2021-03-23 Anesthesia CRG Meeting

Christine Spisla Erica Culp Steven Dain

Monica Harry

Jane Millar

Jane Millar will contact Stephen Dain about the e-mail discussions and requests for information from the American Society of Anesthesiologists regarding intellectual property and copyright in modelling the ASA physical status classification as observables as part of the ongoing work regarding assessment scale modelling (item 4)

Update on discussions with observables project groups. 

 GCS & Mallampati qualifier scale values terms.docx

GCS notes S.Dain.docx

Ordinal Valuesets.pptx

Anesthesia Ordinal Scales.pptx

James R. Campbellgave an update on the proposals developed through the Observables group for the modelling of assessment scales scores as observables. Observables could be fully defined in terms of property attributes.

The example of the Mallampati scale was discussed in detail.  The grade numbers equating to the clinical grade findings would be regarded as an ordinal set of values to be modelled in the qualifier hierarchy. It was proposed that this would be supplemented by a supporting refset of clinical descriptions forming the definitions of scale points. It was felt that this approach would support clinical analysis from EHR's and applications such as machine learning.

It was noted that existing content was in the form of clinical finding primitives. The Anesthesia CRG was asked to consider proposals for clinical observation results vs clinical findings as illustrated in examples in Anesthesia Ordinal Scales.pptx.

Martin Hurrell will consider these proposals as they relate to use in HL7 FHIR observation resources

Document from an e-mail detailing a number of requests and suggestions for terms

 Requests and comments from Steven Dain on SNOMED content.docx

Deferred to next meeting due to time constraints and apologies from Steven

Andrew Norton

Steven Dain

user-619d4

Vent modes 19223 batch template.xls   vent patterns 19223 batch template.xls

user-619d4had sent useful comments on the spreadsheet of ISO 19223 ventilator modes, and modifications will be made accordingly.

There were two main issues for discussion:

1) Syntax - it was agreed that hyphenated compound nouns as used in ISO 19223 would be acceptable within SNOMED editiorial guidance. Unicode / and \ will need to be handled as words describing the meaning.

2) Depth of coding, adjuncts and possibilities of combinatorial explosion.  The current spreadsheet models for SNOMED all modes outlined in table E1 of ISO19223.  If adjuncts were modelled full as precoordinated mode descriptions there would be huge combinatorial explosion as illustrated by an ISO11073 document outlining mode combinations for Drager ventilators. Such an approach would also create problems with manufacturer specific terms that would not be acceptable for SNOMED CT  user-619d4 suggested that the depth and detail of mode modelling should include non selectable adjuncts (ACAP - assured constant airway pressure)  but exclude all selectable adjuncts (e.g. tube compensation, compliance compensation).  This would equate to a mode table equivalent to the content of ISO19223 table E2. 

user-619d4 will supply suggestions for wording and content and would be available for further discussion and input during completion of the modelling.

Consideration would be given to some further SNOMED submissions to model selectable adjuncts as qualifier values for a post coordination representation of ventilator modes including adjuncts.

Andrew Norton

Andrew Marchant

None identified