PCD RTM 2008-09-03 WebEx

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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, September 3, 2008

Time: 12:00 pm, Eastern Daylight Time (GMT -04:00, 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 agenda
2 Review previous meeting minutes
3 November F2F Location & Dates
4 TC121 Update
5 Review X73 Semantic Model + Information Model
6 Update on "Furniss" Model Development
7 Update on Rosetta Vent / Resp Groups
8 IHE PCD Vent Specialization profile proposal
9 New Issues

Attachments / Materials

<add any attachments here>'

Minutes

Participants

Chair/Host: Todd Cooper (Breakthrough Solutions Foundry)
Steven Dain (ISO TC121/SC4), Robert Flanders (GE), Chip Furniss (Philips/Respironics), Manny Furst (Improvement Technologies), Ken Marks (GE), Andrew Norton (Iota), Paul Schluter (GE)

Discussion

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

Decisions/Issues:

  • Agenda approved without changes.

Action(s):

2 Approval of Minutes
- Chair
Status/Discussion:

Decisions/Issues:

Action(s):

3 Face-to-Face Discussion
- Chair
Status/Discussion:
  • Proposal was to hold the meetings sometime during the first two weeks of November, somewhere in the Southern California area (given the number of companies located in that area).
  • A Doodle poll was created to collect proposals for the exact dates & location.
  • The original meeting host may not be able to sponsor the sessions. So another call for sponsorship should be made.

Decisions/Issues:

Action(s):

  • (Todd) Send out a reminder for the fall meeting poll.
  • (Todd) Send out a request for Host for these meetings
4 PCD Profile Proposals
- Chair
Status/Discussion:
  • The IHE PCD is currently calling for profile proposals for the next development cycle. This can include proposals for a ventilator device specialziation, as well as specific integration issues in which ventilator devices play a roll.
  • Todd indicated that it would be good to have a few profile editors from this group for a Ventilator Device Specialization profile.

Decisions/Issues:

Action(s):

  • (Todd) to issue a call for Ventilator Device Specialization profile proposal editors.
5 ISO TC121/SC4 Update
- Dain
Status/Discussion:
  • Steven Dain (chair of SC4) gave us an update on the activities of this group since their London meetings last June, esp. regarding developing terminology describing ventilator operational modes.
  • In addition to reviewing the structure of TC121, Steven indicated that a key activity was harmonizing the 3rd edition of IEC 60601-1 with the various ventilator standards.
  • Regarding ventilator terminology, it appears that the best path forward may be to develop a completely new nomenclature, rather than refining or evolving existing terms. This is due to the confusion around the meaning of many of the terms in current usage. Examples discussed included CMV and Assist Control.
  • Given the organization of TC121, including separate groups for Anesthesia Work Stations and Critical Care Ventilators, the question was asked regarding how each group viewed the "vent" function, as well as the level of coordination / harmonization between the different committees. In short:
- AWS tend to be fairly simple (e.g., set rate & tidal volume) - since the patient is under anesthesia, there is little concern regarding patient respiratory activity; however, over the last 5 - 10 years, the level of sophistication of these systems has started to increase.
- CC Ventilators tend to be increasingly sophisticated, monitoring the patient's condition and responding based on operational mode settings.
It was noted that from an informatics perspective, an AWS "vent" function should be a subset of the more complex CC ventilator data model and terminology. Economics are also a major factor, with CC vents costing considerably more than those embedded into AWS's. That said, Steven indicated that when the higher level of functionality is needed, then a CC Vent may be brought in and used in tandem with the AWS. Chip also mentioned that there was a considerable difference in design requirements between OR, ICU ... home care contexts due to the degree of difference in clinician monitoring that is provided.
  • The next meeeting of ISO TC121/SC4 is 2009.01.26-30 in Kyoto Japan.

Decisions/Issues:

Action(s):

  • (Dain) Circulate a draft of the SC4 terminology work.
6 Device Specializations
- Group
Status/Discussion:
  • Todd brought up the topic of device specialization IHE profiles or ISO/IEEE standards - how they should be organized, general content, devices to be targeted, etc.
  • There was a lengthy discussion regarding whether it is even valid to have device specialization profiles for a system such as a ventilator or whether the granularity should be much lower, focused on groups of terms w/ usage constraints that can then be utilized for various device-level configurations as necessary.
  • Todd noted that there are many levels on a device informatics semantic architecture, starting from a terminology metamodel (applies to all defined terms) to subject matter (e.g., units of measurement, events, measurement parameters - respiratory, haemodynamic monitoring, cardio monitoring, etc.) to groups typically found in various device types (at least at the Channel or VMD level) to clinical clusters and archetypes that include more of the patient and clinical context around specific groups of parameters. Device specializations / profiles need to comprehend these different semantic "levels" and address them appropriately.
  • It was also noteded, that for various measurements there are different ways of using the general terms and information model to represent various concepts. Specialization profiles standardize on an agreed method for representing each term or group of data.

Decisions/Issues:

Action(s):

7 Rosetta Profile Respiratory Group ID Review
- Schluter
Status/Discussion:
  • Paul led the group in a review of the current Rosetta profile [ftp::/ftp.ihe.net/Patient_Care_Devices/Profiles/RTM/Rosetta/PCD_RTM_RosettaTable.1k.2008-02-14T14 Respiratory Group ID's]. Since it was last published 2008.02.14 for the HIMSS IHE Showcase '08 in Orlando, the Rosetta tables have been greatly increased; however, an analysis of the terms indicate that the groups need to be reworked to reflect all of the proposed additions.
  • Todd pointed out that the ISO/IEEE 11073 standards have a nomenclature partition for "group IDs" - though it currently has relatively few terms. Also the data model (11073-10201) has VMD and Channel attributes for these Group ID's.
  • It was also mentioned that these group IDs fit into the DEC profiles "dotted notation" (OBX-4) as a 5th parameter.
  • Pre (term level) & post (information model level) coordination was also discussed. For example, with a "resp rate" parameter, there are different methods for how this may be measured, and these should be captured at the term definition level; however, various devices may include the same "resp rate" parameter, in which case the information model should provide the device context in which the parameter was acquired.

Decisions/Issues:

  • Need to get a broader clinical review of the proposed groupings to ensure that they are correct and relevant at that level.

Action(s):

8 Next Meeting
- Chair
Status/Discussion:

Decisions/Issues:

Action(s):

Next Meeting

2008.11.12 RTM Vent TG Meeting


<Add review line here when minutes are approved; e.g., "(Reviewed & approved by PCD RTM Vent TG 2008-04-16)">


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