Toward Standardization of Terminology in Anesthesia Information Management Systems

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Toward Standardization of Terminology in
Anesthesia Information Management Systems
Dr. Terri Monk, Dr. Martin Hurrell, Dr. Andrew
Norton Data Dictionary Task Force International
Organization for Terminology in
Anesthesia Representing Anesthesia Patient
Safety Foundation USA Royal College of
Anaesthetists - UK

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Anesthesia Patient Safety Foundation

• 1984 - APSF founded
• President - Dr. Ellison C. Pierce
• Patient-centered safety foundation approved by
  the ASA
• Mission To assure that no patient shall be
  harmed by the effects of anesthesia
• Emphasis on education and research
• Instrumental in making pulse oximetry
  capnography a standard of care

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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
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A minor issue
We have lots of information technology we just
dont have any information
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IOTAs Modus Operandi

• Data Dictionary Task Force (DDTF) organized by
  APSF in 2001
• In 2002, the DDTF accepted UK members and changed
  name to International Organization for
  Terminology in Anesthesia (IOTA)
• Current work of IOTA
• Model terms for anesthesia information systems
  using corps of international experts
• Reference storage of resources on a versioning
  control system, with web access
• Anesthesia Extension Group at SNOMED controls
  all new anesthesia terminology in SNOMED CT
• Special Interest Group for the Generation of
  Anesthesia Standards (SIGGAS) in HL7 to develop
  anesthesia record compliant with the CDA

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DDTF/IOTA Organization
U.S. Content Adviser Dr. David Reich
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IOTAs International Work Group
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Why a Formal Terminology?

• To provide effective database analysis
• To enable the effective pooling of data
• To allow predictive modeling
• To allow any sort of deductive reasoning
• Essential for the use of intelligent software
  agents

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Anesthesiology what are the drivers ?

• The anesthetic record
• Medico-legal
• On-line document
• Audit research
• Data sharing
• Common record structure to identify clinical
  context
• Common terminology for aggregation and analysis
• Common model to enable AI applications,
  reasoning and decision support

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Foundations for future AIMS
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Scope of the reference set

• All clinically descriptive terms
• Procedure notes, Equipment, Positioning,
  Emergencies, Outcomes
• Business and Administrative terms
• HCFA notes, Demographic terms, Insurers,
  Procedures, Diagnoses
• Drug formulary
• Agreed abbreviations, totaling units, (suggested
  doses?)
• Monitored data
• Agreed monitored data descriptors, abbreviations
• Data Exchange
• HL7, Devices etc

Any text element in an AIMS GUI, database or
data transaction where you might otherwise
have to invent a term to make it work.
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Relevance of a Data Dictionary
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Terminology and Ontology Work in Protégé OWL

• Why use Protégé
• Has a large international user community
• Supports OWL (Web Ontology Language) W3C
  recommendation
• Has rich support for properties and description
  logics (OWL DL)
• Has visualisation, versioning plugins reasoners
• Protégé is free

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Protégé OWL front end
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The Schema Defines the Structure for Well-Formed
Anesthesia XML Documents
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Vital Signs modeled in CDA
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The Promise - Sharing of Information
Hospital A
Hospital B

• Portability of records
• Outcomes research
• Knowledge
• The pre-emptive use of Information

Hospital C
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How Should Future Standardization of Anesthesia
Information Progress?

• 2 options
• Continue to work on the terminology with SNOMED
  and the record schema in HL7
• Bring the completed (or near completed work) to
  the appropriate ISO group and ask it to adopt
  the work as a standard.
• 2. Join an ISO technical committee? If so, which
  one?

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THE END