1. 1 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a Update HL7 DEV SIG and IEEE 11073 GC Meetings, Atlanta, GA Wednesday Q1, October 7, 2015 Paul Schluter, GE Healthcare Jan Wittenber and Todd Cooper, C4MI

2. 2 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a Status IEEE P11073-10101a/D5 recirculation ballot currently underway after six IHE PCD ACM numeric codes were corrected. IEEE-SA RevCom review now rescheduled for December 2015, with anticipated approval on December 5 th and publication possibly as early as December 9 th. Plan to facilitate upload of new terms to NIST RTMMS at the earliest possible date, with wider disclosure when permitted by IEEE-SA (hopefully on or around December 10 th ). Key question: Will this be early enough to allow testing with the NIST RTMMS, NIST test tools and IHE NA Connectathon during January 25-29, 2016?

3. 3 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a transfer to RTMMS IEEE Std 11073-10101a Annex A and Annex C as XML for IEEE distribution (mimics tables in standard) For RTMMS, include ‘Disc’ in term tables also used to create refid[disc]code 3-tuples [MMM] Statistical Discriminators {2 bits} dOffsetdSuffixdDescription 0 {base measurement} or not specified 1_MAX maximum value observed over an interval 2_MIN minimum value observed over an interval 3_MEAN mean value observed over an interval Reference IDDiscPart::Code CF_CODE1 0 MDC_SAT_O2_DELIV_INDEX MMM2::19596150668 MDC_PRESS_BLD_VEN_FEMO RAL SDM2::19604150676 MDC_PRESS_BLD_ART_BRACH IAL SDM2::19608150680 MDC_TTHOR_HEART_RATE RCE2::18482149554

4. 4 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 refid[disc]code 3-tuples Provides unambiguous method for expanding REFIDs with all discriminator variants and numeric codes Essential for automatic REFID and code generation Fully automatic, but aware of existing code blocking conventions Semi-automatic, with editorial oversight regarding conventions Essential for automatic REFID and code conflict detection Can support REFIDs and codes ‘as is’ with or with discriminators! Reference IDDiscPart::Code CF_CODE1 0 MDC_SAT_O2_DELIV_INDEX MMM2::19596150668 MDC_SAT_O2_DELIV_INDEX_MA X MMM2::19597150669 MDC_SAT_O2_DELIV_INDEX_MI N MMM2::19598150670 MDC_SAT_O2_DELIV_INDEX_ME AN MMM2::19599150671

5. 5 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 Disposition of -10101a and hRTM terms The ‘harmonized’ Rosetta (hRTM) terms contains existing terms, terms that require a numeric code, new terms and obsolete and deprecated terms. Their disposition will be documented. Existing NIST RTMMS hRTM TermsActionUpdated NIST RTMMS hRTM Existing -10101:2004 terms in hRTMRetainedAsRetained with UoM, enum, site info New -10101a terms in hRTMAssignCodeRetained with UoM, enum, site info New -10101a terms not in hRTMAddNewTermAdded, determine UoM, enums, site info Proposed hRTM 0^PP/Conc terms not in - 10101a ObsoleteNot transferred (shall not be used) Deprecated -10101:2004 terms (identified by #)DeprecatedNot transferred (use strongly discouraged)

6. 6 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 Term Co-Management Issues with PHD Root cause is lack of a single authoritative repository for both PoCD and PHD terms PoCD uses RTMMS, spreadsheets and MS-Word (in draft standard) PHD uses MS-Word, #defines and spreadsheet maintained by co- chairs Difficult to keep synchronized! Six ACM attribute code conflicts with existing PHD caused delay from October to December RevCom; timing is critical for IHE Connectathon! NIST RTMMS would be perfect choice for PoCD and PHD to use Single numeric code generator and repository to guarantee non- overlap Preliminary agreement by PHD co-chairs to use RTMMS (Paul facilitates) Update methods Method 1: Standard RTTMS term entry after initial bulk upload (preferred). Method 2: For an interim period, periodic bulk uploads with term conflict detection with terms already in RTMMS (aligned with current PHD term workflow).

7. 7 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 PHD REFIDs and codes alone are insufficient Phase 1: Need other Rosetta co-constraints: units, enumerations, measurement sites and other information: Essential: Reference ID, Disc, Part::Code [CF_CODE10 calculated] also used to create refid[disc]code 3-tuples Source: specifies term source, e.g. 11073-10424-2014-Cor1-D1 Co-constraints: units, enums, sites The Disc and Source attributes would be added to the existing NIST RTMMS as additional columns. Phase 2: PHD device specializations MDC_DEV_SPEC_PROFILE_* and containment/content models would be captured separately, as a computable representation based on Continua WAN Annex J (differences between WAN and PHD would be noted).

8. 8 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 Making things easier... Confirmed that REFIDs have unambiguous mappings to numeric codes (only four exceptions found) facilitating documentation using only Reference IDs. REFIDs are only associated with a single numeric code (by design) whereas a numeric code may have multiple ‘REFID-synonyms’. Allows codes to be filled on an ‘as needed’ basis in documentation. The NIST RTMMS excellently supports REFIDs, codes, units, enumerations, and measurement sites, facilitating transfer of PHD information into RTMMS. This will help significantly align PoCD and PHD efforts. As noted previously, Continua WAN ‘Annex J’ and later have containment tables for many PHD devices as sent over the Continua WAN (which is based on IHE PCD DEC).

9. 9 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a Collaborations NIST RTMMS, IHE PCD Rosetta and IEEE 11073 working group ISO/TC121/SC4 (ISO/CD 19223 working group) Dr. Norman Jones (Technical chair, ISO 19223) Dr. Steven Dain (Chair ISO 19223, anesthesiologist, editor for IEC 60601-1-8 Ed 1) Dr. John Walsh (anesthesiologist at Partners) HL7 GAS SIG Dr. John Walsh (HL7 GAS SIG chair, anesthesiologist at Partners) NIH/NLM/LHC and Regenstrief (Mapping IEEE 11073 to LOINC) Drs. Clem McDonald, MD, and Swapna Abhankar, MD THANK YOU for your expertise and guidance!

10. 10 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101b Infusion pumps and infusion events (IHE PCD PIV and IPEC) Ventilator mode, high-frequency ventilation, breath-by-breath annotations NMT Neuro-muscular transmission Finalize the WCM waveform attributes (or just use aECG) IHE PCD Device Management Control (DMC) IHE PCD Real-Time Location Services (LS) Generalized Signal Quality Index Additional observation identifiers and settings

11. 11 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101c IHE PCD Rosetta identifiers for Events, Alerts and Alarms

12. 12 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 EXTRA SLIDES

13. 13 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a Annex A Annex A (normative) Nomenclature Semantics4 A.5 Nomenclature, data dictionary, and code extensions for vital signs devices (Block A)5 A.6 Terminology and code extensions for units of measurement (Block B)8 A.7 Nomenclature, data dictionary, and codes for metrics (measurements and enumerations) (Block C)14 A.7.3 Nomenclature and code extensions for hemodynamic monitoring measurements14 A.7.4 Nomenclature and code extensions for respiratory, ventilator and anesthesia measurements17 A.7.4.18 Gas concentration and partial pressure measurements17 A.7.4.19 Inspiratory breath type classification19 A.7.4.20 Nomenclature and code table21 A.7.4.21 Nomenclature and codes for nebulizers62 A.7.5 Nomenclature, data dictionary, and codes for common blood-gas, blood, urine, and other fluid chemistry measurements64 A.7.8 Nomenclature, data dictionary, and codes for neurological monitoring measurements66 A.7.11 Nomenclature and code extensions for miscellaneous measurements68 A.7.11.7 Body Weight and Surface Area69 A.7.12 Nomenclature and code extensions for infant incubator and warmer microenvironments70 A.7.13 Nomenclature and code extensions for personal health devices72 A.8 Nomenclature, data dictionary, and codes for body sites (Block D)72 A.8.4 Sites for EEG-electrode placement on the head76 A.11 Information attributes to support IHE PCD DEC and PCHA Continua WAN77 A.11.1 Information attributes to support IHE PCD Alert Communication Management77 A.11.2 Infrastructure attributes to support PCHA/Continua WAN and IHE PCD DEC77 A.11.3 Information attributes to support PCHA/Continua WAN78 A.11.4 Information attributes to support IHE PCD DEC and PCHA/Continua WAN timekeeping79 A.11.5 Information attributes to support semantics defined by this standard81

14. 14 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a Annexes C-G Annex C (normative) Terms and Codes82 C.1 Overview82 C.2 Discriminator Sets82 C.3 Terms and Discriminators84 Annex D (informative) Breaths and Inflations101 Annex E (informative) Respiratory, Ventilator and Anesthesia Reference ID Naming Conventions103 Annex F (informative) Anesthesia Ventilation and Breathing Circuits105 F.1 Bellows driven on expiratory side107 F.2 Piston driven on inspiratory side108 F.3 Mapleson circuits109 Annex G (informative) Bibliography111

15. 15 HL7 DEV SIG and IEEE 11073 GC 2015-01-22 IEEE P11073-10101a/D4 Table A.7.4.8 Respiratory, Ventilator and Anesthesia observation and setting identifiers Respiratory Rates – method specific Ventilator Respiratory and Inflation Rates Phase and Time Intervals Airway Measured Flow Ventilator Measured Flow and Settings Tidal volume (airway and ventilator) Minute volume (airway and ventilator, units = volume/minute) Minute volume (Adaptive Support Ventilation: Reference, Percentage and Target) Other volumes Airway and other pressures Ventilator and airway pressures Pressure Limits Pressure risetimes Plateau pressure Resistance and compliance PEEP Apnea Patient-ventilator synchronization Metabolics Work of Breathing (WOB) Inspiratory Pressure-time Product (PTP) Tube Compensation Miscellaneous Ventilator Mode Agents and Gases Gas identification and selection Gas concentrations and partial pressures Nebulizer Topics shown with black font were added or augmented during balloting phase