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LOINC review — clinician guide

This page is for clinicians and superusers who approve how lab test names map to LOINC codes. It is not where medical assistants review lab values on the chart — that stays in Elation.

For roles and responsibilities, see Who does what.

The screen was rebuilt on 2026-09-18, and the review rules changed on 2026-09-29 ("one question, one answer"). Screenshots will be retaken; until then this page describes the screen in words.

What this screen does

When the fax system reads a lab report, it tries to pick a LOINC code for each test row.

System result What happens
Mapped (confident) The code is filed to the chart automatically. No case opens, also when the report printed no unit or no specimen: that is counted for the operator, not asked of you.
Abstained (not confident) A review case opens here for you to pick the right LOINC.
Filed by inference (filed on the judge's suggestion, after Gemini repaired the name, or on a name the OCR text does not show) A case opens so you can confirm it; confirming makes the mapper deterministic next time. When the judge picked the code, a Named match or Not named badge says whether the printed test name names that code — a first check, not a verdict.
Wrong mapped code (someone flagged it) A disputed case opens here to correct the code.

One question, one answer

Each test is asked once. A question is the printed test name together with what the report printed for it: the kind of result (a number, a titer, an answer word), the unit, the panel, the specimen, the method. The laboratory is shown on the card and is never part of the question. A row that prints less (no unit, no panel) belongs to the same question and takes the same answer; only a fact that is printed and different makes another question (serum glucose and urine glucose are two).

Your approval applies from the next fax. It does not wait for a publish. Publish… certifies the approvals in the mapping registry. Until then each one shows as Approved, not yet published, and a result filed through it says so in its Elation note ("filed per Dr X's decision of (not yet published)").

Important: Fixing a value in Elation does not teach the mapper. Only an approval on these screens does.

Before you start

  1. Bookmark the staff site (do not bookmark internal Cloud Run URLs): https://fax-staff-gate.dhruv-5ef.workers.dev
  2. Sign in with the clinic fax-app password (shared out of band — not your Elation password). If your session expires, the app sends you to sign in and back to the case you were on.
  3. Open LOINC review from the top navigation.
  4. Use this tool during clinic hours. After hours the staff site may show a closed page.

You will see test names and mapping facts only — no patient names, MRNs, or chart fields on this screen.

Quick review on a phone

Open Quick review from the top navigation (or the link at the top of LOINC review). It shows one case at a time and nothing technical: the test name (and the cell as printed, when that differs), what the report printed for it, where the question was seen from, how many faxes asked it, one line on why it is asked, and up to five codes as big buttons.

List What is in it
Questions The mapper could not choose: several codes fit the name, or its top pick failed a check on a printed fact. On a tie the card says what separates the codes (for example "Method: IF" against "Method: not stated") and opens on the code the practice's policy would choose. When the test already has an answer and this report prints a fact that answer does not fit, the card says so: "The approved code 23878-2 does not fit the method this report prints (EIA). Pick the code for this one."
Filed by inference A code is already on the chart (the judge's suggestion, a repaired name, a name the OCR text does not show). Confirm it or pick the right one. Confirm all confirms every filing that nothing contradicts; the others stay on the list for you.

The first time, the screen asks for your reviewer ID and name and keeps them on that device; every approval is signed with them. Then: tap a code, read the line under the card, tap the button. The line says what your tap would mean before anything is saved:

The line says The button
New for this test. Approve the code
Already approved as this code by Dr X on . This confirms it. Confirm the code
Dr X approved for this test on (published / not yet published). Keep it, or replace it with for all future reports? Keep the earlier code, or Replace it with yours
The reason the code does not fit what the report printed (for example a titer code on a row that prints a word). none: pick another code

Keep closes the card and writes no new decision. Replace approves your code and sets the earlier answer aside (it stays in the audit trail). Full review sends the case to the LOINC review page under Needs attention when none of the codes is right. Skip puts it at the back of the list. On a keyboard, 1–5 pick a code, Enter approves (never when the choice is Keep or Replace), F sends to full review, S skips; a swipe left skips.

An approval here is a universal approval with a written rationale ("Quick review: chosen from the mapper's candidates"), the same record the full page writes. Publish at the top shows what waits and certifies it. A case that is not a quick case (a dispute, an ops-queue case, a question with fewer than two codes) is only on the full page.

One case per question, however many times it was asked

The same question on another fax — or on a re-run of the same fax, or from another laboratory — is counted on the existing case (seen on N faxes), never a second case; an open case shows the latest fax's candidates. Once you answered a question, later rows of it file your code and open no card.

The same test with another printed fact

An answer holds for every report that prints nothing against it. When another laboratory prints a fact your code does not fit (another method, another specimen, another kind of result), that report asks a narrower question, once. Your answer to it is used for reports that print that fact. Your earlier answer keeps serving the others: a row that prints no method still files the code you approved for it.

Screen overview

Three columns on a wide screen (two on a laptop, one on a phone):

Area Purpose
Toolbar (top right) Refresh, New correction, Export CSV, Publish…
Cases (left) Search box, filter chips with counts (Open, Needs attention, Disputed, Filed by inference, Ops queue, All), and the case rows with badges. Under Ops queue a table lists what was filed or set aside without a case (by test and by reason).
Case detail (middle) What the fax showed, what the mapper made of it, the candidates, and the technical details.
Decide (right, stays on screen while you scroll) The steps, the decision form, and the confirmation line under Submit decision.

The status strip in the header shows whether the mapper is loaded and, while approvals wait for a publish, how many apply without being published yet.

Step 1 — Pick a case

Type part of a test name, a code, a status or a job id in the search box to narrow the list, or click a chip. Each row shows the test name, badges (Abstained, Disputed, Needs attention, Filed by inference, Named match / Not named, where its decision stands — Approved, not yet published, Published, Returned — and Closed) and, when Gemini repaired the name, "printed as …". Click a row to open it. You can also open a case from a link: /loinc-review?case=<case id>.

Step 2 — Read the case

Above the facts, the case lists where each of its decisions stands: approved and by whom, published in which registry version, replaced, returned by a publish with the reason, or kept.

What the fax showed lists the test, the name printed on the fax when it differs, the facts of the question (the kind of result, the unit, the panel, the specimen, the method the report printed), how many faxes asked it and from which laboratories, the value, unit, specimen, collection, method, timing, scale, reference range, laboratory and the panel heading the mapper saw — with how it was recognized (a recognized heading, Gemini's guess, or not recognized) and whether it had member codes; "no member codes" means the heading could not help the mapper, which is a configuration gap on the mapper side, not a fault of the fax.

What the mapper made of it says in words why the mapper did not code the row (for example, it could not read the printed unit, or several codes fit equally well), the closest candidate, and What to do.

Candidates are the codes the mapper considered. The mapper's best is marked but not chosen for you — they are often wrong for screens, immunology and similarly named tests. Click a row to put its code in the form. You are not required to pick from this list. When the mapper did not use a code a clinician had already approved for this test, that code appears as its own row marked blocked by the mapper, and the pipeline never files one of the other candidates in its place. Two cases: the report prints a fact the code does not fit (the line above the candidates names it, for example the method) and you pick the code for reports that print it; or the printed unit could not be read, which is the operator's to fix (Ops queue) with Correct and re-check.

Safety checks and mapper details and Case facts are collapsed sections for technical staff; Copy puts the facts on the clipboard to share with a colleague (no patient fields).

Step 3 — Search for the correct LOINC

In Search active LOINC, type part of the test name or a code (for example glucose or 42254-3). Use the arrow keys and Enter, or click a result; it fills Selected LOINC. The clinic deploys with LOINC 2.82.

Step 4 — Decide

Field What to enter
Selected LOINC The code you approve (required for approvals). As soon as a code stands here, the line under the field says what approving it would mean: new, a confirmation, a conflict with an earlier answer (then Keep and Replace take the place of Submit decision), or the reason the code does not fit.
Decision Usually Approve — works at all laboratories. Use this laboratory only when the same name means something different at one lab, or when the name is a bare repaired word (for example a single word Gemini recovered from a longer cell). The scope line under the field shows what will be written.
Only under this panel Appears when the fax printed a panel heading the mapper recognizes (the Panel record fact names it). Tick it for a universal approval whose name is only unambiguous inside that panel — % SATURATION means iron saturation under an iron panel and oxygen saturation elsewhere. The mapper then uses the code when a fax prints that heading (or infers the panel from the neighbouring rows) and sends the row to review anywhere else.
Corrected printed facts Only for Correct the printed facts and recheck: the unit (leave blank for ratios and titers), the specimen wording, the analytical and collection specimen.
Rationale Required for approvals and rejections: one or two sentences why this code is right for this test name.
Reviewer ID / name Your short ID (the same each time) and your name; remembered on this browser.

Click Submit decision. If something is missing, the field is outlined and named beside the button — nothing scrolls away. On success the line under the button turns green with the decision and the code, and says that the approval applies from the next fax. The case closes with its state as a badge and the form locks.

Selecting the next case gives you an empty form. Opening a decided case shows its decision prefilled and locked; Withdraw approval and reopen (top of the detail) asks first, then unlocks the form prefilled from the withdrawn decision so you can edit and submit again.

Step 5 — Publish

  1. Click Publish…. The app checks first and changes nothing: it shows the approvals that would be published with their codes, the ones the registry already holds, any approval that would go back to its reviewer with the reason, and any laboratory-specific approval that waits for an operator. If no approval is waiting, Confirm stays disabled.
  2. Click Confirm publish. Each approval is judged on its own: what passes is published, what does not comes back. The message says, for example, "24 approvals published in registry-…. 1 returned: …".
  3. A returned approval keeps its record. Its card is open again under Needs attention with the reason; answer it there (Keep, Replace, or another code).

Publishing certifies; it does not switch the approvals on. They applied from the fax after you approved.

Only clinicians or designated superusers should publish.

If something goes wrong

Messages appear beside the button you used, in plain words: what happened and what to do next (reopen the case, refresh, ask an operator). An earlier answer for the same test is shown to you with Keep and Replace; no operator is needed.

If the earlier answer changed while you were looking (a colleague replaced or withdrew it), the card shows the new line and asks you to answer again.

"N cases written before this version are not shown" under the filters means old case files are kept on disk and no longer listed; nothing was lost, and the tests are asked again the next time a fax prints them.

Wrong mapped code (not abstain)

If the system did assign a LOINC but it was clinically wrong on the chart:

  1. From Extraction or the Fax explorer, click Wrong code on that lab row, or
  2. Click New correction here and fill in the test name, the wrong code (if known) and why it is wrong.

A disputed case opens. Pick the correct code; when the test already has an answer, the line under the code says so and you Replace it. Then Publish as usual.

Quick checklist (one case)

  1. [ ] Open LOINC review; pick an Open (or Disputed) case
  2. [ ] Confirm the test, value, unit and specimen match the fax; read What the mapper made of it
  3. [ ] Pick the correct LOINC (search if the candidates are wrong) and read the line under it
  4. [ ] Choose Approve — works at all laboratories (unless lab-specific)
  5. [ ] Write the rationale; check your reviewer ID
  6. [ ] Submit decision (or Keep / Replace on a conflict) — the line under the button confirms it
  7. [ ] When several cases are done: Publish… → Confirm publish

Privacy

  • Do not paste patient names, MRNs, dates of birth, or fax numbers into rationale text or chat.
  • This UI is for mapping facts and opaque job IDs only.

More detail (technical staff)