2021-10-25 Anesthesia CRG at SNOMED International Business Meeting

Matters arising from the previous meeting notes

2021-09-28 Anesthesia CRG Meeting (Cancelled)

Notes from the last meeting were accepted as satisfactory.

Update on progress with ISO 19223 mode term submissions.

Consideration of comments from SNOMED terminologists about the inclusion of ventilation mode grouper concepts

Mode of mechanical ventilation as a grouper vs 40617009 artificial respiration (procedure)

APRV - regime/therapy or procedure; discussion of what to do about existing "mode" terms currently modelled as procedures, but have same/similar wording to ISO 19223 modes

Ventilation adjuncts

Harmonisation of SNOMED ventilatory regime/ therapy with existing terms in ISO. The group accepted that grouper terms not be introduced into the vocabulary. Jane MIllar has discussed issues of copyright with ISO, and needs to know what content from ISO 19223 might be included in SNOMED. Approximately 40 terms are estimated (AN) to be included. These 40 are ventilation modes and refinements/ adjustments to the modes. This does not include some respiratory physiology definitions, perhaps 100 in total. We don't need permissions to include the terms, but the definitions themselves might require permission. ISO have suggested discussion with BSI, which may not be the most appropriate route. Monica and Jane will investigate the most effective way of harmonising SNOMED with other systems. "Ventilation patterns" (with 8 components) and "Inflation Types" (with 5 components) will be important to include.

Where terms already exist in SNOMED, often as procedures, they can be ported over to the regime/ therapy class.

Monica has asked the CRG to review and comment on the status of a number of terms from the 266700009 | assisted breathing (procedure) section of SNOMED CT.  

see Google Docs 

https://docs.google.com/spreadsheets/d/1u9WAEIoqvzn0_dmrSTvgW8QI6W0D_O9cp452TkMwayI/edit?usp=sharing

The group noted this document. MH noted that we should perhaps concentrate on finding terms which are obsolete. SD suggested that such terms should be deprecated in the first instance as they may still be in active use. Synonymous terms can be combined, and the proposed new terms being preferred. SD noted that ventilation was a therapy rather than a procedure - there was general agreement that the ventilation modes should be considered as therapies rather than procedures.

If members of the group can review and annotate the document, that would be valuable. AN will proceed with the first pass of the review process.

Bird respirators were viewed as an example, although they date from the 1950s they are still used in clinical practice so the term should be maintained.

Correspondence from Elaine Wooler regarding issues raised in the translation working group about Intensive care related disorders and causality

Terming of concepts such as intensive care psychiatric disorder, psychosis associated with intensive care, critical illness polyneuropathy

Consider need for additional terms, notably critical illness associated delirium.

The group was in agreement that it doesn't make sense to term a clinical syndrome as "due to" the location "intensive care", when critical illness itself is causal. Perhaps use terms such as "critical illness polyneuropathy".

Broader terms were discussed, including delirium. Terms including "hypoactive delirium" have previously been included in SNOMED. The multifactorial nature of delirium, even within a single patient, was noted. AN will work on terms to express delirium associated with critical illness.

Identification of missing significant scales; inclusion of terms for XXXXX scale (assessment scale) and assessment using XXXXX scale (procedure).

AN noted work in this area by the Observables group. In common with other groups, we should identify scales which should be incorporated in SNOMED. The scale should be represented, and there should be a procedure for the act of making each individual assessment. Examples such as POSSUM, SOFA and NEWS scoring have been noted. JM recognised that there remains progress to be made, though AN notes that groups such as the Nursing SIG are working on the issues. SNOMED should at least represent the existing scales, though discussions on copyright need to occur before the full content of the scales can be included - considerations such as definitions of the scales may require discussion re copyright.

By the usual schedule of 4th Tuesday alternate months we will meet at:

Tuesday November 23rd 2021 at 20:00-21:30 UTC / 20:00 - 21:30 UK / 15:00-16:30 ET