The Center for Medical Interoperability IEEE 11073 Nomenclature Status IEEE 11073 GC at HL7, Baltimore Wednesday, October 3, 2018 Paul Schluter The Center for Medical Interoperability

IEEE 11073 Nomenclature Highlights IEEE P11073-10101b – New Observation Identifiers (Q1) New Observation Identifiers (NMT, TPTP-CCO, vents ...) Events and Alerts and par-src-evt tuples (with user-facing definitions) Dialysis – HL7 IG based on IHE PCD and IEEE 11073 nomenclature IHE PCD Infusion Pump terms – coming soon IEEE 11073 to LOINC mapping (Q1) (Dr. Swapna Abhyankar) RTMMS and Term Approval Process (Q1, Q2) RTM Governance Model (Spencer Crosswy, CMI) Additional proposals (Malcolm, others) and discussion IEEE 11073-10101R – Mandatory revision, 930+ pages (Q2, Q3) Combines ISO/IEEE 11073-10101:2004 and -10101a-2012 Integrates IEEE 11073 Personal Health Devices (led by Malcolm Clarke) Additional terms for ventilators, WCM, MEM-LS, MEM-DMC and UoM. When approved and published and uploaded into NIST RTMMS, this will provide a common baseline for definition of additional terms.

IEEE P11073-10101b Extends ISO/IEEE Std 11073-10101:2004 and -10101a-2015: Initial Proposal REFIDS Definitions UoM Enums WG Appr Codes N/A Infusion pumps and infusion events (IHE PCD PIV and IPEC) b Ventilator mode, high-frequency ventilation, annotations NMT Neuromuscular transmission (level of neuromuscular block) Finalize the WCM waveform attributes R Ventilator E:I ratio, Ipart, Epart and other terms IHE PCD Device Management Control (DMC) R,b IHE PCD Real-Time Location Services (LS) Event and Alert Identifiers (in progress) Dialysis Surgical and OR devices (by OR.NET at http://www.ornet.org/) Hemodynamic parameters using transpulmonary thermodilution and pulse contour analysis Note: R indicates inclusion in -10101R, b indicates inclusion in -10101b soon afterwards.

IEEE P11073-10101b Events and Alerts The existing list of ISO/IEEE 11073-10101:2004 MDC_EVT_ identifiers has been extended to support the IHE PCD Rosetta for Events and Alerts and ACM. This work extends the existing -10101:2004 nomenclature with contributions from GE, Philips, Dräger and others. Events and alerts will be included in IEEE P11073-10101b , based on earlier discussions. Physiologic events and alerts – largely done, with par-src-evt 3-tuples. Technical events and alerts – 800+ proposed and existing REFIDs and definitions based on GE, Philips and -10101:2004 standard, with more terms from Dräger and other vendors. Par-src-evt 3-tuples for ecg, ecgResp, nbp, spO2, temp, ip, eeg, bis and entropy, followed by all resp, spiro, gasMonCO2, gasMon, ventilator and anesthesia tuples, the latter combined into a single anesthesia-mds: phys-tech.3e.x3i.2018-06-26T20.src-as-VMDs.xslx . (work in progress)

Lessons Learned (so far) Physiologic numeric limit and ‘named’ events and alerts have been relatively easy to define: Existing numeric observation identifiers are reused. The majority of ‘named’ clinical events and alerts, e.g. asystole, are based on existing clinically spoken nomenclatures. Technical events and alerts have been significantly more challenging: They often reflect the myriad of details embodied in vendor designs. Vendors often insist that the level of detail conveyed by their proprietary protocols should also be conveyed by standards-based protocols and nomenclatures; typically precise 1:1 mapping is required. Technical event identifiers can be expressed in a variety of ways, from simple enumerated identifiers to more sophisticated {parameter, source, event} 3-tuples, making subsequent harmonization difficult. The following practices and conventions have been very helpful: Use complete and concise definitions, suitable for clinician review, that are unambiguously associated with their on-the-wire src-evt pairs. Definitions may be used ’as is’ in products. Use table sections as an informative method to group related terms together. This facilitates recognition of synonyms and missing terms. The overall effort is less daunting and easier for new vendors to participate.

Example – Hemodialysis Hemodialysis Block Diagram (from https://en.wikipedia.org/wiki/Dialysis) Containment tree with numeric observations, settings and events and alerts

IEEE P11073-10103a Implanted Devices Cardiac Extends IEEE P11073-10103:2012 Implanted Devices Cardiac New IDC term codes, extending IEEE P11073-10103:2012. Notifications (‘alerts’) are complete with the definition of 14 standardized notification categories that convey publically- disclosed vendor-specific notifications. [This reflects the sometimes significant differences in the underlying vendor design of these devices.] Additional new terms and term-sets have been reviewed by the Heart Rhythm Society (HRS) and will be included in the standard. (for example, see HRS notes from August and September 2018) The IDCO WG meets weekly on Fridays at 10:00 AM Central (US).