PCD RTM 2009-07-01 WebEx

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(Vent TG Main Page)

Meeting Purpose

IHE PCD Rosetta Terminology Mapping (RTM) Ventilator Task Group regular discussion meeting. See the Proposed Agenda below for specific topics.

WebEx Information

Topic: IHE PCD RTM Vent TG

Date: Wednesday, July 1, 2009

Time: 12:00 pm, Eastern Time (GMT -05:00, New York)

Duration: 120 Minutes


Note: Specific web & phone informaiton will be provided via e-mail to group members.

Contact Manny Furst for more information.

Proposed Agenda

1 Review & Approve Agenda
2 Review 2009.06.17 Discussion Notes
3 TC121/SC4 Meeting Update (Dain) - Deferred
4 Rosetta Update Report (Schluter)
5 Review Pamphlet Organization - Deferred
6 Review proposed Templates for pamphlets(Isaza) - Deferred
7 Agenda for Next Meeting

Attachments / Materials

Discussion Notes

Chair/Host: Todd Cooper (Breakthrough Solutions Foundry)
Maria Cherkaoui (NIST), Steven Dain (ISO TC121/SC4), Robert Flanders (GE), Christof Gessner (MxDx), Fernando Isaza (Philips/Respironics), Ken Marks (GE), Sandra Martinez (NIST), John Rhoads (Philips), Paul Schluter (GE), Jan Wittenber (Philips), John Zaleski (Philips)


Item Topic Discussion
1 Introductions & Agenda Review
- Chair 		Status/Discussion:

Decisions/Issues:

  • Agenda reviewed and approved, including additional detail provided by Paul Schluter for Rosetta review:
- Units of Measurement for "minute-volume"
- REFID consolidation: generalized treatment of SET/SETTINGs
- REFID consolidation: gas measurements
- Other topics highlighted in blue in the attached Rosetta document
- Temperature measurements: use pre-coordinated sites or post-coordinated OBX-20

Action(s):

2 Discussion Summary Review
- Chair 		Status/Discussion:

Decisions/Issues:

Action(s):

3 Minute Volume Discussion
- Paul 		Status/Discussion:
  • Continuing discussion regarding the Minute Volume terms (MDC_VENT_VOL_MINUTE_AWAY), with a focus on the appropriate UoM and fundamental semantic: flow or volume.
  • From a clinical perspective, MV indicates a "capacitive measure of pulmonary health" ... in other words, a volume
  • Though it is sometimes displayed to clinicians as a volume and sometimes as a flow, all related calculations require "flow" UoM (i.e., L/min or mL/min).
  • As a "flow", this is not instantaneous flow, rather flow integrated over a minute window ... in other words, a volume.
  • Since this is displayed and used clinically both as a volume and a flow UoM, any Rosetta-based solution must address the historical ambiguity as well as provide direction for future implementations.
  • Need to be able to communicate both the computational form (by default, L/min & mL/min) and the displayed form (L, mL, mL/min & L/min).
  • Isaza: this MV parameter is analogous to cardiac output and urine per day (L/day) ... neither of which are necessarily a "flow"
  • Marks: The -10101 entry for this parameter is incorrect, both the systematic name that starts with "flow" and the acronym which is V-dot.

Decisions/Issues:

  • For computational purposes, L/min or mL/min should be used. This should be the primary semantic communicated electronically from the device.

Action(s):

  • ACTION: (Cooper/Wittenber) Propose an approach to provide a correct, consolidated representation of MV (computational UoM), and the displayed representation (with displayed UoM). This may result in new parameter proposals, as well as usage of compound numerics. This may also result in recommendations to correct the -10101 entry for the currently defined parameter (per Marks' issues identified above)
  • ACTION: (Schluter) Add clarification notes to the Rosetta document re. meaning of this parameter and how it should be used.
4 Generalized Treatment of SETTINGs
- Todd 		Status/Discussion:
  • Question: How can parameter types, such as SETTINGs, be clearly identified in their REFIDs and numeric codes?
  • Todd provided a verbal review of discussions in this group over the last 9 months around this topic, namely:
- Proposed REFID compositional syntax rules to provide for this new requirement
- A "uber-discriminator" involving the upper 16-bits that would enable context-free identification of general parameter "type" information
- This could be an "export format" that would include key semantics that are currently supported in the 11073-10201 information model (as opposed to pre-coordinated in the term itself).
- The key factor in determining what parameter type information is included in this Export Format is what information must not be lost in a context-free expression that could adversely affect patient safety.
  • This format should be applicable to existing terms, though in some cases the type information may be redundant.

Decisions/Issues:

  • Usage of device type (e.g., MDC_VENT_) should be deprecated since (a) it is applied inconsistently, and (b) it is still ambiguous in many cases.

Action(s):

  • ACTION: (Cooper / Wittenber) Develop a proposal for an Export Format to cover the previous discussions in this area. Due by the next discussion 2009.07.15.
5 Gas Measurements Consolidation
- Paul 		Status/Discussion:
  • Paul presented a number of variations (and duplications) in how gas measurements are expressed in the current -10101 terminolgy and Rosetta.
  • For example, MDC_AWAY_DESFL_EXP and MDC_CONC_AWAY_DESFL: Same semantic but different numeric codes!
  • Discussion about the difference between end-tidal and general time-period (e.g., expiratory) semantics - need both!
  • Objective: Identify a consistent, colidated way of expressing these gas concentration related semantics.

Decisions/Issues:

  • Provide for a generic non-time-specific expression, as well as a time point specific parameter (e.g., end-tidal)
  • Provide for both setting and monitored values, inhalation and exhalation.

Action(s):

  • ACTION: (Wittenber) Take one example (e.g., DESFL) and identify the various current defintions (incl. duplicates), apply the approaches discussed above, identify the UoM variations, and determine whether the emerging discriminator rules (export format) might help.
  • ACTION: (Dain) Provide information / reference from the appropriate ISO gas monitoring standard.
6 Temperature Term Consolidation
- TBD 		Status/Discussion:
  • Most of the existing temperature related terms are pre-coordinated; however, some are not present and the set needs to be extended.
  • Question: Should the group standardize on a simple set of terms + a list of body-sites to associate with each parameter OR should the current set be extended to address existing gaps.
  • Problems are that...
- Not all qualifiers are "body sites"
- the existing terms are fairly well established clinically as vital signs

Decisions/Issues:

  • The currently defined set should be extended as needed (should only be about 5 more terms; currently 15-20 have been defined) (pre-coordinated approach)
  • Provision should be made for a generic set of temperature terms (as currently defined) that can be augmented with a list. (i.e., post-coordinated approach)

Action(s):

7 Next Meeting
- Chair 		Status/Discussion:

Decisions/Issues:

Action(s):

Next Meeting

2009.07.15 General Vent Discussion



(Reviewed & approved by PCD RTM Vent TG <tbd>)">


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