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
MH / 18 September, 2018

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
MH / 18 September, 2018

3. The Tower of Babel! Hospital A
Multicenter study of factors related to tourniquet injuries
Hospital C
Hospital B
The Tower of Babel!
MH / 18 September, 2018

4. in partnership with … = Data Dictionary Task Force
MH / 18 September, 2018

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
MH / 18 September, 2018

6. DDTF Organization Task Force Chair Dr. Terri Monk
Organizational control
Project reporting
APSF Executive Board
Financial control
Guidance and direction
Content Director
Dr. Andrew Norton
Content direction
Term submission
Technical Director
Dr. Martin Hurrell
Technical direction
Tools construction
Terming Group
Clinical review
Minimum data set
Ontology Group
Modelling
U.S. Content
Adviser
Dr. David Reich
MH / 18 September, 2018

7. Relevance of a Data Dictionary
Used by APSF
Corporate partners
SNOMED CT
DDTF
Reference
set
The terms are mapped/linked to an existing wider body of work …
which is adopted by the medical community
Anesthesia
Subset
DDTF
Reference
set
Combine points from previous slide with this
Change title to ‘Relevance of a data dictionary’
Remove ‘Used by UK/US etc.’ and replace with point #3 in previous slide then remove previous slide entirely
MH / 18 September, 2018

8. 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
A prerequisite for the progress of the specialty
and industry into enhanced uses of AIMS.
MH / 18 September, 2018

9. DDTF’s transition to IOTA
I O T A The International Organization for Terminology in Anesthesia Modeling and maintaining anaesthesia terms for the English-speaking anaesthesia community
MH / 18 September, 2018

10. IOTA’s Modus Operandi
Model terms for AIMS using corps 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
MH / 18 September, 2018

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
MH / 18 September, 2018

12. The October 2004 termset 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
MH / 18 September, 2018

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
MH / 18 September, 2018

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
MH / 18 September, 2018

15. X 73 Nomenclature Attributes
Description / Definition
Purpose
Systematic Name
An organization of differentating, relational descriptors
Formal or semi-formal but human-readable derivation
Common Term
A brief description of the name
Human-readable ident-ification for efficient lookup
Acronym
An abbreviated form of the name
Mnemonic or parametric abbreviation
A long or sentence form of the name
Human readable and as understandable as possible
Reference ID
A symbolic programmatic form of the term
Development of APIs
Code
[alpha-]numeric identifier
Human- and machine readable and efficiently processable by Machines
MH / 18 September, 2018

16. Base concepts Respiratory measurements
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
MH / 18 September, 2018

17. First Set of Differentiating Criteria 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:
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
MH / 18 September, 2018

18. First Set of Differentiating Criteria (contd
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:
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
Semantic Link “pertains to” - applicable descriptors include:
MH / 18 September, 2018

19. First Set of Differentiating Criteria (contd
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:
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
Semantic Link “has origin” - applicable descriptors include:
MH / 18 September, 2018

20. First Set of Differentiating Criteria (contd
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:
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
MH / 18 September, 2018

21. Second Set of Differentiating Criteria (contd
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:
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.
MH / 18 September, 2018

22. Second Set of Differentiating Criteria (contd
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:
Sigh/ SighMultiple/ TriggerSensitivity Define part or site in body. VentilationMode
Ventilation Defines that the pattern of respiration is controlled or modified by a ventilator
MH / 18 September, 2018

23. Third Set of Differentiating Criteria 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 respiration/ventilation.
Semantic Link "has context”
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
MH / 18 September, 2018

24. ‘Peak expiratory flow’
Measurement example
Systematic name
Flow | Expiration, Maximum | Gas | Ventilator
Common Term
Ventilation Expiratory Maximum Flow
Acronym
V E max
Description / Definition
Maximum expiratory gas flow during
mechanical ventilation
Reference ID
MDC_VENT_FLOW_EXP_MAX
Code
20873
IOTA Concept name
IOTA Concept
description
IOTA Synonym
‘Peak expiratory flow’
MH / 18 September, 2018

25. SPO2 Monitor 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
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]
MH / 18 September, 2018

26. 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 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]
MH / 18 September, 2018

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
MH / 18 September, 2018