1. 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

2. 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

3. 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

4. HAI Public Reporting Legislation Enacted 2006 ActivityNo Data www.apic.org 06.30.2006 Study Bills WWW.APIC.ORG 06.30.2006

5. 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

6. Vendors Working With CDC to Enable Use of CDA for Reporting HAIs to NHSN Becton Dickinson Cereplex EpiQuest ICPA MedMined TheraDoc Vecna

7. Initial Feedback from HL7’s Structured 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.

8. Possible Roles for HL7’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.