2017-01-17 AQI/NACOR outcomes terms
Date
Tuesday 17th January 2017
This meeting is being held during the HL7 Working Group meeting in San Antonio TX. Session times will be:
0900 - 1030 CST (1500-1630 UTC)
1100 - 1230 CST (1700-1830 UTC)
1345 - 1500 CST (1945 -2100 UTC)
1530 - 1700 CST (2130-2300 UTC)
Attendees
@Martin Hurrell
@Former user (Deleted)
@Former user (Deleted)
@Former user (Deleted)
Heather Sherman (AQI)
@Former user (Deleted)
@Former user (Deleted)
@Former user (Deleted)
Koichiro Matsumoto
@Andrew Marchant
Apologies
@Patrick McCormick
@Zac.Whitewood-Moores
@Former user (Deleted)
Objectives
To review the Anesthesia Quality Institute / National Anesthesia Clinical Outcomes Registry Data elements for outcomes with regard to SNOMED CT content, definitions and identify work to be undertaken to ensure comprehensive SNOMED CT content in this area
Purpose
The purpose of this meeting was to review the outcome terms section (pages 28-65) of the Anesthesia Quality Institute (AQI) / National Clinical Anesthesia Outcomes Registry (NACOR) with regard to:
Draft SNOMED coding of the elements
Identify erroneous SNOMED CT codes
Identify concepts for which SNOMED CT code available
Make recommendations and request submissions to SNOMED International for additional terms
Review definitions of the outcome data elements with a view to potential suitability for recommendation to SNOMED International to include in SNOMED RF2 release files
General observations
Some general observations with regard to the outcome data elements include:
Some concepts are outcomes, some are physiological states
It is useful to check definitions against other authoritative sources
Definitions would normally need to be acceptable across more than one national domain for potential inclusion in SNOMED CT
Sources of definitions should be referenced
Severity coding / recording of reported outcomes is highly desirable
Outcome data elements and definitions will be clarified and refined over time
Who, what, where, when, why as components for reporting
Detailed discussion of data elements
The meeting reviewed a large number of the outcomes concepts, including
There are some changes needed to preferred terms used for clarity of meaning
Further work is required on the case cancelled terms (before anaesthesia start time, before induction time, after induction time. There are currently no SNOMED CT concepts to enable this degree of detail.
Changes in SNOMED CT to difficult and failed intubation were noted as were the implications and need for a specific term for difficult mask ventilation
Need to model concepts for ICU delirium and emergence delirium
Not currently totally clear way of expressing high spinal and /or high epidural. Most suitable is Excessive cephalad spread of local anesthetic following regional anesthesia. May need new concepts or additional synonyms
There is difficulty in currently coding the infection related to neuraxial and peripheral block terms. New concepts required and for further discussion at follow up meeting on 18/01/2017
Terminology related to temporary and transient changes in blood pressure - most current SNOMED CT terminology is disorder rather than transient situation oriented. No suitable concept to record transient hypotension, especially in the anesthesia setting
Additional meeting 2pm CST 18/01/2017
Present
@Former user (Deleted)
Heather Sherman
@Patrick McCormick
@Former user (Deleted)
@Former user (Deleted)
@Former user (Deleted)
Background and AQI/NACOR conceptual data elements
An additional call was made to review progress made at the time noted above.
Arnold Berry gave an outline of the evolution of NACOR under the Anesthesia Quality Institute. It was noted that there was currently no underlying data dictionary with clear reference to submitters as to the meaning and constraints on concepts to be reported. Many providers of submissions to AQI are only able to provide billing data with little or no outcomes information
AB noted the need to enhance and develop the quality improvement activity in the NACOR database because of the financial incentives and penalties from CMS Medicare in relation to quality improvement activity and data submission
AB had led a working group to put together a data dictionary of conceptual elements for NACOR. This had subsequently been published for field testing and comment from anesthesiologists. The results had informed the AQI/NACOR conceptual data elements v2.0 published October 2016. The IHTSDO Anesthesia SIG is now engaged to review the terminology and definitions of the data elements with a view to alignment with SNOMED CT and objectives outlined.
A further version of the data elements would be published in due course, hopefully with the addition of some co-morbidity information.
Terminology discussions arising from terminology review on 17/01/2017
AN gave an outline of the terminology review of the data elements illustrating a number of the findings and suggestions from the Anesthesia SIG
It was agreed that terminology to represent transient states of blood pressure change are needed in SNOMED CT, but members felt that the current definitions represent degrees of change that would frequently be seen in anesthesia without necessarily representing a reportable adverse outcome. AQI definitions would not be suitable for SNOMED CT
Infection after neuraxial blocks and peripheral nerve blocks. AB explained how these were closely modelled from NSQIP and CDC reportable events for sepsis. Current SNOMED CT terminology only enables coding of a few of the elements defined here. Noted that concepts relating to infection after epidural anesthesia would have a wider context than surgical anesthesia - they could potentially occur after procedures in pain management and epidural analgesia for labour
Case cancellation terms are significant in quality metrics for anesthesia. More specific terms as defined in the AQI/NACOR data elements are desirable for inclusion in SNOMED CT.
Actions agreed
IHTSDO Anesthesia SIG will complete the review of the outcomes section of the data elements. The edited outcomes document is available by request from @Former user (Deleted).
The completed mapping of SNOMED CT to the outcome data elements will be returned to AQI including:
Suggested changes and corrections in SNOMED CT maps
Comments made during the mapping process
Planned submissions via the SNOMED Request Service for new terms
Definitions that are proposed for inclusion in SNOMED RF2 release files
Other concept definitions identified from authoritative sources during this review.
Meeting Files
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