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

Introduction

Purpose

The purpose of this implementation guide (IG) is to specify 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.

As reports are modified and new report types are defined, CDC and Health Level Seven (HL7) will develop and publish additional constraints.

Throughout this process, CDC remains the authority on NHSN data collection protocols. When healthcare enterprises choose to participate in NHSN, they must report to CDC occurrences such as specific reportable procedures, even those without complications, and events such as a bloodstream infection, either confirmed by a positive blood culture or supported by a patient’s clinical symptoms. This specification opens the channel for data submission by all applications compliant with the data coding requirements defined here.

Note that participation in the NHSN requires enrollment and filing of reporting plans, which are not defined by this specification. For an overview of NHSN and full information on NHSN participation requirements, see: http://www.cdc.gov/nhsn. Provisions of the Public Health Service Act protect all data reported to NHSN from discovery through the Freedom of Information Act (FOIA).

Relationship to Another Standard

Starting in the May 2018 ballot cycle, HL7 will develop this FHIR Implementation Guide in parallel with the existing CDA Implementation Guide. This new standard will include all new forms as they are added to the HAI work. We anticipate several STU releases on the path to a Normative Release 1 of the HL7 Implmentaion Guide for FHIR Release 4: Healthcare Associated Infection Reports. The FHIR and CDA implementation guides will align. A change to one standard will require the same change in the other standard. In this release, the new form included in both the CDA and FHIR standards is the Late Onset Sepsis/Meningitis Event (LOS) Report numerator.

Audience

The audience for this work is all developers of software systems who want to enable their systems for reporting HAI data to the NHSN.

Design Considerations

  • This IG specifies a FHIR Questionnaire-based approach. This approach takes advantage of the FHIR Questionnaire resource that has been desigened as an organized collection of questions intended to solicit information from individuals involved in the healthcare domain. This closely mirrors the actual NHSN forms.
  • As this IG is based on the Current FHIR Build, at the current time it is not technically possible to reference the US Core Profiles and as such the base FHIR resources have been referenced instead. It is expected that the US Core profiles will be updated to the current release before publication of this IG and at that time, the base FHIR resource references will be replaced with the US Core profiles.

References

Note: Where possible, the profiles contained in this prototype implementation guide are based on the US Core profiles. (See Design Considerations above).

Name Definition
HL7 CDA® R2 Implementation Guide: NHSN Healthcare Associated Infection Reports, Release 3 - US Realm This project developed an implementation guide constraining CDA Release 2. The implementation guide supports electronic submission of HAI data to the National Healthcare Safety Network. CDC provided NHSN developers, vocabulary experts and CDA experts to support this project. SDWG reviewed the design and draft specification before ballot.
US Core Implementation Guide (Release 1) The US Core Implementation Guide is based on FHIR Version 3.0.0 and defines the minimum conformance requirements for accessing patient data as defined by the Argonaut pilot implementations and the ONC 2015 Edition Common Clinical Data Set (CCDS). These profiles are intended to be 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.

Acknowledgments

This implementation guide was produced and developed by Lantana Consulting Group in conjunction with the Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC). Its development and ultimate deployment is a result of the dedication of the team—led by Daniel A. Pollock, M.D., Surveillance Branch Chief, Division of Healthcare Quality Promotion, NCEZID, CDC—and their support of the development of interoperable data standards for the CDC’s National Healthcare Safety Network (NHSN).

The best standards are those driven by business requirements. A strong set of Healthcare Associated Infection (HAI) surveillance application vendors monitor, evaluate, and test each release of this guide. 

Past contributors: The vendors who participated in the 2007-2008 pilot activities of Bloodstream Infection Reports and Surgical Site Infection deserve special thanks and acknowledgment: MedMined™ services from Cardinal Health, EpiQuest, ICPA, Premier, TheraDoc, and Vecna Technologies. Throughout the development of this guide, Marla Albitz provided essential translation of NHSN business and technical requirements so that Kate Hamilton, Bob Dolin, Rick Geimer, and Susan Hardy could turn those requirements into a CDA-compliant specification. Liora Alschuler provided oversight and review. Additional contributors to the DSTU releases have been Jonathan Edwards, Maggie Dudeck, Dawn Sievert, Teresa Horan, Mary Andrus, Melinda Neuhauser, Ruby Phelps, Mindy Durrance, Alicia Shugart, Tygh Walker, Chris Cole, Cindy Gross, and Scott Fridkin (data specifications); Wenkai Li, Pavla Frazier, Gaye Dolin, Margaret Marshburn, Rob Hausam, Sundak Ganesan, and Denny Cordy (vocabulary); Kelly Peterson (database administration); Venu Sarraff (data importation); and Brett Marquard and Lauren Wood (project management and technical editing). We also thank Ted Klein, Cecil Lynch, and Daniel Vreeman for timely issuance of identifiers and codes. 

This material contains content from SNOMED CT® (http://www.ihtsdo.org/snomed-ct/). SNOMED CT is a registered trademark of the International Health Terminology Standard Development Organisation (IHTSDO).

This material contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.


Co-Chair:

Calvin Beebe
Mayo Clinic
cbeebe@mayo.edu

Co-Chair:

Austin Kreisler
Leidos Consultant to CDC/NHSN
duz1@cdc.gov

Co-Chair:

Brett Marquard
River Rock Associates

brett@riverrockassociates.com

Co-Chair:

Gaye Dolin M.S.N., R.N. 
Intelligent Medical Objects
gdolin@imo-online.com

Co-Chair:

Rick Geimer
Lantana Consulting Group
rick.geimer@lantanagroup.com

Co-Chair:

John Roberts
Tennessee Department of Health
john.a.roberts@tn.gov

Co-Chair:

Rob Savage MS 
Rob Savage Consulting
rob.savage50@gmail.com

Co-Chair:

Joginder Madra 
Madra Consulting Inc.
hl7@madraconsulting.com

Co-Chair:

Erin Holt MPH 
Tennessee Department of Health
erin.holt@tn.gov

Co-Chair:

Ben Flessner
Redox
benjamin@redoxengine.com

Primary Editor:

Sarah Gaunt
Lantana Consulting Group
sarah.gaunt@lantanagroup.com

Co-Editor:

Mindy Durrance 
Leidos Consultant to CDC/NHSN
mdq1@cdc.gov


Co-Editor:

Daniel Pollock, M.D.
CDC
DPollock@cdc.gov

Co-Editor:

Ahmed Tahir
Leidos Consultant to CDC/NHSN 
nmn8@cdc.gov

Co-Editor:

Barry Rhodes
CDC 
mbr1@cdc.gov

Co-Editor:

Sheila Abner
CDC
sha8@cdc.gov

Co-Editor:

Amy Webb
Lantana Consulting Group
amy.webb@lantanagroup.com

Co-Editor:

James Davis
Leidos Consultant to CDC/NHSN
mync0@cdc.gov

Co-Editor:

George Koromia
Lantana Consulting Group
george.koromia@lantanagroup.com

Co-Editor:

Beau Bannerman 
Lantana Consulting Group
beau.bannerman@lantanagroup.com

Co-Editor:

Lauren Wood
Lantana Consulting Group
lauren.wood@lantanagroup.com

Co-Editor:

Eric Parapini
Lantana Consulting Group
eric.parapini@lantanagroup.com

Co-Editor:

Zabrina Gonzaga
Lantana Consulting Group
zabrina.gonzaga@lantanagroup.com

Technical- Editor:

Diana Wright
Lantana Consulting Group
diana.wright@lantanagroup.com

Technical Editor:

Chris Hannigan
Lantana Consulting Group
chris.hannigan@lantanagroup.com