Transcript HL7

Standard Vocabulary
Implementation Experience from
CDC Partners and Programs
PHIN Conference
August 25, 2008
10:30 a.m. – 12 noon
Standard Vocabulary and CDC’s
National Healthcare Safety Network
Daniel Pollock, Marla Albitz, Pavla Frazier,
Jonathan Edwards, Ben Kupronis, Teresa Horan
Surveillance Branch
Division of Healthcare Quality Promotion
National Center for Preparedness, Detection, and
Control of Infectious Diseases
CDC, Atlanta, GA
Acknowledgments
Sundak Ganesan
Rob Hausam
Wenkai Li
Kelly Peterson
Objectives
• Overview of CDC’s National Healthcare Safety
Network (NHSN)
• Use of standard vocabulary in NHSN
eSurveillance initiative
• Collaboration with Public Health Information
Network Vocabulary Access and Distribution
System (PHIN VADS)
• Lessons learned for other public health
surveillance systems
NHSN in a Nutshell
• Integrates legacy CDC systems for surveillance
of nosocomial infections (NNIS), healthcare
worker safety (NaSH), and hemodialysis (DSN)
into a single web-based system
• Serves multiple purposes: infection control,
prevention research, State-level public reporting,
and national-level surveillance
• Data collection from a sample of U.S. healthcare
facilities enables valid estimation of adverse
events among patients and healthcare workers
NHSN Components
and Modules
NHSN
Component
Patient
Safety
Events Modules
• Device Associated
• Procedure Assoc.
• Medication Assoc.
• MDRO and CDAD
• High Risk Inpatient
Influenza Vaccination
MDRO = Multidrug-resistant
organism
CDAD = Clostridium difficile
associated disease
Component
Healthcare
Personnel
Safety
Modules
• Blood/Body Fluid
Exposure
• Vaccination
Component
Biovigilance
Modules
• Hemovigilance
Component
Research and
Development
eSurveillance
• HL7 Messages
• HL7 CDA
Prevention research
HL7 = Health Level Seven
CDA = Clinical Document
Architecture
Am J Infect Control 2008;36:S21-6
NHSN eSurveillance initiative – Efforts are underway at
CDC to foster greater use of electronic data stored in
health care application databases for surveillance of
healthcare-associated infections and antimicrobial use
and resistance. These efforts . . . focus on standardsbased solutions for conveying healthcare data and
validation processes to confirm that the data received
at CDC accurately reflect the data transmitted by health
care facilities.
NHSN eSurveillance Projects Use
HL7 Message and Document Standards
NHSN
Component
Patient
Safety
Events Modules
• Device Associated
• Procedure Assoc.
• Medication Assoc.
• MDRO and CDAD
• High Risk Inpatient
Influenza Vaccination
MDRO = Multidrug-resistant
organism
CDAD = Clostridium difficile
associated disease
Component
Healthcare
Personnel
Safety
Component
Biovigilance
Modules
• Hemovigilance
Modules
• Blood/Body Fluid
Exposure
• Vaccination
Data Transmission Standards
- Messages for laboratory results,
admission/discharge/transfer,
and pharmacy data
- Structured documents for
infection reports, denominators,
and process of care measures
Component
Research and
Development
eSurveillance
• HL7 Messages
• HL7 CDA
Prevention research
HL7 = Health Level Seven
CDA = Clinical Document
Architecture
HL7 Messages to Transmit Antimicrobial
Use and Resistance (AUR) Data
Healthcare Facility
CDC
Existing PHIN MS
Infrastructure –
specific AUR queue
PHIN MS Sender
Standard
HL7 V2.5
Messages
Source IT Systems
Pharmacy
Data
Facility
Firewall
New ETL
System
CDC
Firewall
Microbiology
Data
ADT
Data
AUR
Message
Intermediary
(assigns standard
vocabulary/coding
and formats to
AUR HL7 2.5 spec)
Secure
Internet
Transmission
Exception
Reports
(automatically
receives,
validates,
parses, and
loads data from
PHIN MS)
eSurveillance
Database
HL7 CDA for Reporting Healthcare
Associated Infection (HAI) Data
Healthcare Facility
CDC
Entry of location
mapping codes
and monthly
reporting plan
Web-based
data entry
and access
NHSN Application
Facility
Firewall
Vendor
system used
to collect
HAI data and
create CDA
document
CDC
Firewall
CDA
Document
(HAI event
and
denominator
records)
NHSN
Database
Parsing
and
Validating
Standard Vocabularies Used
in NHSN
• LOINC
• SNOMED
• HL7
• RxNorm
• ICD-9-CM
• UCUM
Use of Standard Vocabulary in NHSN’s
HL7 V2.5 Laboratory Results Message
OBR|1|""|0819029300-651461^UUHSC^2.16.840.1.114222.4.3.2.2.1.256.1^ISO|63636^Clostridium difficile toxin
A+B:ACnc:Pt:Stool:Qn:EIA^LN^65146^C.DIFFICILE TOXINS
(A/B)by EIA^L|||20080708190000|||||||||||||||20080709132500|||F|||||
OBX|1|ST|6363-6^Clostridium difficile toxin
A+B:ACnc:Pt:Stool:Qn:EIA^LN^65146^C.DIFFICILE TOXINS
(A/B)by EIA^L|1|NEGATIVE||NEGATIVE|N^Normal (applies to nonnumeric results)^HL70078^N^^L|||F|||||||||
SPM|1|0819029300-65146-1^UPHSC^
2.16.840.1.114222.4.3.2.2.1.256.1^ISO||119339001^Stool
specimen^SNM^^^L|||||||||||||20080708190000|20080709000000||||||||
||||
SNOMED
HL7
LOINC
Use of Standard Vocabulary in NHSN’s
HL7 V2.5 Pharmacy Message
RXE||198334^^RXNORM^SULF40080T^^L^3/01/2007^^Su
lfamethoxazole + Trimethoprim SS 400+80mg
TAB|1||{tbl}^tablets^UCUM^TABLET^^L||||||||||100789955
5|||||||||||||||||||||||||||6EICU^601^^^^1027-2&Medical critical
care&2.16.840.1.113883.6.259&6EMedICU^^LWard&2.1
6.840.1.113883.6.259&6EMed^^L
TQ1|1|1|q1D&&HL70335&52550000000903&&Transmitter
&2.5&&QDay||||20080526090000|20080530140000
RXR|PO^Oral^HL70162^PO^^L^09/21/2006
HL7
RxNorm
UCUM
Standard Vocabulary in NHSN’s
CDA Surgical Site Infection Report
Signs & Symptoms
Source
Code
□ Purulent drainage or material
SNOMED
307491001
□ Pain or tenderness
NSHN term
SS_pain
NSHN term
SS_locSwell
SNOMED
386713009
SNOMED
304214002
SNOMED
386661006
NSHN term
SS_incision
□ Localized swelling
□ Redness
□ Heat
□ Fever
□ Incision deliberately opened
by surgeon
NHSN Local Vocabulary in
CDA Bloodstream Infection Report
Source
Code
NHSN term
lab_path
NSHN term
lab_skincon
NSHN term
lab_noorg
Laboratory
□ Recognized pathogen from
one or more blood cultures
□ Common skin contaminant
from > 2 blood cultures
□ Blood cultures not done or
no organisms detected in
blood
Standard Vocabulary in NHSN’s
Antimicrobial Susceptibility Report
NHSN
Concept
Source
Code
Coagulasenegative
staphylococci
SNOMED term
116197008
Vancomycin
susceptibility
LOINC term
19000-9
Susceptible,
Intermediate,
Resistant,
Not tested
HL7 term
S, I, R, N
Pathogen # Gram-positive Organisms
_____
Coagulase-negative
staphylococci
VANC
SIRN
_____
Enterococcus
faecalis
AMP
SIRN
DAPTO
SIRN
LNZ
SIRN
NHSN Term Submissions
to SNOMED: BSI and SSI
NHSN Concept
Bloodstream
infection
Surgical site
infection
SNOMED
Concept
SNOMED Concept
Identifier
Infection of
431193003
bloodstream
(disorder)
Surgical site
433202001
infection (disorder)
NHSN Term Submissions to HL7:
Healthcare Service Locations (Examples)
NHSN
Code
HL7
Code
HL7
Hierarchical
Level
−
1024-9
5
Ward
IN:ACUTE:WARD
1050-4
5
Medical
Critical Care
IN:ACUTE:CC:M
1027-2
6
1060-3
6
Healthcare
Service
Location
Intensive
Care Unit
Inpatient
IN:ACUTE:WARD:M
Medical Ward
NHSN Collaboration with PHIN VADS
• NHSN web-based application is bolted to PHIN
VADS 2.3
• Plans call for future migration to PHIN VADS 3.X
• PHIN VADS is the resource that implementers of
NHSN message and CDA solutions will use for
vocabulary access
• NHSN is informing PHIN VADS development by
providing functional requirements and
vocabulary content
Lessons Learned for Other
Public Health Surveillance Systems
• Electronic message and document solutions for
conveying surveillance data require concerted
attention to vocabulary standardization
• Public health surveillance programs are well
positioned to use and contribute to vocabulary
standards
• Shared resources for developing, maintaining,
and distributing vocabulary can yield important
programmatic benefits
Thank You!
www.cdc.gov/ncidod/dhqp/nhsn.html