Anesthesia Clinical Reference Group

Time: Nov 24, 2020 20:00-21:30 UTC / 20:00 - 21:30 UK / 15:00-16:30 ET

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Meeting ID: 969 2640 6018

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1Introductions and Apologies

Apologies: Maria Hendrickson  Mark Banoub Alan Rector


Notes of meeting held on 28 September 2020

2020-10-07 Anesthesia CRG Session - SNOMED for Clinicians Meeting

Andrew Norton

Minutes of previous meetings were discussed, and considered satisfactory.

The SNOMED for Clinicians meeting was well-attended and Constructive. Work on assessment scales and description of findings such as GCS is continuing. Descriptions of the various points of the GCS have been made.

The approach that the Anesthesia CRG have taken to classification scales will inform the appraoch taken by SNOMED as many other clinical scales (over 1000) are reviewed and represented in SNOMED.

Scales which are restricted by issues such as copyright may not prove suitable for use within SNOMED.

3Matters arising from the previous meeting notes

No comments or questions were raised.

4SNOMED updates

The January Relaease of SNOMED is being prepared for pre-release review. Elaine Wooler and Sarah Warren have joined the team and are welcomed.

Planning of content for the July release is under way.

SNOMED releases are planned to become more frequent, this is being planned.

A community release of SNOMED is being planned, with the intent of becoming more user-friendly. There is intent that this will be a more open undertaking, with potential for collaborative use and development of the resource. Content from the community release may become considered suitable for the international release.

SNOMED's clinical engagement strategy is under development, and planning for the April 2021 meeting is beginning. Education materials may be ready for presentation on the Sunday of the meeting. Meetings for other CRGs will be planned on subsequent days. The April 2021 meeting may be physical and/ or virtual but this cannot be confirmed. There is a Clinical Leads meeting on 10th December where some of these issues will be reviewed.

5Assessment scale modeling and content in SNOMED CT

Further to previous meetings and discussion Glasgow Coma Score, a paper has been produced for the SNOMED Editorial Advisory Group. Comments and discussion are welcome

Modelling of Assessment Scales in SNOMED CT.doc

Three approaches were discussed:

1. Model SNOMED term for clinical findings  as described and defined in the parent scale or sub scores.
2. Basic inclusion of observable entities to enter sub scores with otherwise complete reliance on the application information model.
3. Attempt to use existing SNOMED CT content that equates to the clinical findings for points in scores or sub scores.

Mapping existing scales to structured data types is not necessarily straightforward. Problems involve evolutionary updates of source scores, scores with complex/ composite gradings (e.g. convert continuous numeric data to ordinal data (e.g. grades of hypertension)

Martin Hurrell noted handling of data in HL7 via a string format.

The group discussed preservation of old scoring systems so that historic data was maintained in context and could be analysed in the context of definitions which pertained at the time. Representation of core, clinically relevant scores is important but there are many of these systems in circulation. Local variations may exist but Zac Whitewood Moores noted that these may be short-lived, about 1200 scores have been recognised and that further local variations were discouraged, particularly by EMR suppliers. There may be scope for the Anesthesia CRG to work with other CRG's (e.g. Nursing) and Jane Millar will investigate this.

An example of a scale which could be reviewed is SOFA (Sequential organ failure assessment) scoring - although internationally recognised and used, this is only available in the North America Release only as an assessment scale name.

Current SNOMED Editorial Guidance may be ready for review, and perhaps the CRG should ask for revision of guidance in the area of modelling assessment scales.  Zac Whitewood Moores noted that the "Observables Group" have had similar thoughts.

Action: The document will be reviewed by Andrew Norton and Martin Hurrell and comments from the CRG are sought. It will be presented to the Editorial Advosiry Group for further guidance.

6ISO 19223 -progress with modeling of SNOMED concpets

Ventilator Modes are discussed in this document. There was discussion of use of terms such as "volume controlled inflation type" and "volume controlled inflation" - the best choice to decribe this was debated, but Monica Harry noted that clinical usage in practice might be the arbiter. Use of the term "breath" was potentially confused with a physiological breath and so was not preferred. SNOMED has limitations on use of hyphens, which constrains our choices. Steven Dain noted that trademarking of ventilator modes in the past has obfuscated the area somewhat and that modern systematic descriptions are slowly being adopted - three manufacturers so far.

There was little dissent from the view that all manufacturers should converge on the standard ISO terms, and SNOMED should certainly represent these.

Andrew Norton is currently working on batch submission files for modes, patterns and inflation types which will be submitted to Norman Jones and Steven Dain for review before submission for authoring into SNOMED CT

8Date of next meeting - Tuesday 26th January 2021
This is line with the usual schedule of 4th Tuesday alternate months
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