Add more LOINC IDs to clinical enums

[caufieldjh]

The clinical enums have some LOINC IDs already, but more mappings of this type would be very helpful for rapidly assigning appropriate procedure codes, especially in relating them to CDEs.

[github-actions]

Issue Summary & Analysis

Issue Title: Add more LOINC IDs to clinical enums
Opened by: @caufieldjh (Harry Caufield)
Status: Open, labeled as enhancement

Current State

The issue requests expanding LOINC (Logical Observation Identifiers Names and Codes) mappings in the clinical enums defined at src/valuesets/schema/medical/clinical.yaml. Currently, some LOINC IDs are already present in the VitalSignEnum, but additional mappings would enhance the utility for procedure coding and Common Data Elements (CDEs).

Existing LOINC Mappings in clinical.yaml

From my analysis of the current schema, LOINC codes are already mapped in the VitalSignEnum:

• HEART_RATE: LOINC:8867-4
• BLOOD_PRESSURE_SYSTOLIC: LOINC:8480-6
• BLOOD_PRESSURE_DIASTOLIC: LOINC:8462-4
• RESPIRATORY_RATE: LOINC:9279-1
• TEMPERATURE: LOINC:8310-5
• OXYGEN_SATURATION: LOINC:2708-6
• PAIN_SCALE: LOINC:38208-5

Research Context

LOINC is a critical international standard containing 108,249+ terms (as of v2.81) that enables seamless data exchange between healthcare systems. The widespread usage across multiple healthcare ecosystem stakeholders makes LOINC mappings valuable for:

• Clinical data standardization
• Research data harmonization
• Interoperability between different healthcare systems
• Common Data Elements (CDEs) implementation

Related Work in the Ecosystem

My search revealed significant ongoing LOINC-related work across multiple projects:

1. LOINC Enhancement Projects: Multiple CDC projects working on LOINC code enhancement and data augmentation
2. LOINC Hierarchy Support: Projects implementing LOINC hierarchical relationships for better code resolution
3. Clinical Integration: Various healthcare systems implementing LOINC for labs, notes, and clinical documentation

Recommendations

To implement this enhancement effectively:

1. Expand DiagnosticTestTypeEnum: Add LOINC codes for existing test types (blood tests, imaging, etc.)
2. Enhance MedicalSpecialtyEnum: Add specialty-specific LOINC codes where applicable
3. Create Procedure-specific Enums: Consider new enums for procedures that would benefit from LOINC coding
4. Systematic Approach: Use LOINC's hierarchical structure to ensure comprehensive coverage

Implementation Priority

This enhancement aligns well with the project's goal of providing comprehensive value sets for clinical domains. The addition of more LOINC mappings would significantly improve the schema's utility for clinical data standardization and research applications.

Next Steps

1. Identify specific clinical procedures/tests requiring LOINC codes
2. Ensure LOINC IDs are validated using official LOINC resources
3. Follow the existing pattern in VitalSignEnum for consistency
4. Consider creating dedicated procedure-specific enums if the clinical enum becomes too broad

The substantial ecosystem momentum around LOINC standardization makes this a timely and valuable enhancement to the valuesets project.