Reference standards are vital for harmonizing heterogeneous clinical data for research, but little is known about their implementations or costs. We surveyed NIH Clinical and Translational Science Awards (CTSA) hubs to assess operational dimensions of institutional implementation, maintenance, and use of the Logical Observation Identifiers, Names, and Codes (LOINC) standard. Respondents (n = 19,30%) exhibited substantial variability in approaches to implementation. Differences in number and training of staff and frequency of mapping updates make it difficult to estimate costs and comparability of data across sites. CTSA and other multi-site research can benefit from operational definitions and recommended processes for LOINC implementation.