The Esurveillance v2.5 Messaging Initiative for the National Healthcare Safety Network: Migrating Toward Electronic Public Health Surveillance Using Standards-Based Messaging and Vocabulary

Identification and reporting of multidrug-resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA) to the National Health Safety Network (NHSN) is a high priority patient safety initiative for CDC. In addition, nineteen states currently mandate use of NHSN for collection of healthcare-associated infection (HAI) data to meet their specific state reporting requirements.  Currently, data are manually entered into the secure, web-based NHSN application by participating healthcare providers.

This presentation will describe the use of automated HL7 2.5 messaging using standardized vocabulary to reduce or replace the manual entry of data into NHSN.  DHQP, other CDC offices, and external partners developed and implemented HL7 2.5 messages for admission, discharge and transfer (ADT), Microbiology and Pharmacy.  These messages are securely transmitted to NHSN via PHINMS.  This implementation is PHIN-compliant and uses standard vocabularies (e.g., LOINC, SNOMED, ICD-9).  Additionally, local codes are passed for each coded value allowing internal standard code validation and standard code remapping after transmission in the event of incorrect coding.  Local codes facilitate analyzing and identifying new concepts not having standard codes.

DHQP then specified and developed an Extract, Transform and Load (ETL) system using Orion Rhapsody to automatically receive these messages from PHINMS, parse them and then file them into the NHSN eSurveillance database for evaluation and analysis.  The presence of required data elements is confirmed during parsing and the relational database maintains the referential integrity and formatting of the original data.  Each coded element maps to control tables that maintain the version information of vocabularies for all coded elements so multiple versions of a code system can be maintained.

Electronic messaging of data will decrease data collection burden, increase data reliability and expand the areas where infection surveillance can be performed.  Only through a standards-based approach can public health surveillance meet the goal of national coverage.