About CDA

What is CDA?

Clinical Document Architecture (CDA) is a Health Level 7 (HL7) standard that provides a framework for the encoding, formatting and semantics of electronic documents. CDC’s National Healthcare Safety Network (NHSN) supports CDA import of certain healthcare-associated infection (HAI) data. To assist programmers in creating standards for reporting via CDA import, NHSN offers an Implementation Guide and associated materials based fully on HL7-balloted CDA document specifications. Types of data that can be reported include event reports, denominator data, and process-of-care measures.


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?

Valid CDAs are created based on specific NHSN HAI Implementation Guides (IG’s). For a current list of valid CDA imports per IG version, view the Guide to CDA Versions.

  • Surgical Site Infection (SSI)
  • Denominator for Procedure
  • Primary Bloodstream Infection (BSI)
  • Central Line Insertion Practices Adherence Monitoring (CLIP)
  • Urinary Tract Infection (UTI)
  • Laboratory-identified MDRO or CDI Event (LabID)
  • Ventilator-associated Event (VAE)

Summary Reports

  • Denominators for Intensive Care Unit (ICU)/Other Locations (not NICU and SCA)
  • Denominators for Neonatal Intensive Care Unit (NICU)
  • Denominators for Specialty Care Area (SCA)
  • Denominators for LabID: ‘MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring’

Antimicrobial Use and Resistance

  • Summary data for Antimicrobial Use
  • Denominators for Antimicrobial Resistance
  • Numerator for Antimicrobial Resistance


  • Dialysis Event
  • Dialysis Denominator


  • Hemovigilance Module Monthly Reporting Denominator

Healthcare Personnel Safety

  • Flu Summary


  • Late onset Sepsis and Meningitis Events
  • Late onset Sepsis and Meningitis Denominator

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What options are available for reporting data to NHSN?

There are four modes for NHSN reporting:

  • Manual data entry
  • Manual CDA import
  • Manual CSV import (for procedures, patient, and surgeons only)
  • Automated send using NwHIN Direct (also referred to as batch submission or DIRECT CDA Automation)

All 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 modes.


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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