Page History

Andrew Norton

Introductions were made. Apologies for were received from Patrick McCormick Andrew Marchant user-d48df

The group noted with some concern that Andrew Marchant had been denied leave to attend the meeting and that the process of obtaining time to contribute to professional activity such as this was generally becoming more difficult. Additionally the group has noted difficulty in recruiting newer younger members and hoped that more engagement with governing professional bodies as evidence by the agenda of this meeting might help overcome this issue. Jane Millar and Charles Gutteridge are taking up issues of engagement with professional bodies

Zac Whitewood-Moores

Andrew Marchant

Andrew Marchant

The group discussed the matter raised by Zac Whitewood-Moores regarding the anesthesia for xxxx codes. It was noted that they would create "noise" in an attempt to generate an anesthesia subset. To the group's knowledge it is the CPT codes themselves rather than the SNOMED equivalents that are used for billing and reimbursement in the USA. They would not conform to current SNOMED editorial guidelines. Agreed they should be retired from International release, possibly retained in US extension.

A number of items carried forward to this agenda

Work continues on standards for electronic anaesthesia records and, engagement with professional bodies in adopting such standards in accreditation, It is proposed to develop a draft standard for anesthesia records in the UK aligned to the format of Professional Records Standards Body standards. This work will be informed by the HL7 Domain Analysis model for Anaesthesia Records. Feedback awaited from report to AAGBI council

Coma, unconsciousness and concussion. Felt that a true consensus document for definitions is not achievable - A brief report of what the Anesthesia CRG views as best definitions available outlining preferred approach to assessment using Glasgow Coma score and other methods.

Andrew Norton

Monica Harry

Item not reached

James Palmer

Daniel Weegmann

Discussion started with consideration of para 2.3.1.3 of ACSA (Anaesthesia Clinical Standards Accreditation run by the Royal College of Anaesthetists). As currently drafted, these advocate the use of an electronic anaesthesia record in a fairly open way. Additional wording was suggested to mandate the use of record standards and controlled terminology which would be specified (HL7, open EHR, SNOMED CT) in the guidance notes. James Palmer will take these suggested revisions to ACSA for discussion and approval.

Daniel Weegmann gave a presentation on development work within the EPR at Salford Royal Hospitals Trust. This presentation focused on the move from free text entry to structured records based on health issues. Health issues have been gradually structured into Clinical terms (diagnoses, problems), Procedures and Risk factors. Entries since October 2018 are SNOMED encoded. Various methods of searching EPR records were demonstrated on a test data base.

A list of 18 significant anaesthesia issues (significant assessments or events that would have significant bearing on future procedures had been identified and implemented.

The group agreed that this work represented real progress in EPR functionality and utility. It was agreed that the team from Salford would be invited to present their anaesthesia records at the April 2020 meeting.

James Palmer raised some terminology issues:

1) At risk of difficult airway - existing number of finding terms. An at risk term would be included in terminology requests

2) Calder score (airway assessment - jaw protrusion) . Andrew Norton commented that for assessment scales to be included in SNOMED there needed to be a reasonable evidence base and a clear defintion - from internet search did not appear that these criteria were met but it would be further researched.

Post meeting note: There are SNOMED CT terms for reducued mandibular protrusion findings., original reference for Calder scale Anaesthesia 1992 47 582-9.

Monica Harry mentioned her new role as content manager and noted the quality assurance process taking place with regard to existing SNOMED CT content

Presentations to and discussion with invited leaders of Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland

Discussion paper "RCOA Council briefing paper on anaesthesia relevant coding" JJ Pandit, J Palmer & I Moppett - copy in meeting files

Andrew Norton gave a short presentation on the history, development and current content of SNOMED CT to support anaesthesia information management systems(AIMS) and the potential uses of SNOMED CT encoding that could be made for both clinical noting and a wide range of local and national reporting purposes. It was noted that historically the RCoA and AAGBI had published standards for and recommended content of paper anaesthesia records and it was proposed that this would also be useful to support electronic anaesthesia records.

It was suggested that at some stage there will be much wider implementation of AIMS in the UK and therefore wise to plan now in terms of professional recommendations for their implementation. To that end a discussion (item 5 above) was held to suggest some revisions and additions to the ACSA standards as regards electronic anaesthesia records.

Ian Green outlined SNOMED International structures, the international release, National Release Centres and the potential role and benefit of subsets.

Jaideep Pandit noted that the Royal College of Anaesthetists now has a coding panel (remit outlined in Coding Briefing paper outline Vers1.docx

The group also discussed the PRSB (Professional Records Standards Body) Standards for the Structure and Content of Health Care Records, noting that as currently published these relate to more general documents such as discharge summaries with no published example of a specialised record such as anaesthesia or invasive cardiology procedures. The rigorous standards for endorsement and wide engagement were noted. This will be discussed further with the RCoA representatives to the PRSB (Professor Ian Moppett and James Palmer

Kathleen Ferguson and Jaideep Pandit outlined a number of considerations in a move towards AIMS systems including:

• Ability to support time dependency and costing aspects dependent on patient complexity and comorbidity
• Information governance and security issues, especially with information transfer for secondary purposes
• Interoperability and integration between AIMS and wider hospital and primary care systems
• Performance gain vs workload aspects of AIMS

It was requested that the RCoA and AAGBI give consideration to developing some fairly high level recommendations for the implementation of electronic anaesthesia records that would include informatics standards to be used, record content and potential secondary use purposes of such records.

Martin Hurrell

http://www.hl7.org/Special/committees/gas/index.cfm

Martin Hurrell gave a presentation describing the role of HL7 as a standards body, an outline of the purpose of a Domain Analysis Model. He then went on to demonstrate UML class diagrams to represent particular areas of activity and how these are used to generate a document from the DAM model. The DAM is of potential use to a developer as a road map in terms of a conceptual framework that could proceed to the production of an implementation guide as a detailed resource from which to build systems.

Steven Dain gave an update on the ISO 19223 ventilation standard. This is now at the proofing statge. Martin Hurrell noted thanks for the information supplied on ventilation modes and inflation types which had proved very useful in HL7 Domain Analysis Model work.

It was suggested that Steven Dain give a presentation on ISO 19223 at the next zoom meeting on 28th May 2019.

Tuesday, May 28, 2019

Andrew Norton Toni Morrison

Andrew Norton

Toni Morrison

List of commonly used products in anesthesia (see attached Excel file IV Fluids.xlsx.)

SNOMED International is currently undertaking remodelling of products including IV fluids based on a model defining ingredients measured in metric units. This creates a partially automatically generated hierarchy of fully and sufficiently defined concepts. Work is currently in progress but anticipated that should be complete for the January 2020 release. Levels of detail that include pack sizes, manufacturers etc are deemed to be appropriate for national extensions.

Noted that the units adopted differ from current conventions, but the current view is that the International release should not be complicated by synonyms to accomodate different units or representations of composition.

Identified missing solutions were discussed and agreed that requests would be submitted before the close of the submission window (beginning October 2019) for the January 2020 release.

Noted that the representation of balanced electrolyte solutions would be difficult using the current SNOMED model.

Examples of anesthesia and ITU prescribing practice would provide use cases that inform the validation of and any amendments suggested to the current modelling approach.

Steven Dain

Update on the ISO 19223 ventilation standard, now at the proofing stage. user-619d4 and Martin Hurrell discussed the meanings of patterns and inflation types defining modes as related to commonly used artificial ventilation in anaesthesia as tabulated by John Walsh

ventilation modes.xlsx

Commonly used method of oxygen delivery in high dependency care - characteristics of the method is that delivered oxygen is heated and humidified

However, the method is not just nasal - manufacturers (for example Fisher-Paykel) include adapters for delivering the same gas delivery to a tracheostomy. Consider requesting two concepts for the two delivery routes.

user-619d4 noted there will be an addendum to ISO 19223 that will cover this type of respiratory therapy

Tuesday, July 23, 2019