This page is part of the Healthcare Associated Infection Reports (HAI) Long Term Care Facilities (LTCF) (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Background

LTCF HAI Reporting Background

LTCF HAI reporting standards were first released in 2012, with data submitted to NHSN by paper form and manual web entry. The CDA and FHIR standards for electronic HAI reporting from LTCFs were balloted for the first time in 2019. This FHIR IG, and its parallel CDA IG, permit LTCFs to submit standardized surveillance data for public reporting of HAI and other reportable events to NHSN directly from electronic health record (EHR) systems. This method of data collection and submission to NHSN can greatly reduce reporter burden and improve work efficiency. It is also expected that data errors may decrease, thereby improving data quality for national benchmarks, monitoring trends, and measuring progress towards infection prevention goals. Going forward, as this IG will likely be updated and expanded every year, it will continue to go through the HL7 ballot comment and reconciliation process each time.

Current Release

This IG is the first STU release of the LTCF HAI reporting templates. It specifies the creation of two reports :

NHSN HAI LTCF Population Summary Report: MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF

NHSN HAI LTCF Single-Person Event Report: Laboratory-identified MDRO or CDI Event for LTCF

Please note, the latest NHSN Long-Term Care Facility Component modifications published will apply to events on or after January 1, 2020 (See: CDC/NHSN Long-Term Care Facility (LTCF) Component Summary of Modifications, January 2020. https://www.cdc.gov/nhsn/pdfs/ltc/ltcf-summary-of-changes_current.pdf). Future work on LTCF HAI reporting will continue to expand the set of forms covered by the standard.

For further details see the NHSN website for reporting healthcare-associated infections in long-term care facilities.

Mapping to CDA

This implementation guide is the first FHIR release of the HAI LCTF reporting profiles and is being balloted in the same cycle as the HL7 CDA® R2 Implementation Guide: NHSN Healthcare Associated Infection (HAI) Long Term Care Facility (LTCF) Reports Release 1, STU 1—US Realm.

The following tables show the mapping between FHIR Questionnaire items and the corresponding CDA templates

HAI Laboratory Identified MDRO or CDI Event Report for LTCF

FHIR Questionnaire Item	FHIR Questionnaire Item linkId	CDA Mapping
Facility ID	facility	ClinicalDocument/componentOf/encompassingEncounter/location/healthCareFacility/id
Resident Id	US Core Patient.identifier	ClinicalDocument/recordTarget/patientRole/id
Social Security #	US Core Patient.identifier	ClinicalDocument/recordTarget/patientRole/id
Medicare #	US Core Patient.identifier	ClinicalDocument/recordTarget/patientRole/id
Resident name: Last	US Core Patient.name.family	ClinicalDocument/recordTarget/name
Resident name: First	US Core Patient.name.given	ClinicalDocument/recordTarget/name
Resident name: Middle	US Core Patient.name.given	ClinicalDocument/recordTarget/name
Gender	US Core Patient.gender	ClinicalDocument/recordTarget/patientRole/patient/administrativeGenderCode
Date of Birth	US Core Patient.birthDate	ClinicalDocument/recordTarget/patientRole/patient/birthTime
Ethnicity	US Core Patient.us-core-ethnicity	ClinicalDocument/recordTarget/patientRole/patient/ethnicGroupCode
Race	US Core Patient.us-core-race	ClinicalDocument/recordTarget/patientRole/patient/raceCode
Date First Admitted to Facility	date-of-first-admission-to-facility	First Admission Encounter in a Lab Identified Report LTCF/effectiveTime/low
Date of Current Admission to Facility	date-of-current-admission-to-facility	ClinicalDocument/componentOf/encompassingEncounter/effectiveTime/low
Date Specimen Collected	date-specimen-collected	Specimen Collection Procedure in a Lab Identified Report LTCF/effectiveTime/low
Specimen Type	specimen-type	Specimen Collection Procedure in a Lab Identified Report LTCF/participant/participantRole/playingEntity/code
Specific Organism Type	specific-organism-type	Pathogen Identified Organism in a Lab Identified Report LTCF/value
Resident Care Location	resident-care-location	ClinicalDocument/componentOf/encompassingEncounter/location/healthcareFacility/id/@extension
Primary Resident Service Type	primary-resident-service-type	ClinicalDocument/componentOf/encompassingEncounter/location/healthCareFacility/code
Has resident been transferred from acute care facility in past 4 weeks?	transfer-from-acute-care-facility	Transfer from an Acute Care Facility to LTCF in a Lab Identified Report/value
Date of transfer from acute care to your facility	date-of-last-transfer	Transfer from an Acute Care Facility to LTCF in a Lab Identified Report/effectiveTime
Was resident on antibiotic therapy for this organism type at the time of transfer to your facility	antibiotic-at-time-of-transfer	Antibiotic Treatment at time of Transfer in a Lab Identified Report LTCF/value
NHSN Comment	nhsn-comment	NHSN Comment Section/NHSN Comment

MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF

FHIR Questionnaire Item	FHIR Questionnaire Item linkId	CDA Mapping
Facility ID	facility	ClinicalDocument/participant/associatedEntity/id/@root
First Day of Period Reported	report-period-start	ClinicalDocument/documentationOf/serviceEvent/effectiveTime/low
Last Day of Period Reported	report-period-end	ClinicalDocument/documentationOf/serviceEvent/effectiveTime/high
Facility Location Code	facility-location-code	ClinicalDocument/participant/associatedEntity/id/@extension
Resident Days	resident-days	Summary Data Observation LTCF[code/@code="1369-8']/value
Resident Admissions	resident-admissions	Summary Data Observation LTCF[code/@code="1370-6']/value
Number of Admissions on C. diff Treatment	number-admissions-on-c-diff-treatment	Summary Data Observation LTCF[code/@code="1371-4']/value
Number of C. diff Treatment Starts	number-c-diff-treatment-starts	Summary Data Observation LTCF[code/@code="1372-2']/value
Report no labID event - All specimens - Methicillin-resistant Staphylococcus aureus	no-lab-id-event-mrsa	Report No Events[code/@code="3030-4"]/value
Report no labID event - All specimens - Methicillin-sensitive Staphylococcus aureus	no-lab-id-event-mssa	Report No Events[code/@code="1307-8"]/value
Report no labID event - All specimens - Vancomycin resistant Enterococcus	no-lab-id-event-vre	Report No Events[code/@code="3033-8"]/value
Report no labID event - All specimens - CephR Klebsiella	no-lab-id-event-cephr-klebsiella	Report No Events[code/@code="3036-1"]/value
Report no labID event - All specimens - CRE E. coli	no-lab-id-event-mrsa-cre-e-coli	Report No Events[code/@code="3039-5"]/value
Report no labID event - All specimens - CRE Enterobacter	no-lab-id-event-mrsa-cre-enterobacter	Report No Events[code/@code="3042-9"]/value
Report no labID event - All specimens - CRE Klebsiella	no-lab-id-event-cre-klebsiella	Report No Events[code/@code="3045-2"]/value
Report no labID event - All specimens - Acinetobacter	no-lab-id-event-mdr-acinetobacter	Report No Events[code/@code="3048-6"]/value
Report no labID event - All specimens - Clostridium difficile	no-lab-id-event-c-difficile	Report No Events[code/@code="3051-0"]/value

References

Name	Description

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HL7 CDA® R2 Implementation Guide: National Healthcare Safety Network (NHSN) Healthcare Associated Infection (HAI) Reports for Long Term Care Facilities (HAI-LTCF-CDA), Release 1- US Realm

This project developed an implementation guide constraining CDA Release 2. The implementation guide supports electronic submission of HAI LTCF data to the National Healthcare Safety Network.

HL7 FHIR® Implementation Guide: Healthcare Associated Infection Reports, Release 1 - US Realm

This implementation guide (IG) is to specifies standards for electronic submission of Healthcare Associated Infection (HAI) reports to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC). This IG contains a library of FHIR profiles for electronic submission of HAI reports to the NHSN.

US Core Implementation Guide (v3.0.0)

The US Core Implementation Guide is based on FHIR Version 4.0.0 and defines the minimum conformance requirements for accessing patient data The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS) and the latest proposed ONC U.S. Core Data for Interoperability (USCDI) provided the requirements for this guide. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm.