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Healthcare facilities in more than 20 states are now required to report healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN). To meet this mandate, infection preventionists (IPs) need more efficient ways to collect, analyze and report these infections. CDC is attempting to reduce the burden of manual data entry, and at the same time improve the quality and completeness of data reported to NHSN, by piloting an HL7 standard format called Clinical Document Architecture (CDA). CDC’s efforts will enable hospitals to report HAIs using data collected in third-party software systems.
The following interview with Tracy Gustafson, MD and chief AICE® Architect, clarifies the advantages of using such third-party software systems.
Q: Why is the CDC pilot for reporting NHSN data from third-party systems good news for infection preventionists?
A: NHSN provides Web-based infection control software to healthcare facilities at no cost. However, the majority of data must be entered manually. The HL7-CDA pilot is good news because its goal is to eventually allow almost all NHSN data to be submitted electronically. This will save IPs across the country thousands of hours of manual data entry – time they could be spending on education, prevention, and control of these costly infections.
Q: I understand that some facilities already export surgical data electronically to NHSN.
A: Yes. NHSN has already enabled electronic reporting of detailed surgical procedure data. These data can be exported electronically using an infection surveillance software system like AICE, which validates data against NHSN data requirements and creates an export report that meets NHSN specifications.
Q: Why do I need commercial software to transmit data electronically to NHSN?
A: Most hospitals have at least five different computer systems that store data items important to infection control. These include Admissions (ADT), Laboratory, Surgery, Pharmacy, and Electronic Medical Records (EMR) software systems. The latest generation of infection prevention software employs technology to re-use existing electronic data so they do not have to be re-entered manually. Sophisticated computer interfaces also use a type of artificial intelligence to translate these data and ensure they are complete, internally consistent and accurate. This is where a proven third-party software system can dramatically reduce operational costs associated with HAI mandatory reporting.
Q. Can you give me an example of how a third-party system can reuse data that are already in a facility’s information systems?
A. SSIs are a good example. Most hospitals and ambulatory surgical centers have an electronic surgical system which contains information like facility-specific procedure codes, surgical start and stop times, wound class and anesthesia scores. These items are pre-cursors to the data required by NHSN, but before they can be electronically transmitted to NHSN, the data must be verified, translated and transformed to meet NHSN coding requirements and “business rules.”
Q: Are there any quality implications to using the methods you’re describing?
A: Yes. Using a system like AICE can also greatly improve the quality of the data being submitted. NHSN definitions for each surgical procedure are more complicated than most people think. So it’s easy to accidentally report procedures that NHSN does not count, or to omit procedures that are required by state mandate. Of course, these errors will cause a facility’s NHSN surgical infection rates to be incorrect, which could impact NHSN benchmarking results and the facility’s public relations efforts.
IPs can better use their time if they rely on a software program to do what programs do best – transform data correctly and consistently, and then perform validation checks on the results.
Q: When you say “validate” the data, are you saying that AICE confirms hospital-acquired infections?
A: No, quite the opposite. It’s important for an infection surveillance and prevention solution to provide data that help the clinician determine when an HAI might be present, but not make the final decision for the clinician. These determinations now affect CMS reimbursement, state legal mandates, and the validity of NHSN data used for benchmarking, so it would be unwise to allow computers to have the final say. What software can do is calculate whether the data it receives are valid according to NHSN definitions and business rules. For example, in NHSN:
• Each surgical procedure has slightly different required data elements.
• Only specific sites of infection can follow each type of surgical procedure.
• Each site of infection must be documented by a specific combination of lab results, signs and symptoms.
• Data requirements also vary, depending on the patient’s age.
As you can see, NHSN infection definitions and data requirements are much more complicated than they first appear. In previous years, it was easy to report an infection that did not exactly meet NHSN definitions. However, the current NHSN software rejects any infection that does not exactly meet their criteria.
Q: What if my state reporting requirements are different from NHSN requirements? Can commercial software help me with mandatory reporting?
A: The answer to that question depends on what data must be reported under your state’s laws. In some states, like Missouri, the state has its own system for collecting data, and AICE provides a way to automatically transmit data to that system as well.
Q: What about states with no mandatory reporting? How do they benefit from systems like AICE?
A: In today’s tough economic times, IPs in mandatory reporting states have an advantage, because such laws encourage hospital administrators to provide the resources to prevent HAIs. However, even in states that have not yet passed a mandatory reporting law, the goals of the infection surveillance and prevention programs are the same. In either case, NHSN does not collect some of the infection surveillance data IPs need to reduce costs and save patients’ lives. In fact, all IPs are looking for flexible software that can help them identify new problems, develop control efforts and motivate patient care providers to follow evidence-based infection control techniques. This is the only way to reduce costs and save lives.