procedures, or non-interpretive test details like instrument specifics—these are handled by complementary standards like . This focus ensures LOINC serves as a for observations rather than comprehensive clinical documentation. With translations available in 22 languages through community-driven linguistic variants, LOINC supports global by accommodating diverse international laboratory practices and cultural contexts in healthcare data reporting.

Updates and Releases

LOINC maintains its database through a structured process of regular updates, driven by community input and rigorous review to ensure and accuracy in healthcare . New terms and modifications are submitted via an online request form on the LOINC website, where they undergo by the LOINC Committee, an advisory body that guides content development and approves additions or changes. This process includes deprecating obsolete terms to reflect evolving clinical practices, with measures applied to maintain consistency across the nomenclature, such as standardized definitions and alignment with international standards. The release cadence consists of twice-yearly major updates in and , supplemented by interim hotfixes as needed to address errors or omissions. For instance, Version 2.79, released in 2025, introduced 530 new terms, with a significant focus on health-related social needs screening tools developed in collaboration with the Gravity Project, including standardized instruments like the IPV-4 and Perceived Stress Scale (PSS-10 and PSS-14). Version 2.81, released in 2025, added 3,576 new concepts and updated 647 existing ones, totaling over 4,000 changes centered on panels, environmental allergens, and pain assessment instruments. Recent expansions have emphasized growth in specialized areas, including with new concepts, environmental allergens such as avian feathers and mold (adding approximately 400 terms), and orderable groupers under the LABORDERS.ONTOLOGY class (nearly 2,000 new hierarchical structures for lab ordering). By mid-2025, the total number of LOINC terms exceeded 104,000, reaching 108,248 active, deprecated, discouraged, and trial concepts in Version 2.81. Versioning follows semantic principles, with core table changes—such as additions to the LoincTableCore—detailed in comprehensive that outline updates, rationales, and status changes to support user compatibility. Minor releases focus on content expansion without structural alterations, allowing implementers to update within 90 days while preserving for existing codes.

Applications

and Standards

LOINC plays a pivotal role in healthcare by integrating with messaging standards such as HL7 version 2.x, where its codes are utilized in the OBX-3 field of OBX segments to identify and results in electronic messages like ORU (Observation Result) reports. This enables standardized transmission of clinical test data across systems, supporting structured reporting for lab results in healthcare electronic messaging. Furthermore, LOINC aligns with HL7 FHIR through dedicated terminology services, allowing programmatic access to its content via FHIR APIs for querying and exchanging codes in modern information exchanges. In regulatory contexts, LOINC is mandated under the U.S. (CMS) Promoting Program—formerly known as Meaningful Use—for encoding laboratory and vital sign data to meet electronic clinical quality measure (eCQM) requirements, ensuring consistent reporting of elements in certified electronic health records (EHRs). It also supports through the Centers for Disease Control and Prevention (CDC), where LOINC codes are required for electronic laboratory reporting (ELR) of notifiable diseases, facilitating standardized data submission via the National Electronic Disease Surveillance System (NEDSS). LOINC facilitates data pooling by providing universal observation identifiers that standardize laboratory and clinical measurements, enabling aggregation across disparate sources for research databases, clinical trials, and population health analytics without loss of semantic meaning. For instance, in multi-site research, LOINC harmonizes heterogeneous data sets, allowing researchers to combine results from various institutions for secondary analyses and outcomes studies. In clinical trials, it supports core datasets for frequently requested laboratory panels, streamlining patient recruitment and data integration. On a global scale, LOINC aligns with for medical laboratory quality and competence by serving as a recommended coding system for test identifications in accredited facilities, promoting consistent documentation and result reporting. It further supports cross-border data sharing through initiatives aligned with the World Health Organization's (WHO) Global Strategy on , including efforts to standardize diagnostics lists and foster international health coordination via the Joint Initiative Council.

Adoption and Impact

LOINC has achieved widespread global adoption, with over 239,000 registered users across 196 countries as of recent records, facilitating standardized exchange worldwide. It serves as a national standard in more than 25 countries, including the , , and several in and , underscoring its role in international healthcare . In the , LOINC is integrated into major (EHR) systems such as Epic and Cerner, enabling seamless incorporation of results into patient records. Surveys of academic medical centers indicate that a mean of 74% of unique tests are mapped to LOINC codes, with some institutions reporting coverage exceeding 90%, though adoption varies by site. In specialized domains, LOINC has demonstrated significant impacts by standardizing data for targeted applications. In , LOINC codes support reporting through dedicated panels, such as the Master HL7 genetic variant reporting panel (LOINC 81247-9), which enhances the of complex genetic test results across systems. For public health surveillance, particularly during the , LOINC provided essential codes for testing, such as those for detection (LOINC 94565-9) and presence (LOINC 94558-4), enabling consistent aggregation of results from diverse laboratories for national and global tracking. Additionally, LOINC facilitates research by allowing meta-analyses of heterogeneous datasets, as standardized codes enable pooling of laboratory observations from multiple sources without loss of semantic meaning. The adoption of LOINC offers clear benefits in efficiency and , though it involves upfront challenges. Studies show that mapping local laboratory terms to LOINC reduces the time and cost associated with , with automated tools alleviating much of the manual effort required for integration. For instance, institutions using LOINC report improved data accuracy and reduced duplicate testing, contributing to safer patient care, but initial mapping investments are necessary to achieve these gains. Looking ahead to 2025 and beyond, LOINC is poised to play an expanding role in AI-driven healthcare analytics and value-based care models. Its standardized structure supports AI applications in and predictive modeling from laboratory data, fostering more precise clinical . In value-based care, LOINC enhances outcomes research by enabling reliable aggregation of quality measures, aligning with efforts to tie reimbursements to performance metrics across provider networks.

Tools and Resources

RELMA Software

RELMA, the Regenstrief LOINC Mapping Assistant, is a free Windows-based desktop application developed by the Regenstrief Institute to facilitate searching, browsing, and mapping local or clinical terms to LOINC codes. It serves as the primary standalone tool for offline access to the full LOINC database, enabling users to import, match, and export mappings without an connection. Designed for healthcare organizations, RELMA supports the creation of standardized mappings essential for in electronic health records (EHRs) and information systems. Key features of RELMA include advanced search functionality that allows queries using partial names, synonyms, or keywords across multiple linguistic variants, such as English, Spanish, and others, to identify candidate LOINC terms efficiently. The software provides a hierarchy viewer displaying LOINC terms in a multiaxial , organized by components like , , and system, which aids in conceptual navigation and selection of appropriate codes. Users can import bulk local terms from CSV files, HL7 messages, or test catalogs, apply automated mapping algorithms like the Intelligent Mapper for ranked suggestions, and validate matches against detailed LOINC attributes such as status, scale, and method. Mappings can be exported in CSV format for integration into local systems, with options to view community-suggested mappings and request new LOINC codes directly from the interface. For web-based quick lookups, RELMA's search capabilities complement the online LOINC browser, though core mapping remains desktop-focused. RELMA is widely used by laboratories and EHR vendors to standardize test , supporting bulk uploads for large-scale mapping projects and ensuring compliance with the latest LOINC content for accurate data exchange. The tool requires or later, at least 1 GB of RAM, and 2 GB of disk space, with installation including the complete LOINC database for immediate use. Updates to RELMA are aligned with biannual LOINC releases, incorporating new terms, revised content, and database enhancements while maintaining core functionality in a stable release. As of version 7.14, released with LOINC 2.81 in August 2025, RELMA supports the expanded LOINC Ontology, enabling better integration with for hierarchical grouping and improved semantic interoperability in mappings. This update restores features like Greek linguistic search options and ensures access to over 100,000 LOINC terms, though the software remains in with no major new features planned, as functions gradually migrate to web-based alternatives.

Collaborations and Integrations

LOINC has established significant collaborations to enhance in healthcare exchange. A key partnership is with SNOMED International, resulting in the LOINC-SNOMED CT Ontology, which serves as an extension of SNOMED CT's framework to create shared concepts between the two terminologies. Version 2.0 of this ontology, released in September 2025, includes over 6,000 new concepts focused on laboratory order , enabling standardized ordering and result reporting across systems. Additionally, LOINC collaborates with HL7 International to integrate its codes into FHIR resources, facilitating programmatic access to LOINC content via the HL7 FHIR for structured exchange. Integrations with other standards further extend LOINC's reach. The LIVD initiative, led by the Centers for Disease Control and Prevention (CDC), provides mappings between LOINC codes and diagnostic (IVD) device test codes, supporting accurate reporting of test results from instruments. LOINC also aligns with international standards, including recognition by the (WHO) for global health data harmonization and compliance with ISO technical specifications for clinical testing. To support community engagement and implementation, LOINC offers various online resources. The SearchLOINC web application allows users to query and export LOINC terms intuitively, while the Hierarchy Browser enables navigation through LOINC codes organized by categories such as component and system. The LOINC Community Forum provides a platform for users to discuss implementations, share experiences, and submit requests for new terms, fostering collaborative development. Free downloads of the LOINC database are available, along with APIs for programmatic integration, including the Download API and FHIR-based Terminology Service. In 2025, developments included expanded SNOMED grouper concepts to organize panels and improve ordering workflows within the LOINC . Recent releases also added two new language translations— and Czech—bringing the total to 22 linguistic variants to support broader .

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