Healthcare Associated Infection Reports, FHIR STU 2 Ballot - US Realm Implementation Guide CI Build

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

XML Format: Questionnaire-hai-questionnaire-opc-ssi-event

Raw xml 


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