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DRAFT

Short Description

Situation Awareness for Novel Epidemic Response

Long Description

Situation Awareness for Novel Epidemic Response: A FHIR Implementation Guide

Agenda

Test all actors, profiles and Measure Automation

Type

Test an Implementation Guide

Submitting Work Group/Project/Accelerator/Affiliate/Implementer Group  

PH

Proposed Track Lead

Tentatively (Rick GeimerSupporting NHSN activities), David Pyke, John Loonsk


Related Tracks

See other reporting Scenarios under 2021-01 Public Health Track

FHIR Version

FHIR R4 for all actors, R4 with US Core 3.1.1 and/or DSTU2 with Argonaut 1.0.0 for Data Source actor

Specification(s) this track uses

Situational Awareness for Novel Epidemic Response (v0.1.0: STU 1 Ballot 1) based on FHIR R4

Artifacts of focus

http://hl7.org/fhir/uv/saner/2021JAN/index.html (see also http://build.fhir.org/ig/HL7/fhir-saner/)

Clinical input requested (if any)

Definition of Measures for

  • Admissions from Skilled Nursing Facility to Hospital Covid-19 Reporting
  • Covid Complications and Risk Factors (including return to base function on discharge)
  • NHSN Inpatient COVID-19 Medication Administration Reports

Patient input requested (if any)

Consider inputs about how patients might self-identify as being a nursing home resident, and how to collect information on return to base function on discharge

Expected participants

CDC, Ai, Lantana, others TBA

Zulip stream

https://chat.fhir.org/#streams/254944/SANER-Connectathon
TBA

Track Orientation Date

TBA, 2nd week of December

Track Orientation Details

TBA

Track Details

System Roles

Data Source

The Data Source interacts with the Measure Computer and provides data for it to compute from.

The Data Source can be an EHR supporting DSTU2 or R4, or a FHIR Server supporting R4.

Preparation

  • Have a sandbox environment containing ONLY test patient data that can be accessed by applications.
  • Support the Argonaut Data Query 1.0.0  (DSTU2) or FHIR US Core Release 3.1.1 (R4) Implementation Guide.
  • Load realistic sample data into your system to support the Measure computation for measures used during the Scenarios for this Connectathon
Measure Source

The Measure Source reports results for a single facility, results for a collection of facilities, or aggregated data for a region.

Preparation

  • Be able to produce a MeasureReport resource for the CDC Measure.
  • Load realistic sample data into your system to populate the MeasureReport.
    • These data should be sufficiently distinctive that you can recognize them in a MeasureReport or in someone else's system.  
  • If you're doing the publication scenario, have a client that can do a MeasureReport create.
  • If you're doing the retrieval scenario, have a server that can respond to a MeasureReport search.
Measure Consumer

The Measure Consumer provides access to aggregated or fine-grained data gathered from one or more Measure Sources.

Preparation

  • Be able to parse a MeasureReport resource for the CDC Measure and store it in your system. 
  • If you're doing the publication scenario, have a server that can accept a MeasureReport create.
  • If you're doing the retrieval scenario, have a client that can initiate a MeasureReport search.
Measure Computer

The Measure Computer is a Measure Source that can evaluate a Computable Measure against a FHIR Server

Preparation

  • Be able to retrieve a Measure from a Measure Definition Source
  • Be able to parse a Measure and compute against multiple Data Sources (see above)
  • Be able to send a Measure Report to a Measure Report Consumer
Measure Definition Source

Measure Definition Source providing (create/update) Measure resources to a Measure Definition Consumer.

Measure Definition Consumer

Measure Definition Consumer accepting new/updated Measure resources to act upon.

Preparation

  • Be able to read a Measure definition
  • Be able to connect to a FHIR Server containing test patient data
  • Compute the measure from the data in the FHIR Server and report it acting as a Measure Source (see above)

Scenarios 

Identify Patient Panel for Measurements

Step 1: Identify Patients for Measure

Action:

  1. External Source Identifies Patients to use for Measurement

Precondition: Success Criteria: 

  1. See other Scenarios in Public Health Track

Success Criteria:  

  1. Data Source has Patient Resources that will identify patients of interest that can be retrieved when queried.

Bonus point:

N/A

Step 2: Retrieve Measure

Action: Measure Computer (acting through Measure Definition Consumer) requests updated Measure from Measure Definition Source

Precondition: Success Criteria: 

  1. An existing or updated Measure is available on thee Measure Definition Source

Success Criteria:  

  1. The existing Measure has been retrieved by the Measure Computer
  2. The Measure can be parsed by the Measure Computer

Bonus point:

N/A

Step 3: Compute Measure

Action: Measure Computer requests data from Data Source(s)

Precondition: Success Criteria: 

  1. Data Sources have data to request
    1. FHIR Server has a Reportability Response
    2. EHR has Patient Data

Success Criteria:  

  1. Data is transferred to the Measure Computer
  2. The Measure Computer can compute a Measure Report

Bonus point:

N/A

Step 4: Send Measure

Action: Measure Computer (acting through Measure Source) sends data to Measure Consumer

Precondition: Success Criteria: 

  1. A Measure has been Computed

Success Criteria:  

  1. Measure Report is communicated to Measure Consumer
  2. Measure Report contains both the Report and data used for computing it

Bonus point:

N/A

TestScript(s):

We will use Inferno for Testing

Security and Privacy Considerations:

TLS and non-TLS endpoints should both be available for testing.

Automated Measure Computation and Reporting

Action: A provider organization application executes the following actions in appropriate roles in the scenario. 

  1. Application in the role of Measure Definition Consumer retrieves (PULL) a Computable Measure (definition) from a Measure Definition Source
  2. Application in the role of Measure Computer uses the Computable Measure to compute against a FHIR Server
  3. Application in the role of Measure Source creates a Measure Report based on the Computable Measure, and sends (PUSH) the Measure Report to  Measure Consumer

A public health organization application acts as both a Measure Definition Source and a Measure Consumer

  1. Measure Definition Source supports queries for a Computable Measure
  2. Measure Consumer accepts Measure Reports based on a Computable Measure

Precondition:

  • Measure Definition Source prepopulated with a Computable Measure
  • FHIR Server prepopulated with test data for computing measures

Success Criteria:

  • Measure Report pushed to the Measure Consumer
  • Computed measurements match known results for the Computable Measure applied to the provided test data

Bonus point:

  • Provide evidence of FHIR Path/CQL calculations
    • For example, identify the FHIR Patient resources in the measure report that were used to calculate the data.

Exchanging Updated Measure Definition

Action: This scenario is planned for Day 2 of the Connectathon and involves the Measure Definition Source making a new Computable Measure Definition available for use. The new Computable Measure Definition will result in at least one different calculated result in a Measure Report based on the provided test data.  This scenario otherwise follows the Automated Measure Computation and Reporting scenario

Admissions from Skilled Nursing Facility to Hospital Covid-19 Reporting

This scenario will attempt to track inpatient Covid-19 infections for patients who were admitted from skilled nursing facilities. 

Measure

  • Numerator: All in denominator who came from a skilled nursing facility
  • Demoninator: All patients who are Covid-19 positive

Data for Collection

  • TBD
Covid Complications and Risk Factors (including return to base function on discharge)

This scenario will attempt to track complications and risk factors related to Covid 19, as defined below. 

  • Complications:  Conditions that occur during or after a SARS-CoV-2 infection that are the result of that infection.
  • Risk factor and Comorbidities:  Conditions that predict a more severe course of SARS-CoV-2 infection.

Measure

  • Numerator: SNF residents that become covid patients

  • Denominator: Covid confirmed patients

Data for Collection

  • TBD
NHSN Inpatient COVID-19 Medication Administration Reports


This track will test the model specified in the IG to support electronic submission of line-level medication administration data to the National Healthcare Safety Network (NHSN). The intent of this project is to establish an electronic submission standard that is vendor-neutral that leverages existing workflows and eliminates duplicate documentation. This project will work with EHR vendors to identify data elements that can be used to describe medications administered (name, formulation, route, dose, duration) to hospitalized patients (inpatients) diagnosed with COVID-19 as part of NHSN COVID-19 reporting pathways.

With feedback from CDC and pharmacy informatics SMEs, this project will develop the following IG:
• HL7 Implementation Guide for FHIR® Release: NHSN Inpatient Medication Administration Reports

“This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile we will request approval from US Realm SC, and provide the US Realm approved rationale for deviation in the implementation guide where applicable.”

Artifacts of Focus

  • Measure
  • MeasureReport
  • Patient
  • Encounter
  • Condition
  • MedicationRequest
  • Immunization
  • Location
  • Observation (lab)
  • AllergyIntolerance
  • AdverseEvent (maybe)

We will test using a SANER-compliant FHIR denominator Measure resource to query active inpatient encounters for a reporting period with the line level data identified as supplemental data elements The result of evaluating the measure will be a FHIR MeasureReport resource containing the line level data. Time permitting, we will then transform the results to comply with the ​NHSN Inpatient COVID-19 Medication Administration Reports implementation guide. 

Measure

  • Denominator: All patients who are Covid-19 positive

Data Elements Intended for Collection:

  • Presence of isolation order
  • Admission date​
  • Discharge date​
  • Patient sex​
  • Patient age​
  • Patient race​
  • Patient ethnicity​
  • Patient location*​
  • Primary diagnosis ​
  • Chief complaint*​
  • Other diagnoses​
  • Medication/Immunization name​
  • Medication/Immunization code​
  • Medication/Immunization dosage form (or route)​
  • Medication/Immunization dose​
  • Medication/Immunization start date*​
  • Medication/Immunization stop date*​
  • Discharge disposition​
  • Adverse event​
  • SARS-CoV-2 Laboratory Tests - PCR test not antibody tests (for COVID-19 pilot phase, future phases may expand to other laboratory tests). 

*Some results have been returned within the EHR sandbox environment for these data elements, but further confirmation in real-world EHR environment is needed.​

Scenario Steps

  • Action: Generation of medication and MedicationRequest data for patient-specific administered medication data
  • Precondition: Success Criteria: Generation of well-formed patient-specific Medication, MedicationRequest, and associated FHIR artifacts
  • Success Criteria: Generation of error free patient-specific Medication, MedicationRequest, and associated FHIR artifacts upon a pre-defined triggerable event or schedule
  • Bonus point: Successful transmission of above mentioned data to a FHIR consumer

TestScript(s)

Indicate any test scripts that will be used to help verify system behavior

Security and Privacy Considerations

Testing will be performed without TLS.








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