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
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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 5th and publication
possibly as early as December 9th.
• 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 10th).
• 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?
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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
dOffset
0
1
2
3
[MMM] Statistical Discriminators {2 bits}
dSuffix
dDescription
{base measurement} or not specified
_MAX
maximum value observed over an interval
_MIN
minimum value observed over an interval
_MEAN
mean value observed over an interval
Reference ID
Disc
Part::Code
MDC_SAT_O2_DELIV_INDEX
MDC_PRESS_BLD_VEN_FEMO
RAL
MDC_PRESS_BLD_ART_BRACH
IAL
MDC_TTHOR_HEART_RATE
MMM
2::19596
CF_CODE1
0
150668
SDM
2::19604
150676
SDM
2::19608
3
150680
HL7 DEV SIG and IEEE 11073 GC
2015-01-22
RCE
2::18482
149554
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 ID
Disc
Part::Code
MDC_SAT_O2_DELIV_INDEX
MDC_SAT_O2_DELIV_INDEX_MA
X
MDC_SAT_O2_DELIV_INDEX_MI
N
MDC_SAT_O2_DELIV_INDEX_ME
AN
MMM
2::19596
CF_CODE1
0
150668
MMM
2::19597
150669
MMM
2::19598
150670
MMM
2::19599
150671
HL7 DEV SIG and IEEE 11073 GC
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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 Terms
Existing -10101:2004 terms in hRTM
Action
RetainedAs
Updated NIST RTMMS hRTM
Retained with UoM, enum, site info
New -10101a terms in hRTM
AssignCode
Retained with UoM, enum, site info
New -10101a terms not in hRTM
AddNewTerm Added, determine UoM, enums, site info
Proposed hRTM 0^PP/Conc terms not in 10101a
Deprecated -10101:2004 terms (identified by #)
Obsolete
Not transferred (shall not be used)
Deprecated
Not transferred (use strongly discouraged)
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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 cochairs
• 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 nonoverlap
• Preliminary agreement by PHD co-chairs to use RTMMS (Paul
facilitates)
• Update methods
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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).
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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).
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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!
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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
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HL7 DEV SIG and IEEE 11073 GC
2015-01-22
IEEE P11073-10101c
• IHE PCD Rosetta identifiers for Events, Alerts and Alarms
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HL7 DEV SIG and IEEE 11073 GC
2015-01-22
EXTRA SLIDES
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HL7 DEV SIG and IEEE 11073 GC
2015-01-22
IEEE P11073-10101a Annex A
Annex A (normative) Nomenclature Semantics
A.5 Nomenclature, data dictionary, and code extensions for vital signs devices (Block A)
A.6 Terminology and code extensions for units of measurement (Block B)
A.7 Nomenclature, data dictionary, and codes for metrics (measurements and enumerations) (Block C)
A.7.3 Nomenclature and code extensions for hemodynamic monitoring measurements
A.7.4 Nomenclature and code extensions for respiratory, ventilator and anesthesia measurements
A.7.4.18 Gas concentration and partial pressure measurements
A.7.4.19 Inspiratory breath type classification
A.7.4.20 Nomenclature and code table
A.7.4.21 Nomenclature and codes for nebulizers
A.7.5 Nomenclature, data dictionary, and codes for common blood-gas, blood, urine,
and other fluid chemistry measurements
A.7.8 Nomenclature, data dictionary, and codes for neurological monitoring measurements
A.7.11 Nomenclature and code extensions for miscellaneous measurements
A.7.11.7 Body Weight and Surface Area
A.7.12 Nomenclature and code extensions for infant incubator and warmer microenvironments
A.7.13 Nomenclature and code extensions for personal health devices
A.8 Nomenclature, data dictionary, and codes for body sites (Block D)
A.8.4 Sites for EEG-electrode placement on the head
A.11 Information attributes to support IHE PCD DEC and PCHA Continua WAN
A.11.1 Information attributes to support IHE PCD Alert Communication Management
A.11.2 Infrastructure attributes to support PCHA/Continua WAN and IHE PCD DEC
A.11.3 Information attributes to support PCHA/Continua WAN
A.11.4 Information attributes to support IHE PCD DEC and PCHA/Continua WAN timekeeping
A.11.5 Information attributes to support semantics defined by this standard
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5
8
14
14
17
17
19
21
62
64
66
68
69
70
72
72
76
77
77
77
78
79
81
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HL7 DEV SIG and IEEE 11073 GC
2015-01-22
IEEE P11073-10101a Annexes C-G
Annex C (normative) Terms and Codes
82
C.1 Overview
82
C.2 Discriminator Sets
82
C.3 Terms and Discriminators
84
Annex D (informative) Breaths and Inflations
101
Annex E (informative) Respiratory, Ventilator and Anesthesia Reference ID Naming Conventions
103
Annex F (informative) Anesthesia Ventilation and Breathing Circuits
105
F.1 Bellows driven on expiratory side
107
F.2 Piston driven on inspiratory side
108
F.3 Mapleson circuits
109
Annex G (informative) Bibliography
111
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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
Topics shown with black font were added
Resistance and compliance
or augmented during balloting phase
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
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Nebulizer
HL7 DEV SIG and IEEE 11073 GC
2015-01-22