2020-01-28 Anesthesia CRG Conference Call

Andrew Norton

Zac Whitewood-Moores My apologies I am at a different meeting at this time, NEWS makes sense in the international edition assuming Ireland desire it. Approach as with other assessment scores until modelling of Observables possible.

Andrew Marchant

Review minutes from 2019-11-26 Anesthesia CRG Conference Call. Minutes agreed as a true record of previous meeting

Theresa Barry

Use of SNOMED for NEWS scoring - need to check with Theresa Barry whether this proceeding in Ireland. If so, NEWS scoring terms would need to be added to international release

Toni Morrison Monica Harry

Paul Amos

novel-CoV terms added

significant new content added

orphanet work - SNOMED →Orphanet map to be released

Retirement of Anesthesia for patient with systemic disease procedure concepts (analagous to ASA physical status) from International Edition (retain in US extension) see discussion: Concepts relating to "Anesthesia for patients with varying degrees of pre-existing disease" Will instead promote finding concepts for ASA physical status assessment.

Jane Millar noted forthcoming SNOMED products:

• Map of SNOMED →MEDRA
• Map of MEDRA→ SNOMED

The maps are different due to the differing database structures of the two systems and they are to support adverse drug incident reporting

Device adverse incident reporting is under consideration, but is a large piece of work that needs resourcing.

Jane Millar Ian Green

SNOMED Clinical Community webinar scheduled for Wednesday 29th January 2000 UTC

2020-01-29 - Clinical Community Conference Call

CRGs will have 3-5 minutes to prevent a brief overview of their group and activity. A few presentation slides would be welcomed. Meeting is planned to last 2 hours.

Andrew Norton

Terri Monk

Anesthesia Assistants and other specialist non medical roles - issue raised by Terri Monk . Has been previously looked at by the Anesthesia SIG. Part of the problem lies in differing roles internationally with the same job title.

US and many other countries (107 according to Wikipedia): certified registered nurse anesthetist. It was also noted that US practice and job titles vary from state to state

SNOMED has occupations but not roles. Martin Hurrell suggested a role based model would be useful

In the UK there are now 4 non medically qualified advanced practitioner (medical associate professions) with varying degrees of autonomy and regulation (Physician assistants, physician assistant (anaesthesia), Surgical care practitioners, Advanced critical care practitioners). It would be appropriate to include these in the UK SNOMED extension.

It was noted that globally anesthesia may be delivered by doctors, nurses or technicians. Anesthesia assistants can vary extensively in their roles (from more basic technical support to a level analagous to CRNA's and other independent nurse anestheists

Meeting held with ASA EMIT committee. The purpose of and progress with the intraoperative DAM had been outlined to the EMIT. The committee had been asked to review the content especially with a view to gap analysis and to provide some expert opinion on wider stakeholders in the anesthesia record - who, why and what they want from it. It is hoped that this will provide a continued useful source of feedback and advice.

Physiological and Operative Severity Score for the EnUmeration of Mortality and Morbidity. Martin Hurrell and Andrew Norton had noted that there is no SNOMED content for this assessment scale and its variants.

POSSUM is widely used for the estimation of surgical risk and in many hospitals is calculated for all emergency surgical procedures and many higher risk elective patients and operations.

The most widely used version is p-POSSUM (portsmouth modification of the original POSSUM) which improves the calibration and accuracy of the model. There are many peer reviewed papers on the use of POSSUM and variants. Specific variants exist for vascular sugery (V-POSSUM), colorectal (CR-POSSUM) and oesophagogastic surgery (O-POSSUM)

This constitutes a significant gap in SNOMED. It is not felt that this is any copyright issue as the scales are widely published, referenced and used both in health care institutions and open access online calculators e.g. http://www.riskprediction.org.uk/

There was discussion about representation in SNOMED. View of the Anesthesia CRG (which applies to other complex scores as well) is that a model and algorithm in the software implementation is preferable, but there is SNOMED CT content for the name of the assessment scale and the output -which will be observable entities to which a value can be ascribed. In the case of POSSUM this would be physiological score, operative factors score, predicted mortality, predicted morbidity.

This are remains a problem due to progress with observable entities and LOINC. Andrew Norton to supply examples of other Anesthesia CRG observable entity requests that have been significantly delayed in SNOMED.

Next Meeting Tuesday 2020-03-24 1500 ET / 2000 UK (Fourth Tuesday, every other month)

This will be largely used for agenda planning and preparation of the April face to face meeting in London.

The Anesthesia CRG will be meeting on Monday 6th and Tuesday 7th April

The SNOMED clinical meeting is Wednesday 8th April