This page is part of the Healthcare Associated Infection Implementation Guide (v2.0.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions
JSON Format: Questionnaire-hai-questionnaire-opc-ssi-event
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{ "resourceType" : "Questionnaire", "id" : "hai-questionnaire-opc-ssi-event", "meta" : { "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 <h1 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Outpatient Procedure Component Surgical Site Infection (SSI) Event</h1>\n <p xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">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 <p xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">For further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website <a href=\"https://www.cdc.gov/nhsn/\">https://www.cdc.gov/nhsn/</a>.</p>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Details</h2>\n <table xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">\n <tr>\n <td>\n <b>Id:</b>\n </td>\n <td>hai-questionnaire-opc-ssi-event</td>\n </tr>\n <tr>\n <td>\n <b>Profile:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire</td>\n </tr>\n <tr>\n <td>\n <b>Language:</b>\n </td>\n <td>en-US</td>\n </tr>\n <tr>\n <td>\n <b>Url:</b>\n </td>\n <td>http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event</td>\n </tr>\n <tr>\n <td>\n <b>Identifier:</b>\n </td>\n <td>\n <span>hai-questionnaire-opc-ssi-event-v1</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Version:</b>\n </td>\n <td>Version: 2.0.0</td>\n </tr>\n <tr>\n <td>\n <b>Name:</b>\n </td>\n <td>HAI_questionnaire_opc_ssi_event</td>\n </tr>\n <tr>\n <td>\n <b>Status:</b>\n </td>\n <td>draft</td>\n </tr>\n <tr>\n <td>\n <b>Experimental:</b>\n </td>\n <td>false</td>\n </tr>\n <tr>\n <td>\n <b>Subject Type:</b>\n </td>\n <td>Patient (Source Patient Resource (US Core Patient))</td>\n </tr>\n <tr>\n <td>\n <b>Date:</b>\n </td>\n <td>2019-04-01</td>\n </tr>\n <tr>\n <td>\n <b>Publisher:</b>\n </td>\n <td>HL7 Structured Documents Work Group</td>\n </tr>\n <tr>\n <td>\n <b>Jurisdiction:</b>\n </td>\n <td>\n <span title=\"Code system: urn:iso:std:iso:3166\">Code: US</span>\n </td>\n </tr>\n <tr>\n <td>\n <b>Code:</b>\n </td>\n <td>\n <ul style=\"list-style:none; padding-left:0; margin:0 0;\">\n <li>Healthcare Associated Infection report Document</li>\n <li>Code system: <a href=\"http://loinc.org\">http://loinc.org</a>\n </li>\n <li>Code: 51897-7</li>\n </ul>\n </td>\n </tr>\n </table>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <br xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\"/>\n <h2 xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\">Questionnaire Items (<span style=\"color:red\">*</span> required)</h2>\n <ul xmlns:xsl=\"http://www.w3.org/1999/XSL/Transform\" style=\"list-style:none;\">\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Facility ID</span> [<span style=\"font-style:italic\">facility-id</span>] (url)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Date of encounter</span> [<span style=\"font-style:italic\">encounter-date</span>] (date)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Infection details</span> [<span style=\"font-style:italic\">infection-details</span>] (group)\n <ul style=\"list-style:none;\">\n <li>This group records the infection type, with details. It records SSI level, all identification criteria used to identify this SSI event, and identified pathogen(s). [<span style=\"font-style:italic\">infection-details-group-description</span>] (display)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Event Type</span> [<span style=\"font-style:italic\">event-type</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Date of event</span> [<span style=\"font-style:italic\">event-date</span>] (date)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">NHSN Procedure Code Category</span> [<span style=\"font-style:italic\">nhsn-procedure-code-category</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Primary CPT Procedure Code</span> [<span style=\"font-style:italic\">primary-cpt-procedure-code</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/ValueSet/cpt-all\">http://hl7.org/fhir/ValueSet/cpt-all</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Procedure Id</span> [<span style=\"font-style:italic\">procedure-id</span>] (url)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Surgical Site Infection (SSI) Level</span> [<span style=\"font-style:italic\">ssi-level</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis</span> [<span style=\"font-style:italic\">criteria-of-diagnosis</span>] (group)\n <ul style=\"list-style:none;\">\n <li>This group records the criteria used in the diagnosis of an infection. [<span style=\"font-style:italic\">criteria-of-diagnosis-group-description</span>] (display)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Abscess</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-abscess</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Redness</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-redness</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Fever</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-fever</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Heat</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-heat</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Purulent drainage</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-incision-purulent-drainage</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Wound spontaneously dehisced</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-wound-dehisced</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Incision deliberately opened</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-incision-opened</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-evidence-found</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Localized swelling</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-localized-swelling</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Pain or tenderness</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-pain-tenderness</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Organism Identified</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-organism-identified</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Culture or non-culture based testing not performed</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-testing-not-performed</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Imaging test evidence of infection</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-imaging-test</span>] (boolean)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician</span> [<span style=\"font-style:italic\">criteria-of-diagnosis-physician-diagnosis</span>] (boolean)\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Surveillence method type (active/passive) through which the SSI was detected</span> [<span style=\"font-style:italic\">ssi-detection-method-type</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Surveillence method through which the SSI was detected</span> [<span style=\"font-style:italic\">ssi-detection-method</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29</a>\n </li>\n </ul>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Findings Group</span> [<span style=\"font-style:italic\">findings-group</span>] (group, repeats)\n <ul style=\"list-style:none;\">\n <li>This group records whether infection organisms were identified and, if so, records details about them. [<span style=\"font-style:italic\">findings-group-description</span>] (display)\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Pathogen Identified</span> [<span style=\"font-style:italic\">pathogen-identified</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16\">http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16</a>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"color:red\">* </span>\n <span style=\"font-weight:bold\">Pathogen Ranking</span> [<span style=\"font-style:italic\">pathogen-ranking</span>] (choice)\n <ul>\n <li>answerValueSet: <a href=\"http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking\">http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking</a>\n </li>\n </ul>\n </li>\n </ul>\n </li>\n <li>\n <span style=\"font-weight:bold\">Comments</span> [<span style=\"font-style:italic\">nhsn-comment</span>] (text)\n </li>\n </ul>\n </div>" }, "url" : "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event", "identifier" : [ { "value" : "hai-questionnaire-opc-ssi-event-v1" } ], "version" : "2.0.0", "name" : "HAI_questionnaire_opc_ssi_event", "title" : "Outpatient Procedure Component Surgical Site Infection (SSI) Event", "status" : "draft", "experimental" : false, "subjectType" : [ "Patient" ], "date" : "2019-04-01", "publisher" : "HL7 Structured Documents Work Group", "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.\n\nFor further details on reporting healthcare-associated infections see the specific protocols and data collection forms on the NHSN website [https://www.cdc.gov/nhsn/](https://www.cdc.gov/nhsn/).\n", "jurisdiction" : [ { "coding" : [ { "system" : "urn:iso:std:iso:3166", "code" : "US" } ] } ], "code" : [ { "system" : "http://loinc.org", "code" : "51897-7", "display" : "Healthcare Associated Infection report Document" } ], "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" : "infection-details-group-description", "text" : "This group records the infection type, with details. It records SSI level, all identification criteria used to identify this SSI event, and identified pathogen(s).", "type" : "display" }, { "linkId" : "event-type", "text" : "Event Type", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "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, "answerValueSet" : "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34" }, { "linkId" : "primary-cpt-procedure-code", "text" : "Primary CPT Procedure Code", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://hl7.org/fhir/ValueSet/cpt-all" }, { "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, "answerValueSet" : "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-group-description", "text" : "This group records the criteria used in the diagnosis of an infection.", "type" : "display" }, { "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, "answerValueSet" : "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, "answerValueSet" : "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", "type" : "group", "required" : true, "repeats" : true, "item" : [ { "linkId" : "findings-group-description", "text" : "This group records whether infection organisms were identified and, if so, records details about them.", "type" : "display" }, { "linkId" : "pathogen-identified", "text" : "Pathogen Identified", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "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, "answerValueSet" : "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 } ] }