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Barry Rhodes

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What is the National Healthcare Safety Network (NHSN)? A secure, internet-based system for monitoring healthcare-associated adverse events and practices – PowerPoint PPT presentation

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Title: Barry Rhodes


1
NHSN InnovationsCreation of Synthetic Data Sets
For Ventilator Associated Events Funded
Through the CHIIC Awards2014
  • Barry Rhodes

2
What is the National Healthcare Safety Network
(NHSN)?
  • A secure, internet-based system for monitoring
    healthcare-associated adverse events and
    practices
  • Participating healthcare facilities use the NHSN
    web application to enter, analyze, and share data
  • Data entry is predominantly manual with some
    electronic submission via Clinical Document
    Architecture (CDA) documents
  • States get HAI data from NHSN based on state
    mandates
  • CMS gets aggregated data for quality monitoring
    and payment purposes

3
NHSN Supports
  • Over 36,000 users representing 14,000 facilities
  • 3,400 facilities 25 reporting at least some
    data electronically via CDA
  • National-level public health surveillance (CDC)
  • State reporting mandates (30 states and DC)
  • CMS reimbursement programs (Inpatient Prospective
    Payment System)

4
NHSN Electronic Data Flow Diagram
Quality Measurement Data
CDA Messages
CMS
Healthcare Facility
NHSN
De-identified Data Sets
Identified Data Sets (SAS, CSV, Excel)
State Public Health
CDC Analysts
5
Public Health Electronic Reporting Food Chain
We are here!
  • Public Health or Facility Action
  • Validation (State or Facility Based)
  • Electronic Reporting
  • CDA creation
  • Event Determination (algorithmic or human)
  • Data aggregation (EHR)
  • Data normalization (vocab mapping)

6
So Whats the Problem?
  • How do we know the definitions are being applied
    properly?
  • Working with data providers to create conformant
    CDA messages is a good thing.
  • The CDA represents the providers assessment that
    there is something to report based on NHSN
    definitions
  • There is a validation step but that is manual,
    labor intensive and can be limited in scope

7
Whats Needed?
  • Need a way to electronically validate that the
    data provider is applying the NHSN definitions
    properly
  • So that when a CDA message is sent to NHSN, we
    can have some level of comfort that it accurately
    represents an HAI event.
  • Two approaches to this problem
  • Web Services
  • Synthetic Data Sets

8
Funded CHIIC Project
  • Synthetic Patient Dataset for the Determination
    of Ventilator-Associated Events in Electronic
    Health Record Systems
  • Barry Rhodes, PhD
  • Shelley Magill, MD, PhD
  • Cindy Gross, MT (ASCP)

9
Procedure
  • Working with NHSN SMEs and a healthcare facility,
    create synthetic EHR patient data seeded with
    Ventilator-Associated Events (VAEs)
  • We used a de-identified data set from a partner
    facility to make the data as real as possible.
  • We tried to think up all the normal
    possibilities for VAEs and as many edge cases
    as seems appropriate.
  • Created the data set in XML
  • Also created a result set with gives the VAE
    determination for each patient

10
Procedure (continued)
  • Provide the data set and result set to vendors
    and other data providers to import into their
    systems
  • Allow them to self-certify that their local
    implementations of the VAE definitions are valid.

11
  • lt?xml version"1.0" encoding"ISO-8859-1" ?gt
  • lt?xml-model href"vaeData.xsd"?gt
  • ltvaeData xmlns"http//nhsn.phiresearchlab.org/ns"
    xmlnsxsi"http//www.w3.org/2001/XMLSchema-insta
    nce" xsinoNamespaceSchemaLocation"vaeData.xsd"gt
  • ltpatientgt
  • ltpatientIndexgt1lt/patientIndexgt
  • ltventDaygt
  • ltdaygt1lt/daygt
  • ltpeepgt2.4lt/peepgt
  • ltfio2gt33.0lt/fio2gt
  • ltminTempgt38.4lt/minTempgt
  • ltmaxTempgt38.7lt/maxTempgt
  • ltminWbcgt4850lt/minWbcgt
  • ltmaxWbcgt5200lt/maxWbcgt
  • lt/ventDaygt
  • ltventDaygt
  • ltdaygt2lt/daygt
  • ltpeepgt2.4lt/peepgt
  • ltfio2gt33.0lt/fio2gt
  • ltminTempgt38.4lt/minTempgt

12
Current Status
  • Sent dataset to vendor community
  • Received feedback from EPIC (they found an error
    actually!)
  • Working with Partners Healthcare in Boston to
    validate their VAE efforts
  • Waiting for more feedback to publish the dataset
    with instructions to the NHSN web site.

13
Where is This Pilot Going?
  • Repeat the process for other HAIs
  • Extend this scenario to a more formal EHR
    certification process.
  • Provide synthetic dataset to vendor
  • Vendor submits CDAs extracted from the data set
    to an NSHN certification site
  • NHSN certification checks the CDAs against the
    known result set and certifies the vendor.

14
NHSN Innovations Philosophy and Why CHIIC is such
a Good Thing for CDC
  • This project is one of several that are ongoing
    in NHSN under the heading of Informatics
    Innovations
  • I believe there are many low cost, low
    technology, quick turn around projects that may
    have a broad impact on very difficult issues.
  • Projects like this are good because by virtue of
    their low cost, they have the privilege of
    failure, i.e. If we do ten small projects and
    8 fail, we still have two successful ones and
    weve learned 8 new things!

15
Comments/ Questions?Please send accolades to
brhodes_at_cdc.gov
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