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Frequently Asked Questions

About Electronic Reporting to NHSN (CDA)

FAQs Regarding CDA Import For NHSN Reporting

FAQs About Electronic Reporting to NHSN (CDA), CMS, and Data Quality

FAQs For CDA Implementers (e.g., Vendors) Creating NHSN Dialysis Event CDA files using the NHSN CDA (R7) HAI Implementation Guide

 

What options are available for reporting data to NHSN?

There are three modes for NHSN reporting:

  • Manual data entry
  • Manual CDA import
  • Automated send using NwHIN Direct (also referred to as batch submission)

Both manual reporting options allow data submission for one facility at a time. Automated send can be used to import CDA files from one or more facilities in a single zip file. All reporting options require that the facility be enrolled and set-up to use NHSN - this includes adding reporting locations and monthly reporting plans. Enrollment, set-up, and annual surveys are completed manually for all three modes.  

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What is CDA?

Facilities interested in importing data into NHSN rather than entering it manually have the option to work with a CDA implementer to create CDA files. The CDA implementer develops software that extracts NHSN data from the facility’s available electronic sources of medical information (e.g., electronic medical record software, laboratory information, and admission, discharge, and transfer data) to create valid CDA files. To report to NHSN, CDA files are created, zipped, and then imported into NHSN. Monthly reporting plans must be added manually before data can be imported. Users who wish to import CDA files into NHSN must have administrative rights.

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How is CDA used for NHSN reporting?

Facilities interested in importing data into NHSN rather than entering it manually have the option to work with a CDA implementer to create CDA files. The CDA implementer develops software that extracts NHSN data from the facility’s available electronic sources of medical information (e.g., electronic medical record software, laboratory information, and admission, discharge, and transfer data) to create valid CDA files. To report to NHSN, CDA files are created, zipped, and then imported into NHSN. Monthly reporting plans must be added manually before data can be imported. Users who wish to import CDA files into NHSN must have administrative rights.

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What can be reported to NHSN using CDA import?

CDA import is available for the following reporting options (please note the NHSN HAI Implementation Guide [IG] Release Number): • Bloodstream Infection (BSI) (NHSN IG R2 & R5)

  • Procedures and Surgical Site Infection (SSI) (NHSN IG R2 & R5)
  • Central Line Insertion Practices Adherence (CLIP) (NHSN IG R5)
  • Urinary Tract Infection (UTI) (NHSN IG R5
  • Laboratory Identified Multidrug –Resistant Organism (MDRO) or Clostridium difficile Infection (CDI)Event (LabID) (NHSN IG R5)
  • Summary Reports for Intensive Care Unit (ICU) (NHSN IG R2 & IG R5)
  • Summary Reports for Neonatal Intensive Care Unit (NICU) and Specialty Care Area (SCA) (NHSN IG R5)
  • Summary Report: Antibiotic Use –Pharmacy option (In Pilot Phase) (NHSN IG R6)
  • Summary Report for the MDRO/CDI Module (Process and Outcome Measure Form, “POM”) (NHSN IG R7)
  • Dialysis Event and Denominators for Outpatient Dialysis (NHSN IG R7)

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Are data reported to NHSN using CDA import the same data that are reported manually?

Yes, data should be the same with all modes of NHSN reporting. Data are still collected according to the NHSN protocols and forms. It is the facility’s responsibility to verify that the data being reported to NHSN are correct.

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What is a “CDA implementer” and how do I locate one?

A CDA implementer is an organization with expertise in CDA standards and ability to develop software according to the CDC NHSN Healthcare Associated Infection (HAI) Implementation Guide (IG). Many NHSN reporting facilities contract with an external CDA vendor (business) with this expertise. However, very large organizations may have the capability to develop and implement CDA with their internal resources. The Association of Professionals in Infection Control and Epidemiology (APIC) maintains a list of vendors that have expressed willingness to provide CDA services for NHSN reporting. Visit APICs Choosing surveillance technology website and select “Vendor resources” to locate the vendor list.

CDA vendors are encouraged to contact APIC to be added to this list at apicinfo@apic.org or by phone at (202) 789-1890.

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If we decide to pursue CDA for NHSN reporting, does our facility need a CDA vendor? Can our Information Technology (IT) department export the data from our electronic medical records to import into NHSN?

Creating CDA files is more complex than simply exporting data in the correct file format. Your facility may not need an official CDA vendor, but expertise to interpret the NHSN Healthcare Associated Infection (HAI) Implementation Guide (IG) and familiarity with Health Level 7 (HL7) standards is required for success. If your CDA implementer is unfamiliar with these terms, they should contact the NHSN CDA Helpdesk at nhsncda@cdc.gov for additional information to determine if they have the capability required to create CDA files.

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How should my facility get started?

Locate a CDA implementer. This may be your electronic medical record (EMR) vendor, a third-party CDA vendor, or for some very large organizations, your Information Technology (IT) department. Ensure the CDA implementer is signed up to receive regular e-mail updates from nhsncda@cdc.gov.  Complete NHSN enrollment and set-up for your facility.

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Can the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) National Healthcare Safety Network (NHSN) Dialysis Event reporting measure requirements be met using Clinical Document Architecture (CDA) to report data?

The CMS ESRD QIP NHSN Dialysis Event reporting measure requirements can be met by submitting data to NHSN via CDA, a reporting method in which data are imported electronically into NHSN instead of entered manually. However, CDC recommends and CMS requires at least one staff member at the facility be trained in and knowledgeable of how to report dialysis event data to the NHSN, regardless of whether electronic or manual methods of data submission are used. A complete understanding of the NHSN Dialysis Event Protocol [PDF - 121 KB] is a prerequisite for the facilities participating in NHSN and this prerequisite must be met by at least one facility staff member. As of September 2012, CDC is able to accept imported dialysis event and dialysis denominator CDA files. However, when your facility will be able to create CDA files depends on your CDA implementer. The CDA process requires time for programming, testing, and validation, which may delay your facility’s ability to generate CDA files beyond the CMS ESRD QIP reporting deadlines:

  • CMS Payment Year 2014 (performance year 2012):
    • Three or more consecutive months of 2012 dialysis event data must be reported by March 31, 2013 for the facility to receive credit for the NHSN reporting measure.
  • CMS PY 2015 (performance year 2013):
    • Six to 12 months of 2013 dialysis event data must be reported by April 15, 2014 for the facility to receive credit for the NHSN reporting measure.

Be prepared to report manually until you are certain that data reported with CDA is complete and accurate.

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What is the role of the sender for validating CDA data?

CDC expects that the sender has done adequate data validation to ensure data being reported using CDA are complete and correct by comparing dialysis event data collected manually to dialysis event data obtained from CDA (both numerator and denominator). In addition, a facility-based NHSN user is expected to have access to NHSN and continue to review the data in NHSN on an ongoing basis to verify data reported via CDA are complete and correct.

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How should CDA data be validated?

CDC expects the facility to collect dialysis event data manually and compare it to CDA data for a minimum of three months and verify that the data are the same. This recommended timeframe should be extended in facilities that experience a low frequency of dialysis events. If discrepancies are identified, work with your CDA implementer to ensure all data are being correctly captured as described by the CDA Implementation Guide (IG) and the Dialysis Event Protocol. If it is determined that incorrect data have been reported to NHSN, add, edit and delete records in NHSN as necessary to make corrections. Corrections to 2012 data should be completed by March 31, 2013. Corrections to 2013 data should be completed by April 15, 2014.

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When should manual data collection occur to validate CDA data?

If you plan to use CDA to report 2013 dialysis event data, you should currently perform manual data collection for two reasons: (1) to validate the CDA data and (2) to serve as a backup plan to CDA reporting to meet the minimum CMS QIP NHSN reporting requirements.

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Who should be involved in validation of CDA files?

Both the CDA implementer and the sender are expected to be involved in validation of CDA files. During the development of CDA, the CDA implementer must use the CDA Implementation Guide (IG), The Lantana Group’s Schematron Validator and NHSN test facilities can be used by the implementer to verify CDA files are created to the correct NHSN specifications. Following development of CDA capacity, a person within the facility is expected to compare manually collected data with CDA data to verify that they are the same, and then continue to review the data in NHSN on an ongoing basis to verify data continue to be reported completely and correctly.

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Validation has identified errors in data that have already been reported to NHSN; what do we do?

If incorrect data have been reported to NHSN, either manually add, edit and delete records in NHSN to make corrections or import a corrected CDA file using the succession management process (refer to the Implementation Guide and contact the NHSN CDA Helpdesk at nhsncda@cdc.gov for more information). Corrections should be made as soon as possible after discovery; for 2012 data, corrections should be completed no later than March 31, 2013 to meet the CMS ESRD QIP deadline. For 2013 data, corrections should be completed no later than April 15, 2014. Contact your CDA implementer if the data were submitted using CDA to ensure the problem is not repeated in future CDA files.

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Why is data validation important to facilities reporting data?

Data validation is important to facilities participating in NHSN for several reasons. First, per the NHSN Agreement to Participate and Consent submitted by each facility during enrollment, to be eligible to participate in NHSN, facilities must “be willing to follow the selected NHSN component protocols exactly and report complete and accurate data in a timely manner during months when reporting data for use by CDC.” Failure to comply with this and the other requirements stipulated in the Agreement to Participate and Consent will result in withdrawal from NHSN.

In the future, it is expected that external organizations, such as CMS and possibly state health departments, will pursue data validation activities, which may have payment and/or regulatory implications. Early data validation by facilities will provide more time to identify and make corrections to problems with NHSN data collection and reporting processes.

Most importantly, the purpose of reporting complete and accurate surveillance data is to generate information that is useful for monitoring facility performance and driving prevention activities. Unreliable data are not useful to facilities’ or Networks’ quality improvement efforts.

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In the R7 IG, among the Dialysis Event CDA specifications there are references to other types of NHSN reporting, such as hemovigilance. Are these non-Dialysis Event CDA specifications required to implement Dialysis Event CDA?

No; to implement Dialysis Event CDA, only the specifications applicable to dialysis event reporting are required. The IG is not specific to one type of NHSN reporting. For consistency and economy, when different types of reporting have an overlap in CDA design, they are referenced together in a single section of the IG. Specifications for any type of reporting that you are not implementing can be ignored.

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What is the imputability observation for the suspected source of a positive blood culture in Dialysis Event CDA?

The purpose of the imputability observation is to report the degree of certainty with which an outcome can be attributed a particular cause. The CDA imputability value set contains values that vary in degree of certainty (e.g., possible, probable, definite).

For the Dialysis Event form, users are required to indicate the suspected source of each positive blood culture reported. The degree of certainty required is that the source is the “suspected” or possible origin of the positive blood culture. Therefore in Dialysis Event CDA, the imputability observation is always set to “possible” to reflect that the positive blood culture is only being attributed to a suspected source.

Values other than “possible” listed in the CDA imputability value set are used for other types of NHSN reporting and can be ignored for the implementation of Dialysis Event CDA.

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CMS requirements click here for more information

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