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Alignment of IOTA Device and Alignment of IOTA Device and Measurement Terms with x73 Measurement Terms with x73
NomenclatureNomenclature
San DiegoSeptember 2005
Martin Hurrell Terri Monk Andrew NortonMartin Hurrell Terri Monk Andrew Norton
Data Dictionary Task Force Data Dictionary Task Force International Organization for Terminology in AnesthesiaInternational Organization for Terminology in Anesthesia
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APSF Commitment to AIMS SystemsAPSF 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 DirectorsOctober 2001
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Multicenter study of factors related to tourniquet injuries
9 0254 Tourniquet time (mins): 454Hospital A
102 Tourniquet interval (mins): 102.5
Hospital C
T1 Tourniquet off-tourniquet on (mins): 01Ae2
Hospital B
The Tower of Babel!
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in partnership with …
=Data Dictionary Task Force
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Data Dictionary Task ForceData Dictionary Task Force
• Created in 2001Created in 2001
• Chairperson: Terri G. Monk, M.D.Chairperson: Terri G. Monk, M.D.
• Given the mission to create a “Data Dictionary” for the Given the mission to create a “Data Dictionary” for the specialty of anesthesiaspecialty of anesthesia
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DDTF OrganizationDDTF Organization
Task Force ChairDr. Terri Monk• Organizational
control• Project reporting
APSF Executive Board• Financial control• Guidance and
direction
Content DirectorDr. Andrew Norton• Content direction• Term submission
Technical DirectorDr. Martin Hurrell• Technical direction• Tools construction
Terming Group• Clinical review• Minimum data set
Ontology Group• Clinical review• Modelling
U.S. Content AdviserDr. David
Reich
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Relevance of a Data DictionaryRelevance of a Data Dictionary
Used by APSFUsed by APSFCorporate partnersCorporate partners
SNOMED CT
DDTFReference
set
The terms are mapped/linked to an
existing wider body of work …
which is adopted by the medical community
AnesthesiaSubset
DDTFReference
set
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Why a Formal Terminology?Why a Formal Terminology?• StandardsStandards• Reduce implementation costsReduce implementation costs• To provide effective database analysisTo provide effective database analysis• To enable the effective pooling of dataTo enable the effective pooling of data• To enable inter institutional comparisonsTo enable inter institutional comparisons• To allow predictive modelingTo allow predictive modeling• To allow any sort of deductive reasoningTo allow any sort of deductive reasoning• Essential for the use of intelligent software agentsEssential for the use of intelligent software agents
A prerequisite for the progress of the specialty and industry into enhanced uses of AIMS.
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DDTF’s transition to IOTADDTF’s transition to IOTA
I O T AI O T A
The International Organization for The International Organization for Terminology in AnesthesiaTerminology in Anesthesia
Modeling and maintaining anaesthesia terms for the Modeling and maintaining anaesthesia terms for the English-speaking anaesthesia communityEnglish-speaking anaesthesia community
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IOTA’s Modus OperandiIOTA’s Modus Operandi
• Model terms for AIMS usingModel terms for AIMS usingcorps of international expertscorps of international experts
• Reference storage of resources on a versioning control Reference storage of resources on a versioning control system, with web accesssystem, with web access
• Much of the terming work now done in frequent net Much of the terming work now done in frequent net meetings using Microsoft Live Meeting meetings using Microsoft Live Meeting
• Distribute termsDistribute terms• On line submissions to CAP SNOMEDOn line submissions to CAP SNOMED
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October 2004 DeliverablesOctober 2004 Deliverables
• 1942 clinical terms (approximately 2200 in May 2005)1942 clinical terms (approximately 2200 in May 2005)• A read only version of DATAMS allowing interested A read only version of DATAMS allowing interested
parties to review the termsparties to review the terms• Term viewer is available on the APSF website at Term viewer is available on the APSF website at
www.apsf.org/datamswww.apsf.org/datams
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The October 2004 termsetThe October 2004 termset
• General anaesthesiaGeneral anaesthesia• Local anaesthesiaLocal anaesthesia• Vascular access Vascular access
proceduresprocedures• Attributes and modifiers for Attributes and modifiers for
proceduresprocedures• Anaesthetic drugsAnaesthetic drugs• Fluids and blood productsFluids and blood products
• Monitoring termsMonitoring terms• Anaesthesia equipmentAnaesthesia equipment• Airway management Airway management • Some administrative Some administrative
terminologyterminology• Scales and assessments Scales and assessments
relevant to anaesthesiarelevant to anaesthesia• Positioning and patient Positioning and patient
protectionprotection
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The October 2004 termset does not The October 2004 termset does not containcontain
• A complete drug formularyA complete drug formulary— (need for multi axial hierarchies)(need for multi axial hierarchies)
• A surgical procedure glossaryA surgical procedure glossary— (ideally would be linked to SNOMED CT procedures)(ideally would be linked to SNOMED CT procedures)
• A full set of terms for pre operative assessmentA full set of terms for pre operative assessment• Items in the forward work programItems in the forward work program
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x73 Nomenclature & IOTA x73 Nomenclature & IOTA ontology / terminologyontology / terminology
• ““the Systematic Name is an <n>-tuple of a Base the Systematic Name is an <n>-tuple of a Base Concept and a series of Differentiating Criteria”Concept and a series of Differentiating Criteria”
• IOTA aims to develop and maintain its ontology in OWL IOTA aims to develop and maintain its ontology in OWL DLDL
• IOTA will aim to use the x73 base concepts and IOTA will aim to use the x73 base concepts and associated 1associated 1stst., 2., 2ndnd. And 3. And 3rdrd. level differentiators in its . level differentiators in its device and measurement ontologydevice and measurement ontology
• Concept names will use the x73 ‘Common Term’ and Concept names will use the x73 ‘Common Term’ and the associated description will be the x73 ‘Description / the associated description will be the x73 ‘Description / Definition’ – optionally, synonyms may be definedDefinition’ – optionally, synonyms may be defined
• x73 Differentiators will be properties of IOTA conceptsx73 Differentiators will be properties of IOTA concepts
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X 73 Nomenclature Attributes
AttributeAttribute Description / DefinitionDescription / Definition PurposePurpose
Systematic Systematic NameName
An organization of differentating, An organization of differentating, relational descriptorsrelational descriptors
Formal or semi-formal but Formal or semi-formal but human-readable derivationhuman-readable derivation
Common Common TermTerm
A brief description of the nameA brief description of the name Human-readable ident-ification Human-readable ident-ification for efficient lookupfor efficient lookup
AcronymAcronym An abbreviated form of the nameAn abbreviated form of the name Mnemonic or parametric Mnemonic or parametric abbreviationabbreviation
Description / Description / DefinitionDefinition
A long or sentence form of the A long or sentence form of the namename
Human readable and as Human readable and as understandable as possibleunderstandable as possible
Reference IDReference ID A symbolic programmatic form of A symbolic programmatic form of the termthe term
Development of APIsDevelopment of APIs
CodeCode [alpha-]numeric identifier[alpha-]numeric identifier Human- and machine readable Human- and machine readable and efficiently processable by and efficiently processable by MachinesMachines
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Base conceptsBase conceptsRespiratory measurements
• Compliance/ Resistance:: These These concepts describe the elastic concepts describe the elastic properties of the lung and the properties of the lung and the resistance in the flow of gas in the resistance in the flow of gas in the airwayairway
• ConcentrationConcentration: : Describes the chemical components of the gas (delivered and metabolic). Derived values are mean values and values at distinct time points like "EndtidalCO2”
• DurationDuration:: Describes a certain time Describes a certain time interval e.g. the inspiration phaseinterval e.g. the inspiration phase
• Electrical ImpedanceElectrical Impedance:: Electrical Electrical measurement, describes changes measurement, describes changes in electrical properties of the thorax in electrical properties of the thorax by volume of gas in lungs and fluid by volume of gas in lungs and fluid volume and distribution in thoraxvolume and distribution in thorax
• Flow: Describes the velocity of the gas exchange, e.g. in the airway
• Index/ Ratio: Index/ Ratio: These concepts These concepts comprise calculated and comprise calculated and derived data. Simple quotients derived data. Simple quotients are called "Ratio", complicated are called "Ratio", complicated calculations "Index".calculations "Index".
• ModeMode: : Describes the type of Describes the type of respiratory ventilation respiratory ventilation (spontaneous and/or mechanically (spontaneous and/or mechanically controlled) which is in use for the controlled) which is in use for the patientpatient
• NumberNumber: : Used for counted eventsUsed for counted events• PressurePressure: : Directly related to Directly related to
physical measurement of pressurephysical measurement of pressure
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First Set of Differentiating CriteriaFirst Set of Differentiating Criteria The second field of the "Systematic Name" refers to the measurement features. The following The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>.property>, <kind of quantity>.
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 ventilationApplied/ Intrinsic/ Positive/ Used for specification of respiration or ventilation PositiveEndexpiratory modeContinuous Defines that the assistance by external means is continuous in timeIntermittent Defines that the assistance by external means is discontinuous in timeSynchronised Defines that the assistance by external means is synchronised to spontaneous breathing
Semantic Link "Semantic Link "has method” - has method” - applicable descriptors include:applicable descriptors include:
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OneMinute Defines the time interval for calculating orintegrating 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 ratiosFlow(AlveolarVentilation)/ Flow(Perfusion) Describe components of gas in the process or /Flow(Expired CO2)/ Flow(O2used) calculation
First Set of Differentiating CriteriaFirst Set of Differentiating Criteria (contd.) (contd.) The second field of the "Systematic Name" refers to the measurement features. The following The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>.property>, <kind of quantity>.Semantic Link "Semantic Link "has method” - has method” - applicable descriptors include:applicable descriptors include:
Semantic Link “Semantic Link “pertains to” - pertains to” - applicable descriptors include:applicable descriptors include:
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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 CriteriaFirst Set of Differentiating Criteria (contd.) (contd.) The second field of the "Systematic Name" refers to the measurement features. The following The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>.property>, <kind of quantity>.Semantic Link "Semantic Link "has time criterion” - has time criterion” - applicable descriptors include:applicable descriptors include:
Semantic Link “Semantic Link “has origin” - has origin” - applicable descriptors include:applicable descriptors include:
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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 CriteriaFirst Set of Differentiating Criteria (contd.) (contd.) The second field of the "Systematic Name" refers to the measurement features. The following The second field of the "Systematic Name" refers to the measurement features. The following semantic links apply, semantic links apply, more than one descriptor is possible. They specify different measurement features, <kind of more than one descriptor is possible. They specify different measurement features, <kind of property>, <kind of quantity>.property>, <kind of quantity>.Semantic Link “Semantic Link “is computed as” - is computed as” - applicable descriptors include:applicable descriptors include:
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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 patientDeadSpace/ 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 CriteriaSecond Set of Differentiating Criteria (contd.)(contd.)The third field of "Systematic Name" describes the target of measurement. More than one descriptor 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. 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 Since mechanical ventilation is included in the application field, Table A.5.5 contains terms concerning ventilator functionality as wellventilator functionality as wellSemantic Link “Semantic Link “concerns” - concerns” - applicable descriptors include:applicable descriptors include:
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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 CriteriaSecond Set of Differentiating Criteria (contd.)(contd.)The third field of "Systematic Name" describes the target of measurement. More than one descriptor 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. 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 Since mechanical ventilation is included in the application field, Table A.5.5 contains terms concerning ventilator functionality as wellventilator functionality as wellSemantic Link “Semantic Link “concerns” - concerns” - applicable descriptors include:applicable descriptors include:
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Third Set of Differentiating CriteriaThird Set of Differentiating Criteria The fourth field holds information about the context, i.e. the functional or organic The 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 system, for which the term is relevant. All terms in this field belong to respiration/ventilation.respiration/ventilation.
First set of semantic link descriptorsFurther 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•VentilatorDefines measurements in ventilation and mechanical ventilator settings
Semantic Link "Semantic Link "has context”has context”
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Measurement exampleMeasurement example
Systematic nameSystematic name Flow | Expiration, Maximum | Gas | Ventilator
Common TermCommon Term Ventilation Expiratory Maximum Flow
AcronymAcronym V E max
Description / Description / DefinitionDefinition
Maximum expiratory gas flow during Maximum expiratory gas flow during mechanical ventilationmechanical ventilation
Reference IDReference ID MDC_VENT_FLOW_EXP_MAX
CodeCode 2087320873
IOTA Concept name
IOTA Concept description
IOTA Synonym‘Peak expiratory flow’
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SPO2 Monitor
SPO2 Monitor {which is a subclass of ‘Analyzer’ [SNOMED: ‘Oxygen analyzer’]}hasMeasuredProperty->Saturation {which is a subclass of ‘Concentration’}hasTarget->BloodhasDeviceType->Medical Device System (MDS) [SNOMED Physical Device]
Systematic Name
Common Term Description / Definition
Reference ID Code
Analyzer | Concentration [Sat] | Blood | <type>
SPO2 Monitor Instrument which derives the % of arterial O2 and pulse rate parameters(blood flow).
MDC_DEV_ANALY_SAT_O2
4104
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Arterial oxygen saturation
Systematic Name
Common Term Description/ Definition
Reference ID Code
Concentration | Saturation, Oxygen | ArterialBlood | BloodChemistry
Arterial oxygen saturation
MDC_SAT_O2_ART
19252
Arterial oxygen saturationhasSpecificMeasurementType->Saturation [SNOMED: IS-A Oxygen saturation measurement]hasSpecificSubstance->pO2 [SNOMED ‘Component’: Oxygen (molecular oxygen)]concernsFluidType->arterial blood [SNOMED ‘Has Specimen’: Arterial blood specimen]
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X73 – IOTA – SNOMED CTX73 – IOTA – SNOMED CT
• IOTA will endeavour to align the X73 common term IOTA will endeavour to align the X73 common term with the equivalent SNOMED CT concept namewith the equivalent SNOMED CT concept name
• The X73 common term may be adopted as the IOTA The X73 common term may be adopted as the IOTA concept name or as a synonym thereofconcept name or as a synonym thereof
• Traceability of IOTA concepts to the X73 nomenclature Traceability of IOTA concepts to the X73 nomenclature will be via the relevant X73 code. SNOMED CT concept will be via the relevant X73 code. SNOMED CT concept identifiers are already recordedidentifiers are already recorded
• This scheme will enable the relationship between This scheme will enable the relationship between SNOMED CT concept identifiers, IOTA identifiers and SNOMED CT concept identifiers, IOTA identifiers and X73 codes to be exposedX73 codes to be exposed