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This is a request for information on the use of the following anaesthesia related concepts:

67902001 |Anesthesia for a normal healthy patient (procedure)|
23102000 |Anesthesia for a patient with mild systemic disease (procedure)|
22211001 |Anesthesia for a patient with severe systemic disease (procedure)|
112989003 |Anesthesia for a moribund patient requiring operation (procedure)|
71191009 |Anesthesia for a patient with severe systemic disease, life threatening (procedure)|

In reviewing these concepts, it has come to our attention that there is some similarity between these concept descriptions and those which are used in the ASA Physical Status Classification System.

The link to this classification is https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system

We note that the date of the last update is given as 15 October 2014 and that while the descriptions used within SNOMED CT bear a close resemblance they differ in the following respects:
    • They do not include a reference to the ASA stage
    • The SNOMED CT description includes the phrase “Anesthesia for….”

In order for us to decide whether we should reach out to the ASA it would be helpful if you could answer the following questions:


1. Is the ASA Physical Status Classification System a nationally accepted classification which is in current widespread use in:
       a. The US
       b. Internationally
2. Are the SNOMED CT concepts identified above widely used in:
       a. The US
       b. Internationally


I would be grateful for your views.
Kind regards
Paul
Paul Amos
I have included Jane Millar in this conversation due to her role as collaboration Lead.

Contributors (6)

7 Comments

  1. I think that these essentially are based on the ASA 1/2/3/5/4 definitions (the mapping is very close), and exploit them to describe procedures rather than as descriptions of patient status. I've had a quick look at Anesthesia SIG minutes from 2014 and I haven't easily found a discussion of this issue although I have a feeling that it has been mentioned (susequent to the ASA classification update in 2014). Perhaps another SIG/ CRG member will recall...

    Specifically:

    1. ASA classification is in widespread UK/ US/ International use for clinical and academic purposes. It is a useful shorthand when I want to express how "unwell" an individual patient is.
    2. I can't speak for the SNOMED terms, as a clinician I haven't specifically encountered their use. They are perhaps, however, more suited to administrative than clinical use. There is no specific anesthetic technique which distinguishes the categories.

    Regards,

    Andrew.


  2. The assessment findings of ASA status would be appropriate to record in shorthand, however the current procedures might lead to an apparent multiple anaesthetics being recorded.  In fact only the last of the concept types is arguably the appropriate procedure to be recorded. 

    • Anaesthesia for (ASA status)
    • Anaesthesia for (surgical procedure) - due to be retire/moved, I believe
    • 50697003 | General anesthesia (procedure) | 

    If they have to be retained they should be fully modelled or risk inadequate equivalence detection.

    Of course the other element is the ambiguity of type of anaesthesia general/local/regional etc

    It would be helpful if a standard for anaesthesia practice was collaborated between SI, HL7, professional bodies in a similar way to the International Patient Summary.  This might give better carity of how the record is meant to be constructed.

  3. Paul,

    Apologies for my slow reply - have been away at BMA annual meeting then on holiday. 

    I think that these "Anesthesia for patient with xxxx systemic disease" originate from the CPT coding system (developed by the American Medical Association and used principally for reimbursement procedural coding in the USA.)  I'm not sure if CPT is used in any other country.

    I think that it is far better to record the relevant ASA physical class finding term from SNOMED in a patient record and agree entirely with the points made by Andrew Marchant

    So in answer to your specific questions:

    1) ASA physical status classification is an internationally widely accepted and used system of broadly classifying patient comorbidity

    2) I would be pretty sure that the compound " Anesthesia for patient with xxxx systemic disease" terms would only have a use in the USA

    Best wishes

    Andrew

  4. Hi All, Andrew Nortonand Andrew Marchant

    The consensus appears to suggest that we should inactivate the 5 concepts above as they are not useful clinically and we could also return them to the US edition.

    Therefore at your next meeting, please could I ask that the group agree to make a decision on the following:

    1. The following should be inactivated from SNOMED International:
    • 67902001 |Anesthesia for a normal healthy patient (procedure)|
    • 23102000 |Anesthesia for a patient with mild systemic disease (procedure)|
    • 22211001 |Anesthesia for a patient with severe systemic disease (procedure)|
    • 112989003 |Anesthesia for a moribund patient requiring operation (procedure)|
    • 71191009 |Anesthesia for a patient with severe systemic disease, life threatening (procedure)|

           2. The above concepts should be returned to the US edition of SNOMED CT YES/NO


    With the answers to these questions we can then close this discussion.

    Many thanks for your help.

    Kind regards

    Paul

    Paul Amos

    1. Paul,

      Next scheduled meeting of the Anesthesia CRG is on Tuesday 28th January 2020.  Will have it on the agenda and try and get views about the recommendation, especially from our US colleagues

      Best wishes

      Andrew

  5. Paul Amos Ok to inactive in SCT International and return to the US extension. - Record the ASA status as a Finding code that already exists in SCT.

    1. Monica Harry , Paul Amos and the CRG: thank you for this response. I have made the agreed upon changes for the July 2020 release.