HL7 FHIR® Implementation Guide: Healthcare Associated Infection Reports, FHIR Release 1 - US Realm
May 2018 Ballot

This page is part of the Healthcare Associated Infection Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR v3.3.0. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 



<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="hai-questionnaireResponse-los-event"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p>This QuestionnaireResponse instance is an example of a completed Late Onset Sepsis/Meningitis Event (LOS) Report and is in response to the Questionnaire instance defining this report.</p>
      <h2>Patient Details</h2>
      <table border="1"> 
        <tbody> 
          <tr> 
            <td>Name</td> 
            <td>Ned <b>Nuclear</b>
            </td> 
          </tr> 
          <tr> 
            <td>Id</td> 
            <td>MRN: 12345</td> 
          </tr> 
          <tr> 
            <td>Medicaid beneficiary number</td> 
            <td>959595</td> 
          </tr>
        </tbody> 
      </table> 
      <h2>Event Details</h2>
      <table border="1">
        <tbody>
          <tr>
            <td>Infection Type</td>
            <td>Late onset sepsis</td>
          </tr>
          <tr>
            <td>Specific Event</td>
            <td>NLCBI 2</td>
          </tr>
          <tr>
            <td>Criteria used</td>
            <td>Recognized pathogen from one or more blood specimens</td>
          </tr>
          <tr>
            <td>Date of Infection</td>
            <td>January 2, 2018</td>
          </tr>
          <tr>
            <td>Inborn/Outborn</td>
            <td>Inborn</td>
          </tr>
          <tr>
            <td>Dead</td>
            <td>Yes</td>
          </tr>
          <tr>
            <td>Infection Contributed to Death</td>
            <td>No</td>
          </tr>
        </tbody>
      </table>
      <h2>Risk Factors</h2>
      <table border="1">
        <tbody>
          <tr>
            <td>Central line present prior to event, including umbilical catheter</td>
            <td>Yes</td>
          </tr>
          <tr>
            <td>Birth Weight</td>
            <td>700 g</td>
          </tr>
          <tr>
            <td>Gestational Age</td>
            <td>276 d</td>
          </tr>
        </tbody>
      </table>

      <h2>Findings</h2>
      <table border="1">
        <tbody>
          <tr>
            <td>Microorganism
                identified</td>
            <td>Clostridium symbiosum (organism)</td>
          </tr>
          <tr>
            <td>Pathogen Ranking</td>
            <td>1</td>
          </tr>
          <tr>
            <td>Clarithro Susc Islt</td>
            <td> Not Applicable Resistant</td>
          </tr>
        </tbody>
      </table>
      <h2>Comment</h2>
      <table border="1">
        <tbody>
          <tr>
            <td>Comment</td>
            <td>NHSN text comment that is less than 2000 characters.</td>
          </tr>
        </tbody>
      </table>
    </div>
  </text>
  <questionnaire value="hai-questionnaire-los-event"/>
  <status value="completed"/>
<!--  Facility ID
       CDA: ClinicalDocument/componentOf/encompassingEncounter/location/healthCareFacility/id  -->
  <item>
    <linkId value="facility"/>
    <text value="Facility ID"/>
    <answer>
      <valueUri value="2.16.840.1.113883.3.117.1.1.5.1.1"/>
    </answer>
  </item>
<!--  Event # 
       CDA: ClinicalDocument/componentOf/encompassingEncounter/id -->
  <item>
    <linkId value="event-number"/>
    <text value="Event #"/>
    <answer>
      <valueUri value="2.16.840.1.113883.3.117.1.1.5.2.1.1.3"/>
    </answer>
  </item>
<!--  Event Type 
       (CDA Mapping: Infection-Type Observation/value)  -->
  <item>
    <linkId value="event-type"/>
    <text value="Event Type"/>
    <answer>
      <valueCoding>
        <system value="https://loinc.org/"/>
        <code value="TEMP_SNOMED_LATE_ONSET_SEPSIS"/>
        <display value="Late Onset Sepsis (LOS)"/>
      </valueCoding>
    </answer>
  </item>
<!--  Date of Event 
       (CDA Mapping: Infection-Type Observation/effectiveTime  -->
  <item>
    <linkId value="date-of-event"/>
    <text value="Date of Event"/>
    <answer>
      <valueDate value="2018-01-02"/>
    </answer>
  </item>
<!--  Facility Location 
       (CDA Mapping: encompassingEncounter/location/healthcareFacility/code) -->
  <item>
    <linkId value="facility-location"/>
    <text value="Facility Location"/>
    <answer>
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.259"/>
        <code value="1029-8"/>
        <display value="Medical/Surgical Critical Care"/>
      </valueCoding>
    </answer>
  </item>
<!--  Date Admitted to Facility
       (CDA Mapping: ClinicalDocument/componentOf/encompassingEncounter/effectiveTime/low)  -->
  <item>
    <linkId value="date-admitted-to-facility"/>
    <text value="Date Admitted to Facility:"/>
    <answer>
      <valueDate value="2018-01-01"/>
    </answer>
  </item>
<!--  Inborn/Outborn Observation 
       (CDA Mapping: Inborn/Outborn Observation/value) -->
  <item>
    <linkId value="inborn-outborn-observation"/>
    <text value="Select: Inborn or Outborn"/>
    <answer>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="445087001"/>
        <display value="Born before arrival to hospital (situation)"/>
      </valueCoding>
    </answer>
  </item>
<!--   Patient Information 
            including:
            - Patient ID
            - Social Security #
            - Secondary ID
            - Medicaid #
            - Patient Name
            - Patient Gender
            - Patient Date of Birth
            - Patient Ethnicity
            - Patient Race
     -->
  <item>
  <!-- <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedProfile">
      <valueReference>
        <reference value="Patient/hai-los-event-patient"/> 
        <display value="Ned Nuclear"/> 
      </valueReference>
    </extension> -->
    <linkId value="questionnaire-patient"/>
    <text value="Patient"/>
    <answer>
      <valueReference>
        <reference value="Patient/hai-patient-1"/>
        <type value="Patient"/>
      </valueReference>
    </answer>
  </item>
<!--  Risk Factors
       CDA: Risk Factors Section (LOS/Men) -->
  <item>
    <linkId value="risk-factors"/>
    <text value="Risk Factors"/>
  <!--  Central Line present prior to event, including umbilical catheter
         (CDA Mapping: Infection Risk Factors Observation/value="1006-6" - if present then true)  -->
    <item>
      <linkId value="risk-factor-central-line"/>
      <text
            value="Central line present prior to event, including umbilical catheter"/>
      <answer>
        <valueBoolean value="true"/>
      </answer>
    </item>
  <!--  Birth Weight (grams)
         (CDA Mapping: Infection Risk Factors Measurement Observaiton/value)  -->
    <item>
      <linkId value="risk-factor-birth-weight"/>
      <text value="Birth Weight (grams)"/>
      <answer>
        <valueQuantity>
          <value value="700"/>
          <unit value="g"/>
        </valueQuantity>
      </answer>
    </item>
  <!--  Gestational Age
         (CDA Mapping: Gestational Age Observation/value)  -->
    <item>
      <linkId value="risk-factor-gestational-age"/>
      <text value="Gestational Age"/>
      <answer>
        <valueQuantity>
          <value value="276"/>
          <unit value="d"/>
        </valueQuantity>
      </answer>
    </item>
  </item>
<!--  Event Details 
         CDA: Infection Details in Late Onset Sepsis Report -->
  <item>
    <linkId value="event-details"/>
    <text value="Event Details"/>
  <!--  Infection Condition 
         (CDA Mapping: Infection Condition Observation/value -->
    <item>
      <linkId value="infection-condition"/>
      <text value="Specific Event"/>
      <answer>
        <valueCoding>
          <system value="urn:oid:2.16.840.1.113883.6.277"/>
          <code value="3067-6"/>
          <display
                   value="Neonatal Laboratory Confirmed Bloodstream Infection (NLCBI 2)"/>
        </valueCoding>
      </answer>
    </item>
  <!--  Criteria Used (Lab) 
         (CDA Mapping: Criterion of Diagnosis Observation/value -->
    <item>
      <linkId value="criteria-used"/>
      <text value="Laboratory Criteria Used"/>
      <answer>
        <valueCoding>
          <system value="urn:oid:2.16.840.1.113883.6.277"/>
          <code value="1951-3"/>
          <display value="Recognized pathogen from one or more blood specimens"/>
        </valueCoding>
      </answer>
    </item>
  <!--  Died 
         (CDA Mapping: Death Observation in an Infection-type Report/value)  -->
    <item>
      <linkId value="died"/>
      <text value="Died"/>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="419099009"/>
          <display value="Dead"/>
        </valueCoding>
      </answer>
    </item>
  <!--  LOS Contributed to Death 
         (CDA Mapping: Infection Contributed to Death Observation)  -->
  <!--  Note: This item is only enabled when the death observation is marked as "true"  -->
    <item>
      <linkId value="los-contributed-to-death"/>
      <text value="Infection contrubuted to death"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
  <!--  Discharge Date 
         (CDA Mapping: ClinicalDocument/componentOf/encompassingEncounter/effectiveTime/high)  -->
    <item>
      <linkId value="discharge-date"/>
      <text value="Discharge Date"/>
      <answer>
        <valueDate value="2018-01-12"/>
      </answer>
    </item>
  </item>
<!--  Findings Group
       CDA: Findings Section in an Infection-Type Report -->
  <item>
    <linkId value="findings-group"/>
    <text value="Findings Group"/>
  <!--  Pathogen Identified
         (CDA Mapping: Pathogen Identified Observation)  -->
    <item>
      <linkId value="pathogen-identified"/>
      <text value="Pathogen Identified"/>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="48321006"/>
          <display value="Clostridium symbiosum (organism)"/>
        </valueCoding>
      </answer>
    </item>
  <!--  Pathogen Ranking
         (CDA Mapping: Pathogen Ranking Observation)  -->
    <item>
      <linkId value="pathogen-ranking"/>
      <text value="Pathogen Ranking"/>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="255216001"/>
          <display value="First"/>
        </valueCoding>
      </answer>
    </item>
  <!--  Drug Susceptibility Test Group
         (CDA Mapping: Drug Susceptibility Test Observation)  -->
    <item>
      <linkId value="drug-susceptibility-test-group"/>
      <text value="Drug Susceptibility Test Group"/>
    <!--  Drug Susceptibilty Test 
           CDA: Drug-Susceptibility Test Observation/code  -->
      <item>
        <linkId value="drug-susceptibility-test"/>
        <text value="Drug Susceptibility Test"/>
        <answer>
          <valueCoding>
            <system value="https://loinc.org/"/>
            <code value="18907-6"/>
            <display value="Clarithro Susc Islt"/>
          </valueCoding>
        </answer>
      </item>
    <!--  Drug Susceptibilty Test Interpretation
           CDA: Drug-Susceptibility Test Observation/interpretationCode  -->
      <item>
        <linkId value="drug-susceptibility-test-interpretation"/>
        <text value="Drug Susceptibility Test Interpretation"/>
        <answer>
          <valueCoding>
            <system value="urn:oid:2.16.840.1.113883.5.83"/>
            <code value="R"/>
            <display value="Resistant"/>
          </valueCoding>
        </answer>
      </item>
    </item>
  </item>
<!--  NHSN Comment
         CDA: NHSN Comment Section/NHSN Comment -->
  <item>
    <linkId value="nhsn-comment"/>
    <text value="nhsn-comment"/>
    <answer>
      <valueString value="NHSN text comment that is less than 2000 characters."/>
    </answer>
  </item>
</QuestionnaireResponse>