HL7 Working Group Meeting

Anesthesiology SIG (GAS)

Tuesday 13January 2009

Present:Martin Hurrell (Co-Chair)

Terri Monk (Co-Chair)

Alan Nicol

Andrew Norton

Pippa Norton

Q1Alan Nicol presented work on the intraoperative use case supporting the CDA-compliant schema, inviting feedback and comment from the group.

Some changes and additions were made and there was discussion around appropriate section headings and the correct order of the sections.

Q2Joint session with the Structured Documents Committee

Bob Dolin (chair)

Alan Nicol and Martin Hurrell presented the intraoperative anesthetic schema to the Structured Documents Committee. The Committee was asked to comment on whether the work so far is along the right lines and could be made CDA2-compliant. It was agreed that the schema as it stands is good, although it may require some minor tweaks to ensure compliance.

The next step will be to write a formal project proposal and send it to the four co-chairs of the Structured Documents Committee, who will help the Anesthesiology SIG through the process of getting this approved as a formal project.

Alan Nicol raised the question of whether devices should be authors (as they currently are in the schema). It was agreed that this is correct, although there is some ambiguity over this issue in the RIM, which needs to be discussed and clarified.There was also discussion around the need to annotate certain observations such that the annotation is both time-stamped and refers clearly to a particular observation. It was pointed out that these and other issues can be dealt with once the project proposal has been written.

Q3Terri Monk had emailed George Schapiro regarding the issue of releasing the whole Protégé model to interested parties at the VA. The APSF has no objection to this, provided there is a non-disclosure clause stating that the model should not be given to any vendor who doesn’t support the project. Martin Hurrell will email George Schapiro with suggestions as to the wording of the NDA to ensure that it covers not only the terminology but the whole Protégé tool. It will probably be best to work with a designated person from the VA to give them the link to download Protégé, the IOTA termset, and the IOTA plugins. This person will then be responsible for distributing the IOTA Protégé tool within the VA.

Andrew Norton suggested that it might be worth considering contributions from health organizations, such as VA and NHS, as well as from vendors, in return for access to the Protégé tool. He will email George Schapiro about this.

The group then returned to consideration of the intraoperative use case and its section headings. There is some ambiguity between events/acts and observations as some concepts can be both these things, depending on the viewpoint. Placement of an aortic cross clamp, for example, is an act from the point of view of the surgeon but an observation from the point of view of the anesthesiologist. A way around this ambiguity may be to specify the author’s role in each case. This is an issue which should be taken to the Structured Documents Committee for guidance.

The “Techniques” section included several different types of concept including procedures and some devices. It was agreed that it would be best to separate these out. A section “Equipment used” was added to house terms such as “forced air warming blanket” and “blood warmer”. A further section “Case setup” was added to include preparation of the environment prior to the arrival of the patient, and a section “preparation” to include preparation of the patient him/herself. “Preparation” was given the following subsections: “attaching monitoring”, “vascular access procedures”, “regional anesthetic procedures”. Finally a section “GA technique” was added with the subsection “airway management”.

Terri Monk pointed out that, although an obstetric anesthesia record would be largely the same, some additional items would need to be included, such as monitoring of fetal heart tones, events such as baby delivered and placenta delivered, and apgar score.

Alan Nicol and Martin Hurrell will consider more compact wording for some of the section headings and circulate these to the group for comment.

Q4Andrew Norton raised some terminology issues which are still outstanding and require discussion at future meetings:

Regulatory terms, such as presence of staff at various procedure milestones. SNOMED currently has “present throughout procedure” and “all critical points”. It was felt that there should probably also be terms for “present at induction” and “present at emergence”. It will be useful to discuss this with David Reich as he is familiar with regulatory requirements.

Terms for negative tests, such as “no blood aspirated”. One possible way to deal with this would be to create a term “aspiration test negative” under “finding by method”. This could then have an associated fluid (blood or CSF) rather than pre-coordinating terms for all tests. Andrew Norton will draft a model for this and send it Christine Spisla at IHTSDO for comment.

Andrew Norton will set up a conference call to include people from the VA. Monday 23rd February was suggested as a date for this, 2:30 – 4:30 p.m. US Eastern, 7:30 – 9:30 p.m. GMT.

IHTSDO working group meetings will be held in Helsingør, Denmark on 2nd – 4th April 2009. Anesthesia SIG meetings will be on Friday 3rd and Saturday 4th. A joint session needs to be organized with some IHTSDO and ISO 11073 representatives to discuss formal alignment with 11073 nomenclature and how much of the 11073 standard should be formally aligned to SNOMED CT.

Andrew Norton asked what progress has been made towards developing the IOTA plugins for Protégé 4. Martin Hurrell will chase this up. Alan Nicol will look into the availability of extraction tools to extract sections of the IOTA termset from Protégé.

Terri Monk stood down as co-chair of the anesthesiology SIG. Alan Nicol was elected as the new co-chair.

Action Points

  1. Alan Nicol and Martin Hurrell to write a project proposal for a CDA-compliant anesthetic record and send this to the co-chairs of the Structured Documents Committee
  2. Martin Hurrell to email George Schapiro with suggested wording for the NDA
  3. Andrew Norton to email George Schapiro to suggest the possibility of accepting contributions from health organizations in return for access to the Protégé tool
  4. Alan Nicol and Martin Hurrell to consider rewording of section headings in the CDA schema and to distribute these to the group for comment
  5. Andrew Norton to draft a model for negative tests and to send this to Christine Spisla at IHTSDO
  6. Andrew Norton to organize a web conference jointly with representatives from the VA
  7. Martin Hurrell to follow up progress on development of IOTA plugins for Protégé 4
  8. Alan Nicol to look into extraction tools for extracting sections of the IOTA termset from Protégé

Wednesday 14 January

Q2Joint session with members of Duke Clinical Research Institute – Domain analysis modeling

Present:Martin HurrellMeredith Nahm

Terri MonkAnita Walden

Alan NicolPatricia Gunter

Andrew Norton

Pippa Norton

This group had shown an interest in the Anesthesiology SIG’s work and the possibility of using some of the IOTA terminology in creating an anesthesia domain analysis model.

Martin Hurrell will speak to Alan Rector about the work of this group and ask him to contact Meredith Nahm.

Anita Walden showed the Anesthesiology SIG members how and where to access the existing domain analysis models (TB and Cardiovascular) via the HL7 website, and demonstrated the cardiovascular model. It was pointed out that, for terms which are common to more than one domain, there is a common class which can be shared across domains.

The models were created using Enterprise Architecture, a viewer for which is available as a free download. Meredith will send a copy of the models to Alan Nicol and Martin Hurrell. Alan asked if it would be possible to send them in MDI format so that they can work with them in other tools.

Meredith asked about the process of submitting new terms to SNOMED. Andrew Norton explained the process and will send Meredith some examples of IOTA submissions to show what information is required for each term submitted.

Terri Monk suggested that Heather Frederick at Duke might wish to become involved with this group. She will speak to Heather and put her in touch with Meredith.

It was pointed out that the IOTA dataset does not cover the whole of anesthesiology, which overlaps with many other areas. It focuses on intraoperative anesthesia, with some preoperative and postoperative terms. Alan will send a copy of the intraoperative use case to Meredith to give an idea of the scope of IOTA’s work.

Q4Joint session with Healthcare Devices SIG

Masaki Hirai gave a presentation of CDA/MFER compliant anesthesia record system. Martin Hurrell tried to clarify the relative place of CDA or MFER for representation of vital signs.

Martin Hurrell questioned the way SIGGAS collaborated with HL7 Healthcare Devices SIG to incorporate and implement 11073 standards (domain information model, nomenclature, device communication standards, including provenance of information). It is probably necessary to look for a solution which is not constrained by size, rather to seek fidelity in representation.

Alan Nicol raised the question of objectidentifiers. Melvin Reynolds suggested the IEEE EUA 64 bit identifier.

Alan Nicol and Martin Hurrell will document issues they perceive and will forward them to the co-chairs of the Healthcare Devices SIG.

The CEN/ISO/IHTSDO Joint Working Group has recognized the need for device term coordination between ISO standards and SNOMED CT. The HL7 Healthcare Devices SIG had attempted to initiate this process at the January 2009 HL7 Working Groups meeting, but IHTSDO representation was not available. A number of pockets of activity in mapping x73 standards to SNOMED have taken place (e.g. IHTSDO Anesthesia SIG for terms of relevance to anesthesia, continua for personal health devices). It is recognized that a systematic scoped project is now required.

Andrew Norton proposed that some of the Anesthesia SIG meeting at the IHTSDO Spring Conference in Helsingør, Denmark, on 3rd/4th April 2009 be used to try and initiate this process. An initial request has been made to the CEO at IHTSDO, Jennifer Zelmer. It was agreed that, in view of the size and complexity of the standards and the task, it would be appropriate to scope and prioritize a work proposal to IHTSDO, as it would require significant terminology resource. Jennifer Zelmer will be asked to identify appropriate IHTSDO offices to discuss the proposal. Melvin Reynolds and Todd Cooper would undertake to ensure appropriate representation from ISO/CEN TC 215 and HL7 Healthcare Devices SIG. A request has been made to IHTSDO for Webex/teleconferencing facilities.

Action Points

  1. Martin Hurrell to speak to Alan Rector and ask him to contact Meredith Nahm
  2. Meredith Nahm to look into the possibility of converting the existing Enterprise Architecture models to MDI format and to send these to Alan Nicol and Martin Hurrell
  3. Andrew Norton to send examples of IOTA’s SNOMED submissions to Meredith Nahm
  4. Terri Monk to speak to Heather Frederick and to put her in touch with Meredith Nahm
  5. Alan Nicol to send a copy of the intraoperative use case to Meredith Nahm
  6. Alan Nicol and Martin Hurrell to document issues they perceive and to forward to co-chairs of the Healthcare Devices SIG