Proposal to Use CDA for Healthcare-Associated

Infections (HAIs) Reporting to the Centers for Disease

Control and Prevention (CDC)

Daniel Pollock, CDC

dpollock@cdc.gov

July 6, 2006 HL7 SDTC Teleconference

Overview• Mounting public interest in surveillance and

prevention of healthcare associated infections (HAIs)

• Many hospitals use CDC’s National Healthcare Safety Network (NHSN) or a vendor IT solution to collect and analyze HAI event data

• CDC is working with IT vendors on a standards-based solution that will enable hospitals that use vendor systems to report HAI data to NHSN

• CDA specifications for HAI event data (numerators and denominators) is a logical solution, but more information is needed about feasibility, cost, timetable

HAI:A Major Clinical and

Public Health Problem• Defined as infections that patients acquire during

the course of receiving treatment for other conditions

• Account for an estimated 2 million infections, 90,000 deaths, and billions of dollars in excess health care costs annually

• After years of debate, mandatory public reporting of HAIs is becoming a reality in an increasing number of States

HAI Public Reporting Legislation

Enacted

2006 Activity No Data

www.apic.org 06.30.2006

Study Bills

WWW.APIC.ORG 06.30.2006

• Infection Control Professionals (ICPs) identify HAI cases (e.g., surgical site infections, bloodstream infections), collect case instance data and denominator data (e.g., surgical procedures, central-line days), and enter these data into the web-based NHSN application

• Healthcare facilities use data entered into NHSN for facility-level monitoring and quality improvement

• CDC uses NHSN data to analyze national-level trends and to provide comparative data for facilities to use in performance measurement

Vendors Working With CDCto Enable Use of CDA

for Reporting HAIs to NHSN

• Becton Dickinson

• Cereplex

• EpiQuest

• ICPA

• MedMined

• TheraDoc

• Vecna

Initial Feedback from HL7’sStructured Documents

Technical Committee (SDTC)• Several changes to CDA might be in order to

optimize its use for HAI event reporting:- Requirement for naming sending institution- Narrative block becomes optional for sections

that fully coded• Possibility of a CDA for Reporting specification

(CDA-R).• CDA specifications for HAI denominator data

may require more creativity as CDA currently defines a clinical document for a single patient.

Possible Roles forHL7’s SDTC

• Consider questions of what is in scope and out of scope for CDA.

• Provide guidance on HL7 Working Group activities that bear on HAI reporting project.

• Review draft specifications and provide feedback on format and appropriate use of the specification.

• Serve as a sponsor for HAI reporting implementation guides that would be considered for a U.S. realm ballot.