alignment of iota device and measurement terms with x73 nomenclature

MH / MH / 22 April 202322 April 2023 11ι

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


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


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!


in partnership with …

=Data Dictionary Task Force

http://www.cerner.com/default.asp


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


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


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


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.


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


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


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


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


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


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


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


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


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:


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:


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:


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:


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:


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:


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”


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’


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


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]


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

alignment of iota device and measurement terms with x73 nomenclature

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