Anesthesia Clinical Reference Group

Time: October 25, 2021 19:00-21:00 UTC / 20:00 - 22:00 UK / 15:00-17:00 ET

Meeting ID: 917 1865 9756

Password: 661800

Or Telephone:

+1 646 518 9805 (US Toll)
+44 203 481 5237 (GB Toll)
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1Introductions and Apologies

Apologies: Ellen Torres Jeremy Rogers Maria Hendrickson Patrick McCormick

Basil Bekdash was welcomed to the meeting.


Matters arising from the previous meeting notes

2021-09-28 Anesthesia CRG Meeting (Cancelled)

Andrew Norton

Notes from the last meeting were accepted as satisfactory.

3Introduction to the Anesthesia CRGAndrew NortonIf new attendees present, a short presentation on the history, interests and activity of the Anesthesia CRG will be given
4ISO 19223

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.

5Assisted breathing content reviewMonica Harry

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

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.

6Intensive Care related disorders

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.

7SNOMED updates

Today's SNOMED meeting for clinicians was noted, it was agreed that there was little to add in this group.

8HL7 updateMartin Hurrell

Comments on HL7 FHIR anesthesia record implementation guide and discussions in the HL7 Devices SIG. 

Agreement with American Society of Anesthesiologists as external collaborator

2021-09-27_HL7 External Collaborator Request.docx

Martin Hurrell noted that terminology/ structure/ implementation of records can be coordinated together, and the current work can be the basis of a universal electronic  anaesthetic record. The ASA have been requested to join as an external collaborator. It would be positive if other national bodies could add to the momentum of the project and create a standard, computable resource for clinical practice and research. AN noted previous efforts to standardise paper records by many bodies, but sees little current effort towards developing standards for electronic systems.

MH noted that a lot of information for the electronic anaesthesia record will automatically be drawn from other medical devices - as co-chair of the new HL7 devices group he hopes there will positive progress. Steven Dain expressed concern at the number of pre-coordinated terms in new ISO work (1173) and its consequences for HL7.

Jane Millar and Monica Harry noted that SNOMED is willing to work with others, such as HL7, towards common standards. It might be possible to contribute time to other efforts and collaborate effectively. Monica will liaise.

9Assessment scales

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.

None raised.

Date of next meeting - Tuesday November 23rd 2021

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

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