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FHIR IG for Anesthesia Records 1 of 2

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  • 2022
    • Project Scope Statement - FHIR IG for Intra-Procedural Anesthesia Records
  • 2023
    • Initial diagramming of simple use cases
      • Peripheral Vascular Cannula (PVC)
      • Arterial Cannula with guidance as a sub-procedure
    • FHIR resource ‘wiring diagrams’ to illustrate potential routes toward the IG
  • 2024
    • Expansion of ‘wiring diagrams’ to include more complex use cases
    • Import of FHIR resources into Enterprise Architect and representation as formal UML
    • Project narrative document with use cases expanded

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Peri-operative Care Episode Overview

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Physiological Monitoring - https://github.com/HL7/uv-pocd/

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Procedures and Medication Administration

  • Medication Administration
    • ‘Mostly’ okay - some quirks and challenges with complex IV regimens
      • TIVA/TCI and inotropes, where dosage is based on agent quantity/body weight/time, or relates an infusion regimen to a target concentration in a model.
      • Inhalational agents and fresh gas flow delivered via vaporizer and breathing systems
  • Procedures
    • When the Fun Begins
    • Invasive procedures using non-electromechanical devices
      • Needles
      • Catheters
      • Tubes

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Incremental complexity

  • Simple Use Cases
    • Peripheral Venous Cannula
    • Arterial Cannula
  • Complex Use Cases
    • Central Venous Catheters
    • Tracheal Intubation
    • Epidural Neuraxial Block

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How are ‘Simple’ Invasive Procedures Recorded?

  • PVC
    • 22g venflon™ DRH
      • 22 standard wire gauge venflon™ dorsum right hand
  • Arterial Line
    • Allen’s positive
    • 8cm 20g Leadercath™ L radial
      • Allen’s test positive
      • 8cm 20 standard wire gauge Leadercath™ left radial artery

​

For a discussion of “Invasive” in this context, please see�https://www.lunariaclinical.co.uk/2022/02/15/invasive-devices-on-fhir/

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Simple Use Case - Peripheral Venous Cannula

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Procedure-Centric vs Device-Centric

  • Procedures are common
    • Sub-procedures are often hierarchical
    • A procedure can use multiple devices for different purposes at different stages
  • Devices are common
    • Device Property is the appropriate element for recording physical properties
      • length, gauge, diameter, material, color etc.
    • DeviceMetric is intended primarily for information from the device
    • DeviceUsage is a kind of procedure!
    • Is there a role for DeviceDefinition?
      • “used to describe the common characteristics and capabilities of a device of a certain type or kind”
  • A device insertion procedure may need to record
    • Use of guidance
    • Complications

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Guidance as a sub-procedure

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Do we need a sub-procedure for guidance?

  • Allows complications to be linked to a sub-procedure
  • Presence (or absence) of a guidewire may be evident from the device inventory for the procedure

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Device Properties and Inventories

  • An inventory of devices used in a procedure is valuable for the record
  • CVC procedure may be recorded briefly
    • Triple-lumen CVC RIJV
      • RIJV = Right Internal Jugular Vein
  • In a perfect world
    • Product bar code scanning produces detailed product information
    • Detailed Device properties can be retrieved from a central or distributed API call
    • The FHIR record is capable of storing these detailed device properties using automation
      • Far in excess of what is recorded currently
    • Huge benefits in terms of time saving and record granularity

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Summary

  • The Intraoperative record can be represented using FHIR resources
  • We have a clear model for extending simple use cases (e.g. vascular access) to more complex use cases such as neuraxial blocks
  • We have a process for importing FHIR resources to Enterprise Architect
    • UML editing tool allows construction of profiles
    • Can apply constraints
    • Can publish detailed UML models quickly

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Next Steps

  • Continue with IG build on GitHub using existing tooling
  • Diagramming for complex use cases
  • Connect with VA project in the US
  • Possible demo/sandbox app as a companion to the IG

https://docs.google.com/presentation/d/1eHU4LPKZwgKBFImnqTpOgcmTAsk69wNd2bpNwBtuEsA/edit?usp=sharing