CRG members
- Andrew Marchant
- Patrick McCormick
- Martin Hurrell
- Steven Dain
- Andrew Norton
- user-d48df
- Monica Harry
- Toni Morrison
- Maria Hendrickson
- Jorge Galvez
- Bruce Goldberg
- user-b7840
- Stuart Abbott
- Zac Whitewood-Moores
- user-9fb53
- Terri Monk
- Daniel Karlsson
- Suzanne Santamaria
- John Walsh
- Maurice McKinney
- Curtis Tinsley
- James Palmer
- Anthony Madden
- Jane Millar
- user-801ee
Present
- Morning session: Andrew NortonJames Palmer Zac Whitewood-Moores Jane Millar Monica Harry Martin Hurrell Steven Dain, Daniel Weegmann.
- Afternoon Session: Andrew NortonPaul Amos Martin Hurrell Ian Green Maria Hendrickson Patrick McCormick, Grant Forrest, Jaideep Pandit, Kathleen Ferguson
Invitees
Daniel Weegmann (EPR Health Issues & Terminology Specialist Nurse, Salford Royal NHS Foundation Trust)
Professor Jaideep Pandit (Council Member, Royal College of Anaesthetists
Dr Kathleen Ferguson (President, Association of Anaesthetists of Great Britain and Ireland)
Lucie Mussett ( NHS Improvement DPSIMs (Development of the Patient Safety Incident Management System) Project)
Venue: Westminster Room, Waldorf Hilton, Aldwych London WC2B 4DD
Morning Conference Call Details
Meeting time is 2019-04-10 09:00 UK to 12:30; 04:00 US ET (0800 UTC)
Meeting ID: 524-400-204
Join from PC, Mac, Linux, iOS or Android: https://snomed.zoom.us/j/524400204
Afternoon Conference Call Details
Meeting time is 2019-04-10 13:30 UK to 16:30; 08:30 US ET (1230 UTC)
Meeting ID: 933-287-627
Join from PC, Mac, Linux, iOS or Android: https://snomed.zoom.us/j/933287627
Or Telephone:
US: +1 415 762 9988 (US Toll) or +1 646 568 7788 (US Toll)
UK: +44 (0) 20 3695 0088
Canada: +1 647 558 0588
More international numbers available: https://zoom.us/u/cYTPCEKj8
Discussion items
Item | Time | Description | Owner | Notes |
---|---|---|---|---|
1 | 0900 | Introductions and apologies | 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 | |
2 | Minutes of previous meeting | Minutes from 2019-03-26 Anesthesia CRG Meeting were agreed to be a true record of the meeting | ||
3 | Matters arising from the minutes | 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. | ||
4 | Outstanding SNOMED CT terminology requests | Include recent correspondence on CRS request 740106 Mechanical Insufflation - Exsufflation Item not reached | ||
5 | 1000 | Electronic Anaesthesia Record Development, Salford Health issues coding in SNOMED CT | 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. |
6 | Definitions for coma and unconsciousness | Paul Amos | See prior discussion on Confluence: "There are a number classification concepts currently within the terminology which are of the form:
Some discussion took place in the morning with the Salford representatives present. James Palmer suggested that a definition of coma would be a GCS of 7 or below(suggesting need for airway support) + an AVPU (as part of NEWS scoring) of U. Discussion noted that the preferred way of doing this kind of assessment is Glasgow Coma Scoring and that GCS thresholds in definitions of coma and unconsciousness vary . It was agreed that further input would be sought from Ed Cheetham (has already contributed in the discussion pages) and from the Academy of Medical Royal Colleges (via RCoA). Andrew Marchant is trying to get a contribution to the discussion from neurosurgeons in Edinburgh. Afternoon session Paul Amos noted the problems and overlap in defintions for coma and unconsciousness and there are a number of poor compound terms for brain injury many of which are ambiguous or imprecise. The QA initiative is hoping to remove ambiguous terms. NICE (UK National Institute for Clinical Excellence) guidance on brain injury supports the use of Glasgow Coma Scoring with frequent remeasurement as indicated clinically | |
7 | SNOMED updates | Monica Harry | Monica Harry mentioned her new role as content manager and noted the quality assurance process taking place with regard to existing SNOMED CT content | |
8 | 1400 | SNOMED CT content for anaesthesia records HL7 International Anesthesia Work Group; HL7 Domain Analysis Model for intraoperative anesthesia records | 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 | |
HL7 Anesthesia DAM discussion | http://www.hl7.org/Special/committees/gas/index.cfm | |||
9 | Summary points for plenary closing session | Andrew Norton | ||
10 | Any other business | |||
11 | Next meeting | Tuesday, May 28, 2019 |