Alignment of IOTA Device and Measurement Terms with x73 Nomenclature

1. Alignment of IOTA Device and Measurement Terms with x73 Nomenclature San Diego September 2005 Martin Hurrell Terri Monk Andrew Norton Data Dictionary Task Force International Organization for Terminology in Anesthesia

2. APSF Commitment to AIMS Systems “ The APSF endorses and advocates the use of automated record keeping in the perioperative period and the subsequent retrieval and analysis of that data to improve patient safety ” APSF Board of Directors October 2001

3. Hospital A Hospital C Hospital B The Tower of Babel! Multicenter study of factors related to tourniquet injuries

4. in partnership with … = Data Dictionary Task Force

5. Data Dictionary Task Force • Created in 2001 • Chairperson: Terri G. Monk, M.D. • Given the mission to create a “Data Dictionary” for the specialty of anesthesia

6. APSF Executive Board • Financial control • Guidance and direction • Task Force Chair • Dr. Terri Monk • Organizational control • Project reporting • Technical Director • Dr. Martin Hurrell • Technical direction • Tools construction • Content Director • Dr. Andrew Norton • Content direction • Term submission • Ontology Group • Clinical review • Modelling • Terming Group • Clinical review • Minimum data set DDTF Organization U.S. Content Adviser Dr. David Reich

7. DDTF Reference set Anesthesia Subset SNOMED CT The terms are mapped/linked to an existing wider body of work … which is adopted by the medical community DDTF Reference set Used by APSF Corporate partners Relevance of a Data Dictionary

8. A prerequisite for the progress of the specialty and industry into enhanced uses of AIMS. Why a Formal Terminology? • Standards • Reduce implementation costs • To provide effective database analysis • To enable the effective pooling of data • To enable inter institutional comparisons • To allow predictive modeling • To allow any sort of deductive reasoning • Essential for the use of intelligent software agents

9. DDTF’s transition to IOTA I O T AThe International Organization for Terminology in AnesthesiaModeling and maintaining anaesthesia terms for the English-speaking anaesthesia community

10. IOTA’s Modus Operandi • Model terms for AIMS usingcorps of international experts • Reference storage of resources on a versioning control system, with web access • Much of the terming work now done in frequent net meetings using Microsoft Live Meeting • Distribute terms • On line submissions to CAP SNOMED

11. October 2004 Deliverables • 1942 clinical terms (approximately 2200 in May 2005) • A read only version of DATAMS allowing interested parties to review the terms • Term viewer is available on the APSF website at www.apsf.org/datams

12. General anaesthesia Local anaesthesia Vascular access procedures Attributes and modifiers for procedures Anaesthetic drugs Fluids and blood products Monitoring terms Anaesthesia equipment Airway management Some administrative terminology Scales and assessments relevant to anaesthesia Positioning and patient protection The October 2004 termset

13. The October 2004 termset does not contain • A complete drug formulary • (need for multi axial hierarchies) • A surgical procedure glossary • (ideally would be linked to SNOMED CT procedures) • A full set of terms for pre operative assessment • Items in the forward work program

14. x73 Nomenclature & IOTA ontology / terminology • “the Systematic Name is an <n>-tuple of a Base Concept and a series of Differentiating Criteria” • IOTA aims to develop and maintain its ontology in OWL DL • IOTA will aim to use the x73 base concepts and associated 1st., 2nd. And 3rd. level differentiators in its device and measurement ontology • Concept names will use the x73 ‘Common Term’ and the associated description will be the x73 ‘Description / Definition’ – optionally, synonyms may be defined • x73 Differentiators will be properties of IOTA concepts

15. X 73 Nomenclature Attributes

16. Compliance/ Resistance:These concepts describe the elastic properties of the lung and the resistance in the flow of gas in the airway Concentration: Describes the chemical components of the gas (delivered and metabolic). Derived values are mean values and values at distinct time points like "EndtidalCO2” Duration:Describes a certain time interval e.g. the inspiration phase Electrical Impedance:Electrical measurement, describes changes in electrical properties of the thorax by volume of gas in lungs and fluid volume and distribution in thorax Flow:Describes the velocity of the gas exchange, e.g. in the airway Index/ Ratio: These concepts comprise calculated and derived data. Simple quotients are called "Ratio", complicated calculations "Index". Mode: Describes the type of respiratory ventilation (spontaneous and/or mechanically controlled) which is in use for the patient Number: Used for counted events Pressure: Directly related to physical measurement of pressure Base conceptsRespiratory measurements

17. Dynamic/ Static/ Occlusion These concepts are used to describe the method of measurement Pressure/ Transthoracic Describes the method of measurement for respiratory rate PressureSupport/ PositivePressure / These are descriptors for the type of breathing or Spontaneous mechanical ventilation Applied/ Intrinsic/ Positive/ Used for specification of respiration or ventilation PositiveEndexpiratory mode Continuous Defines that the assistance by external means is continuous in time Intermittent Defines that the assistance by external means is discontinuous in time Synchronised Defines that the assistance by external means is synchronised to spontaneous breathing First Set of Differentiating CriteriaThe second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>. Semantic Link "has method” - applicable descriptors include:

18. OneMinute Defines the time interval for calculating or integrating a value PartialPressure Defines the type of concentration measurement DeadspaceVolume / TidalVolume Volumes used for calculating the ratio Duration(InspirationPhase)/ Describe time intervals for computation of Duration(ExpirationPhase) time ratios Flow(AlveolarVentilation)/ Flow(Perfusion) Describe components of gas in the process or /Flow(Expired CO2)/ Flow(O2used) calculation First Set of Differentiating Criteria (contd.) The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>. Semantic Link "has method” - applicable descriptors include: Semantic Link “pertains to” - applicable descriptors include:

19. Inspiration/ InspirationPhase/ Expiration/ Describe phases or certain time points in the ExpirationPhase/ Endexpiratory/ EndTidal/ respiration process Pause/ Plateau/ SinceStartInspiration Airway/ NOS/ CO2/ Pressure/ Volume/ Flow Used to define origin of a derived value First Set of Differentiating Criteria (contd.) The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>. Semantic Link "has time criterion” - applicable descriptors include: Semantic Link “has origin” - applicable descriptors include:

20. Mean/Maximum/Minimum Describe calculations to derive values from waveforms Difference(Inspiration, Expiration)/ Difference of values in inspiration and expiration Difference(PartialPressureInspiration, phase is calculated, in this case used for PartialPressureExpiration) concentration differences. Ratio(FlowDifference, PressureDifference) Defines the calculation necessary for index First Set of Differentiating Criteria (contd.) The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>. Semantic Link “is computed as” - applicable descriptors include:

21. Alveolar/ Alveoli/ Airway/ Esophageal/ Define part or site in body. InterPleural/ Lung/ LungStructure/Pleural Apnea Describes one type of functional disorder, the absence of breath, which is an important event or alarm. Duration is normally measured. Breathing Defines the pattern of respiration is spontaneous and controlled by the patient DeadSpace/ Tidal/ TidalVolume/ Describe functional properties of the lung and the Trapped/ VitalCapacity respiratory tract CO2/ O2/ Desflurane/ Enflurane/Halothane Describe compartment, respired gas and /Isoflurane/ NO2 (Nitrogen Dioxide) components. For the most common gas and N2O (Nitrous Oxide)/ Sevoflurane/ anaesthetic vapour concentrations separate Substance terms have been included Leakage Describes loss of gas by leak in ventilator itself, tubing connections etc. Second Set of Differentiating Criteria (contd.)The third field of "Systematic Name" describes the target of measurement. More than one descriptor ispossible. It holds information about body compartments, body parts, body functions or refers to their state. Since mechanical ventilation is included in the application field, Table A.5.5 contains terms concerning ventilator functionality as well Semantic Link “concerns” - applicable descriptors include:

22. Sigh/ SighMultiple/ TriggerSensitivity Define part or site in body. VentilationMode Ventilation Defines that the pattern of respiration is controlled or modified by a ventilator Second Set of Differentiating Criteria (contd.)The third field of "Systematic Name" describes the target of measurement. More than one descriptor ispossible. It holds information about body compartments, body parts, body functions or refers to their state. Since mechanical ventilation is included in the application field, Table A.5.5 contains terms concerning ventilator functionality as well Semantic Link “concerns” - applicable descriptors include:

23. First set of semantic link descriptors Further specifies the general context of respiration. Only one of the following may be selected: Airway Breathing LungStructure RespiratoryProcess RespiratoryTract Second set of semantic link descriptors Ventilator Defines measurements in ventilation and mechanical ventilator settings Third Set of Differentiating CriteriaThe fourth field holds information about the context, i.e. the functional or organic system, for which the term is relevant. All terms in this field belong to respiration/ventilation. Semantic Link "has context”

24. Measurement example IOTA Concept name IOTA Concept description IOTA Synonym ‘Peak expiratory flow’

25. SPO2 Monitor SPO2 Monitor {which is a subclass of ‘Analyzer’ [SNOMED: ‘Oxygen analyzer’]} hasMeasuredProperty->Saturation {which is a subclass of ‘Concentration’} hasTarget->Blood hasDeviceType->Medical Device System (MDS) [SNOMED Physical Device]

26. Arterial oxygen saturation Arterial oxygen saturation hasSpecificMeasurementType->Saturation [SNOMED: IS-A Oxygen saturation measurement] hasSpecificSubstance->pO2 [SNOMED ‘Component’: Oxygen (molecular oxygen)] concernsFluidType->arterial blood [SNOMED ‘Has Specimen’: Arterial blood specimen]

27. X73 – IOTA – SNOMED CT • IOTA will endeavour to align the X73 common term with the equivalent SNOMED CT concept name • The X73 common term may be adopted as the IOTA concept name or as a synonym thereof • Traceability of IOTA concepts to the X73 nomenclature will be via the relevant X73 code. SNOMED CT concept identifiers are already recorded • This scheme will enable the relationship between SNOMED CT concept identifiers, IOTA identifiers and X73 codes to be exposed