Conference Call Details

Meeting time is 2019-11-26 20:00 UK; 15:00 US ET

Meeting ID: 670-439-504

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Discussion items

Introductions and apologies
Minutes of previous meeting

Review minutes from 2019-09-24 Anesthesia CRG Conference Call. Minutes agreed as a true record of previous meeting

Matters arising from the minutes

Terminology for accidental puncture of dura is an agenda item for this meeting.

Some of the IV fluid product requests have now been released. The more complex issues (eg multi-component IV fluids) remain in Inception

SNOMED updates

The January 2020 international release is now in validation. There is a SNOMED staff meeting in December to set strategy for content priorities and forward workplans .

Product roles is currently in QA. Some of the complex medical product isnsues e.g. complex IV fluids , polyvalent vaccines have been put to one side. As regards apparently missing products following the QA work, if confirmed that old term inactivated, no new term and there is a source reference, then a new concept request can be submitted.

Clinical engagement update

Jane Millar noted the Kuala Lumpur meeting was well attended with a full day clinical meeting that delivered a large number of presentations on various clinical developments. It is planned to move the clinical engagement strategy forward by adding 2 x 2hr clinical engagement web meetings in January and June. The focus of the April and October meetings will move more to face to face meeting. Jim Case is setting up an initiative to review clinical areas of SNOMED with international domain expertise. These will form task and finish groups. First subject area will be epilepsy. Where there is need for longer term clinical input a CRG will be formed.

Ian Green spoke to education initiatives. A number of short videos targeted at clinicians related to use of SNOMED browser are being developed and will be placed on the SNOMED YouTube video channel. There are also a number of short powerpoint presentations that explain SNOMED at a high level and focus on day to day clinical use. These resources are all designed for busy clinicians with limited time resources.

The April 2020 meeting will be announced shortly with a call for clinical groups who want meeting space and time. There will be a whole day clinical meetings and presentations will be sought.

Tracheostomy terminology and modelling

Monica has raised issues about modelling and classification of emergency tracheostomy terms (see discussion pages) Need to consider attributes relating to 287439000 Emergency tracheostomy and 55622001 Tracheostomy, emergency procedure by transtracheal approach (procedure). In discussion it was agreed that the latter represents a duplicate concept, as there can only be a transtracheal approach. Method atrributes require some review - exteriorization is felt to be more reflective and accurate than "bypass". Terms for percutaneous tracheostomy, which is generally not an emergency procedure appear adequate, but the multiplicity of similar techniques and devices have not been requested as this would lead to some problems with trade names.

HL7 Anesthesia Record DAM updateMartin Hurrell

Martin Hurrell gave an update focusing on implementation of the ISO 19223 artificial ventilation standard in the HL7 Anesthesia Record DAM, illustrating class diagrams, reference tables and documentation. Work is progressing with the DAM, but time constraints require submission of ballot materials by 22nd December 2019 unless further extension is sought. The group noted the quality of the work. Martin also commented on interest in the work from HL7 Financial Management SIG - it was noted that it will probably not be possible to fully address this area in the first iteration of the Anesthesia record DAM.

user-619d4 gave an elegant explanation of the basic underlying concepts of the model, Ventilation "modes" essentially consisting of patterns (n=5) and breath types (n=5). Any mode can be described by reference to these attributes allowing defining characteristics in a relatively simple table. ISO 19223 had been balloted this summer.

Representation of Early Warning scores

Theresa Barry raised the issue of clinical input and requirements in the implementation, use and reporting from NEWS scoring in Ireland. This requires the collation of values of heart rate, temperature, systolic blood pressure, respiration rate, oxygen saturation and AVPU score to allocate the recorded values to the scoring bands and summation of the component scores to produce the NEWS score. One way of approaching this is only minimally terminology dependent - i.e. recording the observable entity values for the component observables and using an information model to collate and calculate the score. SNOMED CT currently has relevant observeable entity concept for all observables except the AVPU score.

Another approach is using the terminology implemented in the UK extension that contains extensive observable entity terms for the band scores for each observable , for example: 1104301000000104 Royal College of Physicians NEWS2 (National Early Warning Score 2) - respiration rate score. Theresa felt that her understanding from the clinicians in this project was that actual recorded physiological values were required as basis for recording and calculation

It was suggested that Theresa should contact Zac Whitewood-Moores for discussion and advice as how SNOMED was employed in any UK implementations of NEWS

Ian Green confirmed that the NEWS score had been copyrighted by the Royal College of Physicians. It was also noted that NEWS concepts are currently only in the UK extension, but would need inclusion in the International release is NEWS is implemented outside the UK.

Dural tap

Replacement of common synonyms from retired concept. Discussion of term requests 747972 & 747973 to resolve issues raised in previous 2019-09-24 Anesthesia CRG Conference Call. A request has been made to replace a concept to represent accidental dural puncture that happened in circumstances other than anesthesia. Monica Harry pointed out potential difficulties with synonyms and Steven Dain noted that "dural tap" may not necessarily imply a complication during care. Andrew Norton noted that this form of words remains the most common representation and it was noted that a solution may lie in using the words "inadvertent dural tap". Requests will be updated to reflect this discussion


Steven Dain noted that he was presenting a poster on the ISO 19223 lung ventilator standard at the Society for Technology in Anesthesia (STA) meeting in Austin, TX 15-18 January 2020. He suggested that it would be valuable to also put together a poster on SNOMED CT for this meeting. This will be referred to Patrick McCormick

Next meeting

Meeting schedule for 2020 not yet defined. Tuesday 28th January 2020 was suggested as a provisional date that would follow previous meeting schedules. Also awaiting confirmation of the SNOMED clinical engagement web meeting in January.

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