Objectives
- To review the Anesthesia Quality Institute / National Anesthesia Clinic=
al Outcomes Registry Data elements for outcomes with regard to SNOMED CT co=
ntent, definitions and identify work to be undertaken to ensure comprehensi=
ve SNOMED CT content in this area
Purpose
The purpose of this meeting was to review the outcome terms section (pag=
es 28-65) of the Anesthesia Quality Institute (AQI) / National Clinical Ane=
sthesia Outcomes Registry (NACOR) with regard to:
- Draft SNOMED coding of the elements
- Identify erroneous SNOMED CT codes
- Identify concepts for which SNOMED CT code available
- Make recommendations and request submissions to SNOMED International fo=
r additional terms
- Review definitions of the outcome data elements with a view to potentia=
l suitability for recommendation to SNOMED International to include in SNOM=
ED RF2 release files
Ge=
neral observations
Some general observations with regard to the outcome data elements inclu=
de:
- Some concepts are outcomes, some are physiological states
- It is useful to check definitions against other authoritative sources=
li>
- Definitions would normally need to be acceptable across more than one n=
ational domain for potential inclusion in SNOMED CT
- Sources of definitions should be referenced
- Severity coding / recording of reported outcomes is highly desirable
- Outcome data elements and definitions will be clarified and refined ove=
r time
- Who, what, where, when, why as components for reporting
Detailed discussion of data elements
The meeting reviewed a large number of the outcomes concepts, including<=
/p>
- There are some changes needed to preferred terms used for clarity of me=
aning
- Further work is required on the case cancelled terms (before anaesthesi=
a start time, before induction time, after induction time. There are curren=
tly no SNOMED CT concepts to enable this degree of detail.
- Changes in SNOMED CT to difficult and failed intubation were noted as w=
ere the implications and need for a specific term for difficult mask ventil=
ation
- Need to model concepts for ICU delirium and emergence delirium
- Not currently totally clear way of expressing high spinal and /or high =
epidural. Most suitable is Excessive cephalad spread of local anesthetic fo=
llowing regional anesthesia. May need new concepts or additional synonyms=
li>
- There is difficulty in currently coding the infection related to neurax=
ial and peripheral block terms. New concepts required and for further discu=
ssion at follow up meeting on 18/01/2017
- Terminology related to temporary and transient changes in blood pressur=
e - most current SNOMED CT terminology is disorder rather than transient si=
tuation oriented. No suitable concept to record transient hypotension, espe=
cially in the anesthesia setting
Additional meeting 2pm CST 18/01/2017
Present
Background and AQI/NACOR conceptual data elements
An additional call was made to review progress made at the time noted ab=
ove.
Arnold Berry gave an outline of the evolution of NACOR under the Anesthe=
sia Quality Institute. It was noted that there was currently no underlying =
data dictionary with clear reference to submitters as to the meaning and co=
nstraints on concepts to be reported. Many providers of submissions to AQI =
are only able to provide billing data with little or no outcomes informatio=
n
AB noted the need to enhance and develop the quality improvement activit=
y in the NACOR database because of the financial incentives and penalties f=
rom CMS Medicare in relation to quality improvement activity and data submi=
ssion
AB had led a working group to put together a data dictionary of conceptu=
al elements for NACOR. This had subsequently been published for field=
testing and comment from anesthesiologists. The results had informed the A=
QI/NACOR conceptual data elements v2.0 published October 2016. =
The IHTSDO Anesthesia SIG is now engaged to review the terminology and defi=
nitions of the data elements with a view to alignment with SNOMED CT and ob=
jectives outlined.
A further version of the data elements would be published in due course,=
hopefully with the addition of some co-morbidity information.
Terminology discussions arising fr=
om terminology review on 17/01/2017
- AN gave an outline of the terminology review of the data elements illus=
trating a number of the findings and suggestions from the Anesthesia SIG
- It was agreed that terminology to represent transient states of blood p=
ressure change are needed in SNOMED CT, but members felt that the current d=
efinitions represent degrees of change that would frequently be seen =
in anesthesia without necessarily representing a reportable adverse outcome=
. AQI definitions would not be suitable for SNOMED CT
- Infection after neuraxial blocks and peripheral nerve blocks. AB explai=
ned how these were closely modelled from NSQIP and CDC reportable events fo=
r sepsis. Current SNOMED CT terminology only enables coding of a few of the=
elements defined here. Noted that concepts relating to infection after epi=
dural anesthesia would have a wider context than surgical anesthesia - they=
could potentially occur after procedures in pain management and epidural a=
nalgesia for labour
- Case cancellation terms are significant in quality metrics for anesthes=
ia. More specific terms as defined in the AQI/NACOR data elements are desir=
able for inclusion in SNOMED CT.
Actions =
agreed
- IHTSDO Anesthesia SIG will complete the review of the outcomes section =
of the data elements. The edited outcomes document is available by request =
from Andrew Norton.
- The completed mapping of SNOMED CT to the outcome data elements will be=
returned to AQI including:
- Suggested changes and corrections in SNOMED CT maps
- Comments made during the mapping process
- Planned submissions via the SNOMED Request Service for new terms
- Definitions that are proposed for inclusion in SNOMED RF2 release files=
- Other concept definitions identified from authoritative sources during =
this review.