Challenges implementing treatment guidelines in electronic health records: the American Diabetes Association Standards of Care as a case example
Objective: Treatment guidelines can improve population health; however, their implementation within electronic health records (EHRs) can be challenging. We aimed to create an implementable framework using the American Diabetes Association (ADA) Standards of Care (SOC) for people with type 2 diabetes and cardiovascular or renal disease as an example. Materials and methods: A multidisciplinary team used agile methods to translate...
Addressing property and unit discordance in laboratory interoperability: the role of NPU as a governance layer
Objectives: Unified Code for Units of Measure (UCUM) encodes syntax without prescribing which unit should be used. The Nomenclature for Properties and Units (NPU) terminology, developed by IFCC and IUPAC, specifies both the kind-of-quantity (e.g., mass concentration or substance concentration) and the recommended unit for each code, and can serve as a governance layer, yet no study has evaluated how...
National implementation of LOINC: translation methodology and experience from the Polish laboratory terminology standardization project
Objectives: This study aimed to present the results of translating the LOINC standard into Polish, summarize key methodological lessons, and outline the current stage of LOINC implementation in Poland. Methods: Three editions of the LOINC dictionary translation process were conducted using a part-based translation strategy. In the first two editions, MS Excel spreadsheets were used to translate the parts provided...
SyntheaWeb: A Web-Based Platform for the Generation and Interactive Inspection of Synthetic Healthcare Data
Access to real-world healthcare data is increasingly hindered by privacy concerns and stringent legal frameworks, including the General Data Protection Regulation (GDPR) and the Health Insurance Portability and Accountability Act (HIPAA). Consequently, synthetic healthcare data generators, notably Synthea™, have emerged as essential tools to generate high-quality datasets with minimal privacy and legal concerns. However, many simulation engines including, Synthea™, predominantly...
LLM-Assisted Clinical Data Harmonization: Combining Automated ETL Generation with Semantic Vocabulary Mapping for OMOP CDM
Transforming clinical data into the OMOP Common Data Model requires structural schema mapping and semantic vocabulary harmonization, demanding both technical and clinical expertise. We investigated Large Language Models for both tasks using the eICU Collaborative Research Database. For structural transformation, context-enriched prompting with White Rabbit profiling reports guided Gemini 2.5 Pro to generate PostgreSQL Extract-Transform-Load (ETL) scripts, populating eight OMOP...
ARKE: An ontology-driven framework for automated mapping of local radiology procedure terms to the LOINC-RadLex playbook using large language model
Objective: To develop an ontology-driven framework that standardizes heterogeneous local radiology procedure names by decomposing them into semantic components and aligning them to LOINC/RSNA Radiology Playbook codes using constrained large language model (LLM)-based parsing and selection. Methods: Radiology procedure names from two tertiary hospitals in Korea were parsed into semantic components using LLM prompting with retrieval-augmented generation, aligned with the...
Diagnostic stewardship monitoring systems: institutional and system-level approaches
Diagnostic stewardship-performing the right test for the right patient at the right time-improves diagnostic accuracy and reduces healthcare resource waste. Various stewardship interventions have been introduced, yet their effects dissipate without systematic, sustained monitoring. One-time education and isolated system controls consistently show effect attenuation over time, and inappropriate ordering practices rapidly rebound once active oversight ceases. To date, the literature...
Automated LOINC Mapping of Persian-English Mixed-Language Clinical Laboratory Test Names
Background: Although LOINC is widely adopted, clinical laboratory test names are frequently recorded in non-standardized free-formats, often involving mixed Persian-English terminology, in Iran. This study presents an intelligent service for automated mapping of mixed-language clinical laboratory test names to LOINC. Methods: A dataset of 1,400 local laboratory test names and codes was extracted from a hospital information system. All records...
Towards a nomenclature of health services for implementing universal health coverage in low- and middle-income countries
Background: Achieving Universal Health Coverage (UHC) in low- and middle-income countries (LMICs) requires a robust digital infrastructure capable of monitoring healthcare services and associated costs. A major barrier is the absence of a standardized and comprehensive nomenclature for billable healthcare services. Assessment across five hospitals in Burundi confirmed this problem by showing significant inconsistencies in service naming and coding. This...
From “Black Box” to Learning System: Formative Viewpoint on Digital Health Governance for Childhood Cancer Information in Japan
Japan has universal coverage and designated pediatric oncology centers, yet the childhood cancer information ecosystem remains a "black box." The incidence is measurable, but treatment exposure and long-term follow-up are not reliably linked across hospitals, registries, and survivorship services. The World Health Organization (WHO) CureAll framework highlights information governance as a lever for equity. This study aims to propose a...
National Patterns of Biomarker Testing in Colorectal, Lung, and Prostate Cancers: Insights From the NIH All of Us Research Program
Background: Biomarker testing is central to precision oncology, yet real-world implementation across cancer types and populations remains inconsistent. Social determinants of health (SDoH) may influence testing uptake and exacerbate disparities in access to targeted therapies. Methods: We conducted a retrospective cohort study using Version 7 of the NIH All of Us Research Program Curated Data Repository. Adults diagnosed with colorectal...
Automated Logical Observation Identifiers Names and Codes mapping with biomedical natural language processing models: enabling scalable health information exchange via the Open Concept Lab
Objectives: Efficient exchange of health information requires consistent representation of clinical concepts across laboratories, hospitals, and public health systems. LOINC supports this interoperability by standardizing laboratory test codes, but mapping remains difficult when datasets are incomplete, inconsistently formatted, or structurally diverse. These challenges often create a mismatch between algorithmic performance in controlled settings and real-world deployment. This study aimed to...
Some remarks on the methodology of determining serum creatinine levels, transaminase activity, and albumin levels
Despite advances in modern medicine, classic laboratory parameters are still crucial pillars of clinical decision-making. The report focuses on four routinely measured analytes: serum creatinine levels, liver transaminase activities and albumin levels. In 2024, these accounted for more than 15% of laboratory determinations in Hungary. Laboratories measure serum creatinine levels using two methods: the Jaffé or the enzymatic method. Although...
Mapping clinical terms to standard terminology for multi-institutional research platform: Mapping principles and system deployment
Objective: To develop and implement a multi-institutional research platform by standardizing and integrating clinical terms with international terminologies. Materials and methods: This study introduces the Health data Research Suite (HRS) platform, designed to standardize and connect electronic medical record (EMR) data across institutions for efficient multi-institutional research. A hybrid mapping process-combining automated and manual methods-ensures semantic equivalency, consistency, and compliance...
Large Language Models’ Performances regarding logical observation identifiers names and codes mapping in laboratory medicine: A comparative analysis of ChatGPT-4.0, Gemini, and Perplexity
Objectives This study aimed to assess the feasibility and practical utility of using large language models (LLMs) for Logical Observation Identifiers Names and Codes (LOINC) mapping to standardise healthcare data in the field of laboratory medicine. We evaluated the accuracy and applicability of three LLMs—ChatGPT-4.0 (OpenAI), Gemini 1.5 (Google DeepMind), and Perplexity AI (Perplexity.ai)—in mapping laboratory test items, which typically...
Building health system resilience in Romania: a consensus on policy priorities
Romania's healthcare system struggles with the EU's highest rates of treatable and preventable mortality and the lowest per capita health expenditure. Critical issues include unsustainable financing, an entrenched physician-centered model lacking institutional accountability, delayed digitalization, and inadequate clinical research capacity, necessitating structural and paradigmatic shifts. The objective of this study was to synthesize multi-stakeholder consensus recommendations for comprehensive reform of...
Exploring common data model coverage of nursing flowsheet data: a pilot study using SNOMED CT and LOINC mapping
Objectives: The primary objective of this research is to assess the content coverage of nursing data within a publicly available common data model (CDM), focusing on how nursing data, documented in flowsheets, are represented within the model. Materials and methods: This mapping study was informed by previous evaluation studies and serves as a framework for evaluating information resources, including to...
FHIR Standard-Based Oncology Data Model for Cancer Screening: Design and Implementation Study
Background: Cancer is a leading cause of death worldwide. Early detection through screening, diagnosis, and effective management can reduce cancer mortality. Risk assessment is crucial for improving outcomes by identifying high-risk individuals based on family history, genetics, lifestyle, and environment. Such targeted screening enhances accuracy and resource efficiency. However, the complex nature of oncology data-which includes clinical observations, lab results,...
AI Mapping of In-House Codes to LOINC Codes Using Laboratory Test Results Excluding Test Names: Toward International Sharing of Medical Data
There is an increasing demand for automatic mapping to standardized codes such as LOINC codes to create integrated medical databases across multiple facilities. However, natural language processing (NLP) in Japanese presents greater challenges than in English owing to a limited Japanese corpus for medical terms, such as test names. To address this limitation, we developed a machine learning-based method that...
Prevalence and Correlates of Lipoprotein(a) Testing in a Diverse Cohort of U.S. Adults
Background: Once-per-lifetime lipoprotein(a) [Lp(a)] testing is recommended by multiple professional societies during cardiovascular disease risk assessment. Objective: The purpose of this study was to assess the prevalence and identify correlates of Lp(a) testing in a real-world, diverse sample. Methods: Participants were ≥18 years of age from the All of Us Research Study who shared electronic medical record information through 2022...