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.