1. IEEE 11073 Nomenclature Status
IEEE HL7, Montreal, Quebec
May 8, 2016
Paul Schluter
The Center for Medical Interoperability

2. IEEE 11073 Nomenclature Highlights
IEEE R – Revision, pages (Malcolm Clarke)
Combines ISO/IEEE :2004 and a-2015
Integrates IEEE Personal Health Devices
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.
RTMMS and Term Approval Process
Term Approval and Governance Model
IEEE P b – New Observation Identifiers
New devices and observation identifiers (NMT, TPTD-CCO, ...)
Events and Alerts and par-src-evt tuples (with user-facing definitions)
Dialysis – HL7 IG based on IHE PCD and IEEE nomenclature
IHE PCD Infusion Pump terms – coming soon
IEEE to LOINC mapping (Dr. Swapna Abhyankar)

3. IEEE P11073-10101b Events and Alerts
The existing list of ISO/IEEE :2004 MDC_EVT_ identifiers has been extended to support the IHE PCD Rosetta for Events and Alerts and ACM. This work extends the existing :2004 nomenclature with contributions from GE, Philips, Dräger and others.
Events and alerts will be included in IEEE P b , 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 :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.3f.x3k T13.src-as-VMD.html>> and <<phys-tech.3f.x3k T13.src-as-par.html>> . Available in the May 1 RTM GoogleGroup meeting invitation, sent on April 30, 2019.

4. IEEE 11073 <source-event> pairs#
par-type
short description
source
event 1
ecg-phys
Heart rate limit exceeded
MDC_ECG_HEART_RATE
MDC_EVT_LO,
MDC_EVT_HI 2
Ventricular tachycardia
MDC_ECG_V_P_C_CNT
MDC_DEV_ECG_VMD
MDC_EVT_ECG_V_TACHY 3
ecg-tech
Lead disconnected
MDC_ECG_LEAD_*
MDC_DEV_SPEC_PROFILE_ECG
MDC_EVT_LEAD_DISCONN 4
vent-tech
Patient circuit disconnected
MDC_VENT_VOL_LEAK
MDC_DEV_SYS_PT_VENT_VMD
MDC_DEV_SPEC_PROFILE_HHEV
MDC_EVT_PAT_CIRCUIT_DISCONN
Notes:
1. ‘physiologic numeric limit alert’ re-uses existing numeric observation identifiers
2. ‘named physiologic alert’ such as ventricular tachycardia (source specifies metric or device)
3. ‘named technical event’ source identifies specific lead or metric or device
4. ‘named technical event’ source identifies specific metric or device

5. New devices likely to be included in 10101b
New 10101b Devices and Parameters
Infusion Pumps (based on IHE PCD Pump WG and PIV and IPEC profiles)
Hemodialysis (DaVita, Fresenius Medical Care / NxStage, Baxter, BBraun, Medtronic)
Regional Oxygen Saturation (rSO2 using NIRS) (2+)
Neuromuscular Transmission (NMT) (4+)
Transpulmonary Thermodilution – Continuous Cardiac Output (TPTD-CCO) (2+)
Perfusion Index PI and Pulse Variability Index PVI (Masimo)
Surgical Pleth Index (SPI) (GE)
Maternal Fetal Monitor (2+)
Bed (2+) (bed)
Nurse Call (3+) (ncs)
Bowman Perfusion Monitor (1) (bpm)

6. Devices and Data Types R existing b pending review active review tbd
new work
ParameterDevice
num
set
wav
evt-phys
evt-tech
Review Status
ecg R
ecgResp
nbp nibp
spO2
temp
ip hemo
eeg b
Events and Alerts
bis
Active Review
entropy
RTM weekly tcons
anesthesia vent
vent
spiro resp spiroVent
gasMon*
gasDeliv*
neb
n/a
NMT (4+)
PI PVI (Masimo)
Next: New Devices
SPI (GE)
and Parameters
rSO2 (2+)
TPTD-CCO (2+)
Infusion Pumps (5+3+)
Hemodialysis (4+3+)
Later: New Devices
Maternal-Fetal Monitor (2+)
tbd
and Systems
Bed (2+)
Nurse Call (3+)
Bowman Perfusion Monitor

7. Topics for Discussion

8. ST Deviation relative to baseline reference
MDC_EVT_ST_DEV_BSLN_REF_LO and _HI alerts
ST deviation relative to baseline reference exceeds lower or upper limit. The baseline reference template can be a running average or median or a time snapshot. <source> = MDC_ECG_AMPL_ST*
ST baseline reference – new ‘per-lead’ term for waveform templates and numeric values, MDC_ECG_AMPL_ST_DEV_BSLN_REF_<lead>.
Report absolute (not delta) ST values and alert thresholds as evidentiary data.

9. <source-event> identifier pairs
<source-event> identifiers specified as pairs.
Removes ambiguity and facilitates consistent and testable implementations, especially with new adopters.

10. <source-event> identifier pair synonyms
Multiple <source-event> identifier pairs can map to the same user-facing definition.
src
evt
mdcDescription
MDC_ECG_V_P_C_CNT, MDC_DEV_ECG_VMD
MDC_EVT_ECG_BIGEM
Ventricular bigeminy
MDC_ECG_CARD_BEAT_RATE, MDC_DEV_ECG_VMD
MDC_EVT_ECG_BRADY
Bradycardia

11. MDC_EVT_LO and MDC_EVT_HI
There are three names for numeric limit alerts, largely considered synonymous by most vendors and 10101R:
REFID and Part::Code
10101R Definition
MDC_EVT_LO (3::62)
"A metric falls short of a given threshold”
MDC_EVT_LO_LT_LIM  (3::64)
MDC_EVT_LO_VAL_LT_LIM (3::66)
Consider defining _CRITICAL and _TRACKING numeric limits?
MDC_EVT_HI_CRITICAL
“Hard” upper limit, based on patient age, gender, case/policy
MDC_EVT_HI_TRACKING
Adaptive tracking threshold exceeded.
MDC_EVT_HI
Traditional user settable threshold exceeded.
-- within normal limits --
MDC_EVT_LO
... corresponding lower numeric limits
MDC_EVT_LO_TRACKING
MDC_EVT_LO_CRITICAL

12. Additional Slides

13. IEEE P11073-10103a Implanted Devices Cardiac
Extends IEEE P :2012 Implanted Devices Cardiac
New IDC term codes, extending IEEE P :2012.
Additional new terms and term-sets have been reviewed by the Heart Rhythm Society (HRS) and will be included in the standard.
The HRS has recommended that the currently work be captured in an update/amendment to , preferably now.
The IDCO WG meets weekly on Fridays at 10:00 AM Central (US).

14. Hemodialysis
Hemodialysis Block Diagram (from
Containment tree with numeric observations, settings and events and alerts