NPU, LOINC, and SNOMED CT: a comparison of terminologies for laboratory results reveals individual advantages and a lack of possibilities to encode interpretive comments

Background

Terminologies facilitate data exchange and enable laboratories to assist in patient care even if complex treatment pathways involve multiple stakeholders. This paper examines the three common terminologies Nomenclature for Properties and Units (NPU), Logical Observation Identifiers Names and Codes (LOINC), and SNOMED Clinical Terms (SNOMED CT).

Methods

The potential of each terminology to encode five exemplary laboratory results is assessed. The terminologies are evaluated according to scope, correctness, formal representations, and ease of use.

Results

NPU is based on metrological concepts with strict rules regarding the coding of the measurand and the result value. Clinically equivalent results are regularly mapped to the same code but there is little support to differentiate results from non-standardized measurements. LOINC encodes analyses as offered by the laboratory. Its large number of entries allows different mappings for the same analysis. SNOMED CT contains few analyses natively, but its formal composition mechanism allows representing measurements by post-coordinated expressions that are equivalent to LOINC codes. SNOMED CT’s strength lies in its support of many non-numerical result values. Implicit code hierarchies exist in NPU and LOINC. SNOMED CT has explicit, elaborate axioms that elucidate the meaning of its content. Its complexity and its license conditions, however, impede a more widespread use. Interpretive comments, a crucial part of laboratory results, are still difficult to encode with any of the terminologies.

Conclusions

All three terminologies have distinct potentials and limitations, but the approximation of SNOMED CT and LOINC suggests using them together. Terminologies need to be expanded to also cover interpretive comments.

 

The full text of this article can be downloaded free of charge at https://doi.org/10.1515/labmed-2018-0103. It is part of a special issue on Information and Communication Technologies in laboratory medicine. You can find my editorial "Shaping the digital transformation of laboratory medicine" here.