{
"description": "This Questionnaire instance defines the questions and possible answers in the Outpatient Procedure Component Surgical Site Infection Event. This report is for reporting data on each patient having a SSI event related to one of the NHSN operative procedures selected for monitoring.",
"_filename": "Questionnaire-hai-questionnaire-opc-ssi-event.json",
"package_name": "hl7.fhir.us.hai",
"subjectType": [ "Patient" ],
"date": "2019-04-01",
"meta": {
"profile": [ "http://hl7.org/fhir/us/hai/StructureDefinition/hai-single-person-report-questionnaire" ],
"versionId": "1",
"lastUpdated": "2019-03-14T00:00:46.000-04:00"
},
"publisher": "HL7",
"jurisdiction": [ {
"coding": [ {
"code": "US",
"system": "urn:iso:std:iso:3166"
} ]
} ],
"name": "hai-questionnaire-opc-ssi-event",
"item": [ {
"text": "Facility ID",
"type": "url",
"linkId": "facility-id",
"repeats": false,
"required": true
}, {
"text": "Date of encounter",
"type": "date",
"linkId": "encounter-date",
"repeats": false,
"required": true
}, {
"item": [ {
"text": "Event Type",
"type": "choice",
"linkId": "event-type",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.20"
},
"repeats": false,
"required": true
}, {
"text": "Date of event",
"type": "date",
"linkId": "event-date",
"repeats": false,
"required": true
}, {
"text": "NHSN Procedure Code Category",
"type": "choice",
"linkId": "nhsn-procedure-code-category",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.34"
},
"repeats": false,
"required": true
}, {
"text": "CPT Procedure Code",
"type": "choice",
"linkId": "cpt-procedure-code",
"repeats": false,
"required": true
}, {
"text": "Procedure Id",
"type": "url",
"linkId": "procedure-id",
"repeats": false,
"required": true
}, {
"text": "Surgical Site Infection (SSI) Level",
"type": "choice",
"linkId": "ssi-level",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.114222.4.11.3196"
},
"repeats": false,
"required": true
}, {
"item": [ {
"code": [ {
"code": "128477000",
"system": "http://snomed.info/sct",
"display": "Abscess"
} ],
"text": "Criteria of Diagnosis: Abscess",
"type": "boolean",
"linkId": "criteria-of-diagnosis-abscess",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "386713009",
"system": "http://snomed.info/sct",
"display": "Redness"
} ],
"text": "Criteria of Diagnosis: Redness",
"type": "boolean",
"linkId": "criteria-of-diagnosis-redness",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "386661006",
"system": "http://snomed.info/sct",
"display": "Fever"
} ],
"text": "Criteria of Diagnosis: Fever",
"type": "boolean",
"linkId": "criteria-of-diagnosis-fever",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "304214002",
"system": "http://snomed.info/sct",
"display": "Feels warm (finding)"
} ],
"text": "Criteria of Diagnosis: Heat",
"type": "boolean",
"linkId": "criteria-of-diagnosis-heat",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "255320000",
"system": "http://snomed.info/sct",
"display": "Infection - suppurative (disorder)"
} ],
"text": "Criteria of Diagnosis: Purulent drainage",
"type": "boolean",
"linkId": "criteria-of-diagnosis-incision-purulent-drainage",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "225553008",
"system": "http://snomed.info/sct",
"display": "Wound dehiscence"
} ],
"text": "Criteria of Diagnosis: Wound spontaneously dehisced",
"type": "boolean",
"linkId": "criteria-of-diagnosis-wound-dehisced",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1967-9",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Incision deliberately opened or otherwise drained by physician"
} ],
"text": "Criteria of Diagnosis: Incision deliberately opened",
"type": "boolean",
"linkId": "criteria-of-diagnosis-incision-opened",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1905-9",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Other evidence of infection found on direct exam, during surgery, or by diagnostic tests"
} ],
"text": "Criteria of Diagnosis: Other evidence of infection found on invasive procedure, gross anatomic exam, or histopathologic exam",
"type": "boolean",
"linkId": "criteria-of-diagnosis-evidence-found",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1920-8",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Localized swelling"
} ],
"text": "Criteria of Diagnosis: Localized swelling",
"type": "boolean",
"linkId": "criteria-of-diagnosis-localized-swelling",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1960-4",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Pain or tenderness"
} ],
"text": "Criteria of Diagnosis: Pain or tenderness",
"type": "boolean",
"linkId": "criteria-of-diagnosis-pain-tenderness",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1952-1",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Positive culture"
} ],
"text": "Criteria of Diagnosis: Organism Identified",
"type": "boolean",
"linkId": "criteria-of-diagnosis-organism-identified",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1901-8",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Not cultured"
} ],
"text": "Criteria of Diagnosis: Culture or non-culture based testing not performed",
"type": "boolean",
"linkId": "criteria-of-diagnosis-testing-not-performed",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1924-0",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Radiographic evidence of infection"
} ],
"text": "Criteria of Diagnosis: Imaging test evidence of infection",
"type": "boolean",
"linkId": "criteria-of-diagnosis-imaging-test",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "1963-8",
"system": "http://hl7.org/fhir/us/hai/CodeSystem/2.16.840.1.113883.6.277",
"display": "Physician Diagnosis of this event type"
} ],
"text": "Criteria of Diagnosis: Diagnosis of superficial SSI by surgeon or attending physician",
"type": "boolean",
"linkId": "criteria-of-diagnosis-physician-diagnosis",
"repeats": false,
"required": true
} ],
"text": "Criteria of Diagnosis",
"type": "group",
"linkId": "criteria-of-diagnosis",
"repeats": false,
"required": true
}, {
"text": "Surveillence method type (active/passive) through which the SSI was detected",
"type": "choice",
"linkId": "ssi-detection-method-type",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.31"
},
"repeats": false,
"required": true
}, {
"text": "Surveillence method through which the SSI was detected",
"type": "choice",
"linkId": "ssi-detection-method",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.10.20.5.9.29"
},
"repeats": false,
"required": true
} ],
"text": "Infection details",
"type": "group",
"linkId": "infection-details",
"repeats": false,
"required": true
}, {
"code": [ {
"code": "18769-0",
"system": "http://loinc.org",
"display": "Microbial susceptibility tests Set"
} ],
"item": [ {
"text": "Pathogen Identified",
"type": "choice",
"linkId": "pathogen-identified",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/2.16.840.1.113883.13.16"
},
"repeats": false,
"required": true
}, {
"text": "Pathogen Ranking",
"type": "choice",
"linkId": "pathogen-ranking",
"options": {
"reference": "http://hl7.org/fhir/us/hai/ValueSet/nhsn-pathogen-ranking"
},
"repeats": false,
"required": true
} ],
"text": "Findings Group: Records whether infection organisms were identified and, if so, records details about them.",
"type": "group",
"linkId": "findings-group",
"repeats": true,
"required": true
}, {
"code": [ {
"code": "86468-6",
"system": "http://www.loinc.org",
"display": "Report Comment Section"
} ],
"text": "Comments",
"type": "text",
"linkId": "nhsn-comment",
"repeats": false,
"required": false,
"maxLength": 2000
} ],
"type": null,
"experimental": "false",
"resourceType": "Questionnaire",
"title": "Outpatient Procedure Component Surgical Site Infection (SSI) Event",
"package_version": "1.1.0",
"status": "draft",
"language": "en-US",
"id": "a5e6cbb9-be80-421f-95f7-fed2ecf445d0",
"kind": null,
"url": "http://hl7.org/fhir/us/hai/Questionnaire/hai-questionnaire-opc-ssi-event",
"code": [ {
"code": "51897-7",
"system": "http://loinc.org",
"display": "Healthcare Associated Infection report Document"
} ],
"identifier": [ {
"value": "hai-questionnaire-opc-ssi-event-v1"
} ],
"version": "R1"
}