Barry Rhodes

NHSN Innovations:Creation of Synthetic Data Sets For

Ventilator –Associated Events

Funded Through the CHIIC Awards2014

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

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)

NHSN Electronic Data Flow Diagram

Healthcare Facility

NHSN

State Public Health

CDC Analysts

CDA Messages

Identified Data Sets (SAS, CSV, Excel)

De-identified

Data Sets

CMSQuality Measurement Data

Public Health Electronic Reporting Food Chain

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)

We are here!

So What’s 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 provider’s 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

What’s 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

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)

Procedure

1. 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

2. Also created a result set with gives the VAE determination for each patient

Procedure (continued)

3. Provide the data set and result set to vendors and other data providers to import into their systems

4. Allow them to self-certify that their local implementations of the VAE definitions are valid.

<?xml version="1.0" encoding="ISO-8859-1" ?><?xml-model href="vaeData.xsd"?><vaeData xmlns="http://nhsn.phiresearchlab.org/ns" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="vaeData.xsd">

<patient><patientIndex>1</patientIndex><ventDay>

<day>1</day> <peep>2.4</peep><fio2>33.0</fio2><minTemp>38.4</minTemp><maxTemp>38.7</maxTemp><minWbc>4850</minWbc><maxWbc>5200</maxWbc>

</ventDay><ventDay>

<day>2</day> <peep>2.4</peep><fio2>33.0</fio2><minTemp>38.4</minTemp><maxTemp>38.7</maxTemp><minWbc>4850</minWbc><maxWbc>5200</maxWbc><drug>CEFOX</drug><drug>AMK</drug>

</ventDay><ventDay>……..

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.

Where is This Pilot Going?

Repeat the process for other HAIs Extend this scenario to a more formal EHR

certification process.1. Provide synthetic dataset to vendor2. Vendor submits CDAs extracted from the data set to an

NSHN certification site 3. NHSN certification checks the CDAs against the known

result set and certifies the vendor.

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 we’ve learned 8 new things!

Comments/ Questions?

Please send accolades to brhodes@cdc.gov