This page is part of the Healthcare Associated Infection Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R3. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
JSON Format: Questionnaire-hai-questionnaire-opc-ssi-event
Raw json
{
"resourceType" : "Questionnaire",
"id" : "hai-questionnaire-opc-ssi-event",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-03-14T00:00:46.000-04:00",
"profile" : [
"http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en-US\">\n <p>This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Surgical Site Infection Event. This report is for reporting data on each patient having a SSI event related to one of the NHSN operative procedures selected for monitoring.</p>\n <h2>Outpatient Procedure Component Surgical Site Infection (SSI) Event</h2>\n <table border=\"1\">\n <tbody>\n <tr>\n <td>url</td>\n <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event</td>\n </tr>\n <tr>\n <td>Version</td>\n <td>R1</td>\n </tr>\n <tr>\n <td>title</td>\n <td>Outpatient Procedure Component Surgical Site Infection (SSI) Event</td>\n </tr>\n <tr>\n <td>Publish date</td>\n <td>2019-04-01</td>\n </tr>\n <tr>\n <td>Realm</td>\n <td>US</td>\n </tr>\n <tr>\n <td>Code</td>\n <td>LOINC 51897-7: Healthcare Associated Infection report Document</td>\n </tr>\n <tr>\n <td>Subject type</td>\n <td>Patient</td>\n </tr>\n </tbody>\n </table>\n <h2>Questionnaire Items</h2>\n <table border=\"1\">\n <thead>\n <tr>\n <th>Group</th>\n <th>Item</th>\n <th>Type</th>\n <th>Required</th>\n <th>Repeats</th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td/>\n <td>Facility ID</td>\n <td>url</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Date of encounter</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Infection Details</td>\n <td>group</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>Event Type</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr><tr>\n <td>Infection Details</td>\n <td>Date of event</td>\n <td>date</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>NHSN Procedure Code Category</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>CPT Procedure Code</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>Procedure Id</td>\n <td>url</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>Surgical Site Infection (SSI) Level</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>Criteria of Diagnosis</td>\n <td>group</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Abscess</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Redness</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Fever</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Purulent drainage</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Wound spontaneously dehisced</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Incision deliberately opened</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Localized swelling</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Pain or tenderness</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Organism Identified</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Culture or non-culture based testing not performed</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Imaging test evidence of infection</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Criteria of Diagnosis</td>\n <td>Diagnosis of superficial SSI by surgeon or attending physician</td>\n <td>boolean</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Details</td>\n <td>Surveillence method type (active/passive) through which the SSI was detected</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Infection Deatils</td>\n <td>Surveillence method through which the SSI was detected</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Findings Group</td>\n <td>group</td>\n <td>true</td>\n <td>true</td>\n </tr>\n <tr>\n <td>Findings Group</td>\n <td>Pathogen Identified</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td>Findings Group</td>\n <td>Pathogen Ranking</td>\n <td>choice</td>\n <td>true</td>\n <td>false</td>\n </tr>\n <tr>\n <td/>\n <td>Comments</td>\n <td>text</td>\n <td>false</td>\n <td>false</td>\n </tr>\n </tbody>\n </table>\n </div>"
},
"url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event",
"identifier" : [
{
"value" : "hai-questionnaire-opc-ssi-event-v1"
}
],
"version" : "R1",
"name" : "hai-questionnaire-opc-ssi-event",
"title" : "Outpatient Procedure Component Surgical Site Infection (SSI) Event",
"status" : "draft",
"experimental" : false,
"date" : "2019-04-01",
"publisher" : "HL7",
"description" : "This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Surgical Site Infection Event. This report is for reporting data on each patient having a SSI event related to one of the NHSN operative procedures selected for monitoring.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"code" : [
{
"system" : "http://loinc.org",
"code" : "51897-7",
"display" : "Healthcare Associated Infection report Document"
}
],
"subjectType" : [
"Patient"
],
"item" : [
{
"linkId" : "facility-id",
"text" : "Facility ID",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "encounter-date",
"text" : "Date of encounter",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "infection-details",
"text" : "Infection details",
"type" : "group",
"required" : true,
"repeats" : false,
"item" : [
{
"linkId" : "event-type",
"text" : "Event Type",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20"
}
},
{
"linkId" : "event-date",
"text" : "Date of event",
"type" : "date",
"required" : true,
"repeats" : false
},
{
"linkId" : "nhsn-procedure-code-category",
"text" : "NHSN Procedure Code Category",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34"
}
},
{
"linkId" : "cpt-procedure-code",
"text" : "CPT Procedure Code",
"type" : "choice",
"required" : true,
"repeats" : false
},
{
"linkId" : "procedure-id",
"text" : "Procedure Id",
"type" : "url",
"required" : true,
"repeats" : false
},
{
"linkId" : "ssi-level",
"text" : "Surgical Site Infection (SSI) Level",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196"
}
},
{
"linkId" : "criteria-of-diagnosis",
"text" : "Criteria of Diagnosis",
"type" : "group",
"required" : true,
"repeats" : false,
"item" : [
{
"linkId" : "criteria-of-diagnosis-abscess",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "128477000",
"display" : "Abscess"
}
],
"text" : "Criteria of Diagnosis: Abscess",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-redness",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "386713009",
"display" : "Redness"
}
],
"text" : "Criteria of Diagnosis: Redness",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-fever",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "386661006",
"display" : "Fever"
}
],
"text" : "Criteria of Diagnosis: Fever",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-heat",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "304214002",
"display" : "Feels warm (finding)"
}
],
"text" : "Criteria of Diagnosis: Heat",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-incision-purulent-drainage",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "255320000",
"display" : "Infection - suppurative (disorder)"
}
],
"text" : "Criteria of Diagnosis: Purulent drainage",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-wound-dehisced",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "225553008",
"display" : "Wound dehiscence"
}
],
"text" : "Criteria of Diagnosis: Wound spontaneously dehisced",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-incision-opened",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1967-9",
"display" : "Incision deliberately opened or otherwise drained by physician"
}
],
"text" : "Criteria of Diagnosis: Incision deliberately opened",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-evidence-found",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1905-9",
"display" : "Other evidence of infection found on direct exam, during surgery, or by diagnostic tests"
}
],
"text" : "Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-localized-swelling",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1920-8",
"display" : "Localized swelling"
}
],
"text" : "Criteria of Diagnosis: Localized swelling",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-pain-tenderness",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1960-4",
"display" : "Pain or tenderness"
}
],
"text" : "Criteria of Diagnosis: Pain or tenderness",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-organism-identified",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1952-1",
"display" : "Positive culture"
}
],
"text" : "Criteria of Diagnosis: Organism Identified",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-testing-not-performed",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1901-8",
"display" : "Not cultured"
}
],
"text" : "Criteria of Diagnosis: Culture or non-culture based testing not performed",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-imaging-test",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1924-0",
"display" : "Radiographic evidence of infection"
}
],
"text" : "Criteria of Diagnosis: Imaging test evidence of infection",
"type" : "boolean",
"required" : true,
"repeats" : false
},
{
"linkId" : "criteria-of-diagnosis-physician-diagnosis",
"code" : [
{
"system" : "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"code" : "1963-8",
"display" : "Physician Diagnosis of this event type"
}
],
"text" : "Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician",
"type" : "boolean",
"required" : true,
"repeats" : false
}
]
},
{
"linkId" : "ssi-detection-method-type",
"text" : "Surveillence method type (active/passive) through which the SSI was detected",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31"
}
},
{
"linkId" : "ssi-detection-method",
"text" : "Surveillence method through which the SSI was detected",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29"
}
}
]
},
{
"linkId" : "findings-group",
"code" : [
{
"system" : "http://loinc.org",
"code" : "18769-0",
"display" : "Microbial susceptibility tests Set"
}
],
"text" : "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"type" : "group",
"required" : true,
"repeats" : true,
"item" : [
{
"linkId" : "pathogen-identified",
"text" : "Pathogen Identified",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16"
}
},
{
"linkId" : "pathogen-ranking",
"text" : "Pathogen Ranking",
"type" : "choice",
"required" : true,
"repeats" : false,
"options" : {
"reference" : "http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking"
}
}
]
},
{
"linkId" : "nhsn-comment",
"code" : [
{
"system" : "http://www.loinc.org",
"code" : "86468-6",
"display" : "Report Comment Section"
}
],
"text" : "Comments",
"type" : "text",
"required" : false,
"repeats" : false,
"maxLength" : 2000
}
]
}
