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Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent
Lara J Kanbar1,2, Judith W Dexheimer3, Janet Zahner4
1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Standardizing mechanical ventilation data is crucial for improving care in children requiring long-term mechanical ventilation (LTMV). A new framework for common data models (CDM) facilitates data sharing across institutions.
Area of Science:
- Biomedical Informatics
- Pediatric Critical Care
- Health Data Standardization
Background:
- Data sharing is vital for advancing care in children on long-term mechanical ventilation (LTMV).
- Current mechanical ventilation data within electronic health records (EHR) are complex and lack standardization, hindering data exchange.
- This lack of standardization presents a significant barrier to collaborative research and improved patient outcomes.
Purpose of the Study:
- To characterize existing ventilator data within EHR systems for children with LTMV.
- To propose a framework for standardizing mechanical ventilation data using a common data model (CDM).
- To enable multi-site data sharing and analysis for pediatric mechanical ventilation research.
Main Methods:
- Focused on a cohort of pediatric patients with LTMV dependence who were weaned from mechanical ventilation (MV).
- Extracted and analyzed relevant EHR ventilation data, identifying essential components termed 'Clinical Ideas'.
- Developed a framework to integrate these 'Clinical Ideas' into the PEDSnet CDM, leveraging OMOP standards and SNOMED-CT vocabulary.
Main Results:
- Identified 78 children with LTMV dependence who were successfully weaned.
- Documented significant variability in device (25 unique names) and ventilation mode (28 unique names) terminology.
- Defined key 'Clinical Ideas' for describing mechanical ventilation, including device, interface, mode, settings, measurements, and duration.
Conclusions:
- The developed framework standardizes mechanical ventilation terminology, potentially improving data exchange in multi-site networks.
- This standardization is essential for accelerating research and enhancing clinical care for children with LTMV.
- Facilitating rapid data sharing is critical for advancing the understanding and treatment of LTMV in pediatric populations.
Background:
Sharing data across institutions is critical to improving care for children who are using long-term mechanical ventilation (LTMV). Mechanical ventilation data are complex and poorly standardized. This lack of data standardization is a major barrier to data sharing.
Objective:
We aimed to describe current ventilator data in the electronic health record (EHR) and propose a framework for standardizing these data using a common data model (CDM) across multiple populations and sites.
Methods:
We focused on a cohort of patients with LTMV dependence who were weaned from mechanical ventilation (MV). We extracted and described relevant EHR ventilation data. We identified the minimum necessary components, termed "Clinical Ideas," to describe MV from time of initiation to liberation. We then utilized existing resources and partnered with informatics collaborators to develop a framework for incorporating Clinical Ideas into the PEDSnet CDM based on the Observational Medical Outcomes Partnership (OMOP).
Results:
We identified 78 children with LTMV dependence who weaned from ventilator support. There were 25 unique device names and 28 unique ventilation mode names used in the cohort. We identified multiple Clinical Ideas necessary to describe ventilator support over time: device, interface, ventilation mode, settings, measurements, and duration of ventilation usage per day. We used Concepts from the SNOMED-CT vocabulary and integrated an existing ventilator mode taxonomy to create a framework for CDM and OMOP integration.
Conclusion:
The proposed framework standardizes mechanical ventilation terminology and may facilitate efficient data exchange in a multisite network. Rapid data sharing is necessary to improve research and clinical care for children with LTMV dependence.
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01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement: