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"description" : "This implementation guide provides HL7 FHIR resources to define standards for bi-directional information exchange between a medical and a dental provider or between dental providers. This publication provides the data model, defined data items and their corresponding code and value sets specific to a dental referral note and dental consultation note. This guide describes constraints on the [C-CDA on FHIR](http://www.hl7.org/fhir/us/ccda/) header and body elements for dental information, which are derived from requirements developed by the Dental Summary Exchange Project of the Health Level Seven (HL7) Payer/Provider Information Exchange Work Group (PIE WG). Resources in this US Realm implementation guide are specific to dental referral and consultation notes for exchange and interoperability among dental providers and with medical providers.\n\nThis guide contains a library of FHIR profiles and is compliant with FHIR Release 4. At a minimum, a document bundle (C-CDA on FHIR Referral Note or Consultation Note) will be exchanged along with a ServiceRequest, Patient, and associated medical and dental information. This guide specifies how and where these resources are included within the C-CDA on FHIR profiles. \n\nThis guide defines 7 new profiles:\n* Dental Bundle\n* Dental Referral Note\n* Dental Service Request\n* Dental Consult Note\n* Dental Condition\n* Dental Finding\n* Dental Communication \n\nAll proprietary documents, guides, guidance, standards, codes, and values contained herein remain the property of their respective Standards Developing Organization (SDO). HL7 does not make any claim to ownership herein.\n\nThis HL7 FHIR® R4 Implementation Guide: Dental Data Exchange is developed in parallel to the HL7 CDA® R2 Implementation Guide: Dental Data Exchange.\n (built Tue, Nov 2, 2021 16:19+0000+00:00)",
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"description" : "Adverse drug events (ADEs) are among the most common causes of iatrogenic harm in U.S. hospitals. An effort to establish an EHR- and vendor-neutral standard for submitting ADE data to NHSN is being sought to improve patient safety and facilitate quality improvement effort. This promising initiative seeks to enable EHRs of acute care facilities to serve as source systems for reporting ADE data to the National Healthcare Safety Network (NHSN) via industry electronic messages. This initiative leverages NHSN?s longstanding experience working closely with the Health Level Seven (HL7) standards development organization and HL7 consultants in developing and maintaining electronic healthcare-associated and antibiotic use and resistance reporting implementation guidance for EHRs and infection surveillance system vendors in the acute care arena. That experience, and the working relationships developed over a 10-year partnership, are an important foundation for a collaborative effort in which NHSN, HL7, HL7 consultants, and EHR vendors join forces to advance the field of electronic ADE reporting.\n\nThis first module, Hypoglycemia, planned for the NHSN Medication Safety Component, would enable hospitals to track and benchmark inpatient medication-related hypoglycemia (low blood sugar). Inpatient hypoglycemia can be severe and life-threatening and is associated with longer hospital stays and increased medical costs. Severe hypoglycemia (<40 mg/dL) occurs in 2%-5% of hospitalized patients with diabetes mellitus (DM). Medication-related hypoglycemic events are common causes of adverse drug events (ADEs) occurring in inpatient settings, with rates of severe hypoglycemia varying across hospitals, suggesting opportunities for improvement in the quality of care. Measurement of medication-related hypoglycemia in a meaningful and standardized way may improve glycemic management. The NHSN ADE ? Hypoglycemia Module provides a mechanism for facilities to report and analyze medication-related hypoglycemia as part of patient safety and glycemic management quality improvement efforts.\n\nThe measures planned for used in this module are based on quality reporting metrics previously- or currently-endorsed by the National Quality Forum (NQF): NQF #2363 Glycemic Control - Hypoglycemia and NQF #3503 Hospital Harm ? Severe Hypoglycemia. The metrics reported in this module would be primarily based on linked eMAR (antidiabetic medication administration) and laboratory (blood glucose) data. These long-standing linkages links between public health and vendors can be leveraged in ways that yield benefits for surveillance and prevention that are tightly coupled to business models and growth. (built Tue, Oct 12, 2021 13:32+0000+00:00)",
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"canonical" : "http://hl7.org/fhir/us/central-cancer-registry-reporting",
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"description" : "MedMorph Research Content IG enables researchers to access data from EHRs leveraging the MedMorph Reference Architecture. (built Thu, Dec 9, 2021 14:36+0000+00:00)",
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{
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"description" : "CARIN Digital Insurance Card (built Wed, Jul 13, 2022 17:21+0000+00:00)",
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"canonical" : "https://profiles.ihe.net/ITI/PMIR",
"description" : "The Patient Master Identity Registry (PMIR) Profile supports the creating, updating and deprecating of patient master identity information about a subject of care, as well as subscribing to changes to the patient master identity, using the HL7 FHIR standard resources and RESTful transactions. (built Mon, Aug 8, 2022 16:03-0500-05:00)",
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{
"name" : "fhirtools.ig.template",
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"canonical" : "http://simplifier.net/packages/fictitious/fhirtools.ig.template",
"description" : "FHIR profiles, IG used in the digital health training series ",
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{
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},
{
"name" : "vzvz.covid-vaccinations",
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"name" : "ForgePatientChart.0830",
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},
{
"name" : "vzvz.fhir.mitz",
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"canonical" : "http://simplifier.net/packages/fictitious/vzvz.fhir.mitz",
"description" : "FHIR artifacts for VZVZ projects",
"security" : "none",
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"url" : "https://packages2.fhir.org/packages/vzvz.fhir.mitz/0.1.0-beta"
},
{
"name" : "hl7.fhir.us.ecr",
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"version" : "2.1.0",
"fhirVersion" : "R4",
"count" : "578",
"canonical" : "http://hl7.org/fhir/us/ecr",
"description" : "# Introduction and Purpose\n\nWith the adoption and maturing of Electronic Health Records (EHRs) there are opportunities to better support public health surveillance as well as to better support the delivery of relevant public health information to clinical care. Electronic Case Reporting (eCR) can provide more complete and timely case data, support disease / condition monitoring, and assist in outbreak management and control. It can also improve bidirectional communications through the delivery of public health information in the context of a patient's condition and local disease trends and by facilitating ad hoc communications. eCR will also reduce healthcare provider burden by automating the completion of legal reporting requirements.\n\nWith the advent of FHIR standards, there is a need for FHIR implementation guidance to specify appropriate resources and transactions needed for the eCR process. FHIR offers opportunities to further enable automated triggering and reporting of cases from EHRs, to ease implementation and integration, to support the acquisition of public health investigation supplemental data, and to connect public health information (e.g., guidelines) with clinical workflows. Over time, FHIR may also support the distribution of reporting rules to clinical care to better align data authorities and make broader clinical data available to public health decision support services inside the clinical care environment.\n\nFor more supporting information, use cases, and other background context and material, see Volume 1 of both the [HL7 CDA R2 Electronic Initial Case Report (eICR) Standard for Trial Use (STU) IG](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436) (see the link under \"STU Documents\" for STU 2.0) and the [HL7 CDA R2 Reportability Response (RR) STU IG](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=470).\n\nFor Clinical Safety Information please refer to the [FHIR Implementer?s Safety Checklist](http://hl7.org/fhir/safety.html).\n\n
\n
Known Issue:
\n
The following issue is related to a publication tooling issue. A technical correction is planned once the tooling issue has been addressed.
\n
\n - FHIR-30477: Resolution errors for FHIRHelpers and FHIR-ModelInfo.
\n
\n
\n\n# Stakeholders\n* Regulatory Agencies\n* Standards Development Organizations\n* Vendors: EHR, PHR; Health Care IT; Clinical Decision Support Systems, Public Health Surveillance Systems\n* Providers: Ambulatory and Healthcare Institutions (hospitals, long term care, mental health)\n* Local, State, Tribal and Federal Public Health Agencies (built Wed, Aug 31, 2022 17:39+0000+00:00)",
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},
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"name" : "duwel.nl.r4.sandbox.dev",
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"canonical" : "http://simplifier.net/packages/fictitious/duwel.nl.r4.sandbox.dev",
"description" : "Jorn Duwel sandbox",
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"url" : "https://packages2.fhir.org/packages/duwel.nl.r4.sandbox.dev/0.0.1-dev.4"
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"name" : "hl7.fhir.be.lab",
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"canonical" : "https://www.ehealth.fgov.be/standards/fhir/lab",
"description" : "HL7 BE Laboratory WG Implementation Guide (built Thu, Sep 8, 2022 14:30+0200+02:00)",
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"kind" : "IG",
"url" : "https://packages2.fhir.org/packages/hl7.fhir.be.lab/1.0.0"
},
{
"name" : "hl7.fhir.be.mycarenet",
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"canonical" : "https://www.ehealth.fgov.be/standards/fhir/mycarenet",
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"kind" : "IG",
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},
{
"name" : "surescripts.RecordLocatorExchange",
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"version" : "1.0.0-beta",
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"description" : "**HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1.3 (Standard for Trial Use)**\n\nThis Implementation Guide is a reconciled version, containing changes in response to comments received in the Sept. 2018 ballot. It has been updated to FHIR R4.0.1.\n\n**Introduction and Guidance**\n\nThis Implementation Guide (IG) contains profiles to implement support for Occupational Data for Health (ODH). ODH describes structured work information primarily designed to facilitate clinical care, including population health and value-based care. ODH also can be used to support public health reporting. ODH is not designed to support billing activities. \nThis set of FHIR profiles is specified as a composition resource, but it is not intended to be used as a stand-alone composition. Rather, the desired content should be included in broader IGs and available as a response to requests for ODH information. Some use cases may leverage only a subset of the ODH profiles, and these should be specified within those work products. For instance, in the Vital Records Death Reporting (VRDR) IG, the data requirements for work information are limited to those in the Usual Work profile.\nWhile this profile is specified for the US Realm, the design is intended to also support international needs. Three of the referenced value sets?Occupation, Industry, and Supervisory Level? are necessarily US specific. The remaining three value sets?Work Schedule, Employment Status, and Work Classification?use international concepts. Input is requested regarding whether these should be specified as ?extensible?, ?required? (using ?text only? where a concept does not yet exist such as a new occupation), or as an ?example? for those US specific concepts.\n\n**Background**\n\nThe majority of adults in the U.S. spend more than half their waking hours at work. Therefore, health and work are inextricably inter-related. For example, the management of chronic conditions requires taking the patient?s work environment into consideration. Work-related conditions are often first brought to the attention of a primary care provider. Some conditions related to exposure to hazards in the workplace can have a long latency, requiring knowledge of a person?s work history for recognition, diagnosis, and treatment. The recognition of new conditions related to previously unknown workplace hazards has often come from astute clinicians, which requires knowledge of the patient?s work. ONC has indicated recognition of the value of work information for health care.\nThe incorporation of ODH into Electronic Health Records (EHRs) and other health IT systems presents an opportunity to improve health in relation to work. ODH provides a structure and standardization for work information that can be used across systems to take advantage of system tools for clinical decision support, population health, and public health. Research has been conducted and guidance is available to support clinicians, and the use of ODH by health IT systems can support identification of patients that would benefit the most from this knowledge.\n\n**Scope**\n\nThe Occupational Data for Health (ODH) FHIR IG covers information about a patient?s work, including some voluntary work, or a patient?s household members? work. ODH is designed for the social history section of a medical record, to facilitate clinical care in multiple disciplines and delivery environments. ODH can be used for clinical decision support, population health activities and value-based care, and public health reporting. The scope of the work information in ODH includes:\n\n? Employment Status\n\n? Retirement Date\n\n? Combat Zone Period\n\n? Past or Present Job for the patient or a household member, which includes:\n \n o Past or Present Job Occupation\n \n o Past or Present Job Industry\n \n o Work Classification\n \n o Work Schedule, which includes:\n \n - Weekly Work Days\n \n - Daily Work Hours\n \n o Job Duty\n \n o Occupational Hazard\n \n o Employer name\n \n o Employer address\n \n o Related Subject (when it is Past or Present Job of a household member of the person)\n \n o Start/End Dates\n\n? Usual Work of the patient or a household member, which includes:\n \n o Usual Occupation\n \n o Usual Industry\n \n o Usual Occupation Duration\n \n o Related Subject (when it is Usual Work of a household member of the person)\n \n o Start Date\n\n**Known Issues and Limitations**\n\nThis IG includes more extensive occupational data than typically collected in current systems. The content and structure of this IG is intended to inform clinical care, support population health, and contribute to public health activities. While there may be some overlap with administrative and billing information maintained by some systems, the information in this IG is not designed to support billing and administrative needs.\nWhile multiple retirement dates are supported, the retirement date is not linked to any specific job, or usual occupation.\n\n**Credits**\n\nCo-Editor:\nLori Reed-Fourquet\ne-HealthSign, LLC\nlfourquet@ehealthsign.com\n\nCo-Editor:\nRob Hausam\nHausam Consulting\nrob@hausamconsulting.com\n\nCo-Editor:\nMark Kramer\nMITRE Corporation\nmkramer@mitre.org\n\nThis set of FHIR profiles was produced and developed through the efforts of a project of the National Institute of Occupational Safety and Health (NIOSH), the U.S. federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is a part of the U.S. Centers for Disease Control and Prevention (CDC). NIOSH consulted stakeholders in clinical care, public health, health IT, health informatics and U.S. government agencies to develop ODH. The HL7® Public Health and Emergency Response Work Group sponsored development of this set of FHIR profiles. Co-sponsoring HL7® Work Groups were Orders and Observations (OO), Patient Administration (PA), and Clinical Quality Initiative (CQI).\nThe following individuals provided subject matter expertise for this set of FHIR profiles: Genevieve Barkocy Luensman, NIOSH; Eileen Storey, Professional Services Partners, formerly NIOSH; Margaret S. Filios, NIOSH; Christina Socias-Morales, NIOSH; Lauren Brewer, NIOSH; Barbara Wallace, Professional Services Partners.\n\n**Authors**\n\nName Email/URL\nHL7 International - Public Health http://www.hl7.org/Special/committees/pher (built Mon, Mar 27, 2023 09:54+1100+11:00)",
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"description" : "|Implementation Guide (IG) Characteristic | Value |\n|------------------------------------------------------|--------------------------------------------|\n|**FHIR Version:** | FHIR R4 |\n|**IG Realm:** | US |\n|**IG Type:** | STU Ballot |\n|**Exchange Methods:** | RESTfulAPI, Messages, Transactions, Tasks |\n|**IG Note:** | This HL7 FHIR Guide utilizes and adopts guidance or profiles developed in the US Core FHIR® Implementation Guide. This FHIR IG has narrative pages describing the HL7 V2 Message for At-Home In-Vitro Test Reporting and provides some example messages. Presently public health departments usually only can handle and store HL7 V2|\n{:.table-striped}\n\n|IG Dependencies |\n|----------------------------------|\n| [HL7 FHIR US Core Version 5.0.1](http://hl7.org/fhir/us/core/STU5.0.1/) |\n{:.table-striped}\n\n\n### Background\n\nPoint-of-care (POC) and At-Home In-Vitro Tests offer increased accessibility to needed diagnostic solutions during a pandemic. 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A national data exchange standard should be supported that guides data exchange from test results residing on individual users? digital test applications to public health authorities, at both the federal and regional levels. \n\n### Introduction\nThis implementation guide (IG) constrains the FHIR [US Core Diagnostic Report for Laboratory Results](http://hl7.org/fhir/us/core/StructureDefinition/us-core-diagnosticreport-lab) and the [US Core Laboratory Observation Profile](http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab) for use in transmitting At-Home In-Vitro Test results to local, state, territorial and federal health agencies. The IG will be be used in real world testing. It was developed as part of a collaborative project with the NIH/NIBIB, ONC, a vendor manufacturer of diagnostic healthcare products that makes one of the FDA approved At-Home In-Vitro Test kits, and an app developer who is a leading provider of secure interoperability solutions. The intention of this guide is to assist developers in producing and sending standardized FHIR test result data from tests perfomed at home. FHIR eases app development and the FHIR US Core IG is in a rapid adoption curve. This guide points to already existing US Core Guidance and other guidance with respect to FHIR Parameters, FHIR operations, and RESTful and SMART on FHIR information.\n\nDue to Public Health Departments' familiarity with V2, a test implementation project related to this implementation guide will initially send COVID-19 At-Home In-Vitro Test Reports as V2 lab messages. Longer term the intent is to leverage FHIR for app creativity, growth, and interoperability. For as long as needed to comply with Public Health Department dependecies on V2, the apps will be designed to transform from FHIR to V2. In addition, as a parallel effort, a V2 <-> FHIR data mapping table has been developed [In-Vitro At-Home Test V2 FHIR Mapping.xlsx].\n\n**Please note** : This guide is a framework for future work. It contains \"framework\" profiles that contain constraints common to all At-Home In-Vitro Test Reporting use cases. These framework profiles can be further constrained to a particular use case such as the COVID-19 At-Home In-Vitro Test Reporting use case. The COVID-19 use case profiles have been created and included in this guide.\n\n### Further Information\n[RADx® MARS - Mobile Application Reporting through Standards](https://www.nibib.nih.gov/covid-19/radx-tech-program/mars)\n\n[LOINC In Vitro Diagnostic (LIVD) Test Code Mapping for SARS-CoV-2 Tests](https://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html)\n\n[Test-Specific HL7v2 Field Values Tool](https://app.powerbigov.us/view?r=eyJrIjoiNjQyZjBkOGEtNjE0ZS00NjUyLTg3NjEtZTIxN2JmODE0ZGE1IiwidCI6IjE0Yjc3NTc4LTk3NzMtNDJkNS04NTA3LTI1MWNhMmRjMmIwNiJ9&pageName=ReportSectionhttps://app.powerbigov.us/view?r=eyJrIjoiNjQyZjBkOGEtNjE0ZS00NjUyLTg3NjEtZTIxN2JmODE0ZGE1IiwidCI6IjE0Yjc3NTc4LTk3NzMtNDJkNS04NTA3LTI1MWNhMmRjMmIwNiJ9&pageName=ReportSection3147535a75468ee60d16)\n\n### Acknowledgements/Primary Authors\n* [NIBIB-Interagency Project Team](mailto:krishna.Juluru@pif.gov)\n* [CareEvolution](https://careevolution.com)\n* [Association of Public Health Laboratories](https://www.aphl.org/Pages/default.aspx)\n* [Gay Dolin MSN RN (Namaste Informatics)](mailto:gdolin@NamasteInformatics.com)\n* [Sarah Gaunt](mailto:sarah.gaunt@lantanaconsulting.com) (built Sat, Mar 25, 2023 16:44+0000+00:00)",
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"description" : "### Scope\nThe Longitudinal Maternal & Child Health Information for Research FHIR R4 implementation guide (IG) defines a framework to enable maternal health researchers to aggregate, calculate, and analyze clinical information of research populations to explore the root causes for maternal and child morbidity and mortality. It uses Clinical Quality Language (CQL) expressions to assist researchers in capturing clinical data based on population study cohort criteria. This IG focuses on information relevant to longitudinal maternal care, which includes antepartum (including pre-pregnancy), intrapartum, and postpartum care of a pregnant woman. 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This will support researchers in identifying root causes of maternal mortality and pediatric developmental problems, including SDOH such as limited income, poor nutrition, lack of medical coverage, etc. The goal of the project is to create a method to standardize data capture for comparative analysis over time to improve health outcomes and define a framework for studying additional research populations in the future.\n\nInitial use cases of this IG focus on hypertensive disorders of pregnancy pre, ante, and postpartum and pregnancy and subsequent death within a specific timeframe. The intent is to specify the consistent capture of clinical data of interest to maternal health researchers and outline implementing FHIR resources for that capture. Currently, the IG defines two initial, separate research use case populations: \n\n* Pregnancy and subsequent death within a specific time frame: This cohort includes women who died within a year (365 days) of a pregnancy regardless of cause of death or pregnancy outcome.\n* Hypertensive Disorders of pregnancy: This use case focuses on women with a diagnosis of hypertensive disorders of pregnancy.\n\nIn both instances, the IG will establish linkages via the US Core Related Person profile to collect associated child health data that may inform maternal health research outcomes. \n\nIn the future, the IG will expand this framework to a range of use cases including:\n* Risks for children related to maternal exposure to medications taken during pregnancy\n* Potential adverse maternal obstetric history impacts on child outcomes\n* Access to relevant sensitive health information\n* Retrospective population-based analysis of inherited disorders\n* The impacts of [work habits, work environment, and work-associated health insurance](http://hl7.org/fhir/us/odh/) impacts to pregnancy and maternal health\n\nThis guide fundamentally relies on creating structural relationships between:\n* Maternal and child records to effectively diagnose and treat otherwise fatal child outcomes\n* Maternal and child birth records and/or maternal and child death records\n* Maternal and child records in multiple disparate systems\n\n### Audience \nThe audience for this IG includes EHR vendors, developers of software tooling researchers, and associated information management systems. Researchers, business analysts, and policy managers can also benefit from a basic understanding of the use of this guide to support measure calculation for research purposes.\n\n### Authors & Project Team\nThis table lists the authors, subject matter experts, and the affiliations which contributed to this standard. \n\n\n\n\n \n Name & Affiliation | \n Role | \n Contact | \n
\n\n\n \n Lantana Consulting Group | \n | \n | \n
\n \n Courtney Panaia-Rodi | \n Project Executive | \n courtney.panaia-rodi@lantanagroup.com | \n
\n \n Wendy Wise | \n Project Manager | \n wendy.wise@lantanagroup.com | \n
\n \n Lani Johnson | \n Associate Project Manager | \n lani.johnson@lantanagroup.com | \n
\n \n Rick Geimer | \n FHIR Subject Matter Expert | \n rick.geimer@lantanagroup.com | \n
\n \n Zabrina Gonzaga | \n Terminology Subject Matter Expert | \n zabrina.gonzaga@lantanagroup.com | \n
\n \n Sarah Gaunt | \n Senior FHIR/CDA Analyst | \n sarah.gaunt@lantanagroup.com | \n
\n \n Dave deRoode | \n FHIR/CDA Analyst | \n david.deroode@lantanagroup.com | \n
\n \n Ming Dunajick | \n FHIR/CDA Analyst | \n ming.dunajick@lantanagroup.com | \n
\n \n Ruby Nash | \n FHIR Analyst | \n ruby.nash@lantanagroup.com | \n
\n \n Office of the Assistant Secretary for Planning and Evaluation (ASPE) | \n | \n | \n
\n \n Violanda Grigorescu, MD, MSPH | \n Senior Health Scientist Division of Healthcare Quality and Outcomes, Office of Health Policy | \n violanda.grigorescu@hhs.gov | \n
\n \n Centers for Disease Control and Prevention (CDC) | \n | \n | \n
\n \n Margaret Lampe, RN, MPH | \n Nurse Epidemiologist & Project Officer Perinatal HIV Prevention Program | \n mol0@cdc.gov | \n
\n \n Lisa Romero, DrPH | \n Health Scientist Division of Adolescent School Health | \n eon1@cdc.gov | \n
\n \n National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Information Center on Health Services Research and Health Care Technology (NICHSR) | \n | \n | \n
\n \n Alison Cernich | \n NICHD Deputy Director | \n alison.cernich@nih.hhs.gov | \n
\n \n John (Jack) Moye, Jr., MD | \n Acting Director - National Children's Study NICHD Medical Officer - Maternal & Pediatric Infectious Disease Branch | \n moyej@exchange.nih.gov | \n
\n \n Nahida Chakhtoura, MD, MsGH | \n NICHD Medical Officer Maternal and Pediatric Infectious Disease Branch | \n nahida.chakhtoura@nih.gov | \n
\n \n Juanita Chinn, PhD | \n NICHD Program Director Population Dynamics Branch | \n juanita.chinn@nih.gov | \n
\n \n Valerie Cotton | \n NICHD Deputy Director Office of Data Science and Sharing | \n valerie.cotton@nih.gov | \n
\n \n Liz Amos, MLIS | \n Special Assistant to the Chief Health Data Standards Officer National Library of Medicine | \n liz.amos@nih.gov | \n
\n \n Office of the National Coordinator for Health IT (ONC) | \n | \n | \n
\n \n Carmen Smiley | \n IT Specialist (Systems Analysis) | \n carmen.smiley@hhs.gov | \n
\n \n Rachel Abbey | \n Public Health Analyst & Program Officer | \n rachel.abbey@hhs.gov | \n
\n \n Stephanie Garcia | \n Senior Program Analyst | \n stephanie.garcia@hhs.gov | \n
\n \n Brittney Boakye, MPH | \n Program Assistant Scientific Advancement Branch | \n brittney.boakye@hhs.gov
| \n
\n \n Alan Taylor | \n Medical Informatics Officer, Standards and Terminology | \n albert.taylor@hhs.gov | \n
\n\n
\n\n### Acknowledgements\nThis guide was developed and produced through the efforts of Health Level Seven (HL7) and created using the Trifolia-on-FHIR tool, provided by Lantana Consulting Group. The HL7 Project Insight reference number for this project is 1736.\nThe editors appreciate the support and sponsorship of the HL7 Public Health Workgroup, and all volunteers and staff associated with the creation of this document. This guide would not have been possible without the support of the following groups.\nHealth Level Seven, HL7, CDA, CCD, FHIR and the [FLAME DESIGN] are registered trademarks of Health Level Seven International, registered in the US Trademark Office.\n\nThis IG includes content from SNOMED CT, which is copyright © 2002+ International Health Terminology Standards Development Organisation (IHTSDO), and distributed by agreement between IHTSDO and HL7. Implementer use of SNOMED CT is not covered by this agreement.\n\nThis material contains content from [LOINC](http://loinc.org). LOINC is copyright © 1995-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at https://loinc.org/kb/license/. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. (built Wed, Mar 29, 2023 19:24+0000+00:00)",
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"description" : "This implementation guide (IG) specifies standards for electronic submission of Healthcare Associated Infection (HAI) Long Term Care Facilities (LTCF) reports to the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC). This IG contains a library of FHIR profiles for electronic submission of HAI LTCF reports to the NHSN.\n\nAs reports are modified and new report types are defined, CDC and Health Level Seven (HL7) will develop and publish additional constraints.\n\nThroughout this process, CDC remains the authority on NHSN data collection protocols. When healthcare enterprises choose to participate in NHSN, they must report to CDC reportable events such as identified MDRO (multidrug-resistant organism) or CDI (C. difficile infection) occurrences such as specific reportable procedures, even those without complications, and events such as a bloodstream infection, either confirmed by a positive blood culture or supported by a patients clinical symptoms. This specification opens the channel for data submission by all applications compliant with the data coding requirements defined here.\n\nNote that participation in the NHSN requires enrollment and filing of reporting plans, which are not defined by this specification. For an overview of NHSN and full information on NHSN participation requirements, see: [http://www.cdc.gov/nhsn](http://www.cdc.gov/nhsn). Provisions of the Public Health Service Act protect all data reported to NHSN from discovery through the Freedom of Information Act (FOIA).\n\n\n### Relationship to Another Standard\n\nHL7 has developed this FHIR implementation guide in parallel with the CDA implementation guide. We anticipate several STU releases on the path to a Normative Release 1 of the HL7 implementation guides for CDA and FHIR for Healthcare Associated Infection (HAI) Reports from Long Term Care Facilities (LTCF). The FHIR and CDA implementation guides will align. A change to one standard will require the same change in the other standard. \n\nIn this release, the new forms included in both the CDA and FHIR standards are:\n* **NHSN HAI LTCF Population Summary Report**: MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF\n* **NHSN HAI LTCF Single-Person Event Report**: Laboratory-identified MDRO or CDI Event for LTCF\n\nFor further details see the [NHSN website](https://www.cdc.gov/nhsn/) for reporting healthcare-associated infections in long-term care facilities.\n\n\n### Audience\n\nThe audience for this work is all developers of software systems who want to enable their systems for reporting HAI data to the NHSN.\n\n### Change Notification Process\n\nCDC maintains an e-mail list of contacts at organizations interested in or responsible for implementations of FHIR for LTCF HAI reporting to NHSN. To be added to the list, send a request with your contact information to nhsncda@cdc.gov. CDC uses the list for e-mail notifications of changes, including new data requirements. Changes may apply to this IG and to other documents such as business rules that are needed to implement and support FHIR for LTCF HAI reporting to NHSN. NHSN CDA related information may be found at https://www.cdc.gov/nhsn/cdaportal/index.html. \n\n### Acknowledgements\n\nThis implementation guide was produced and developed by Lantana Consulting Group in conjunction with the Division of Healthcare Quality Promotion in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC). Its development and deployment are results of the dedication of the team?led by Daniel A. Pollock, M.D., Surveillance Branch Chief, Division of Healthcare Quality Promotion, NCEZID, CDC and Jeneita Bell, MD, MPH, Long-term Care Team Lead, DHQP, NCEZID, CDC?and their support of the development of interoperable data standards for the CDC?s National Healthcare Safety Network (NHSN). \n\nSpecial thanks and acknowledgment to stakeholders who participated in calls and provided feedback. Specifically, we would like to thank Cindy Frakes, Steve Herron, Jamie Gatzke, Kelly Luden, Prasath Govindarajulu from Cerner; Laura Ditz, Nancy Chi, Nichole (Nicki) Fetterman, Michael Furman, Patti Barton, Aga Lee from Point Click Care; Donna Doneski from NASL; and Denise Wassenaar, Doc DeVore, Rob Price from Matrix Care. \n\nThe best standards are those driven by business requirements. A strong set of Healthcare Associated Infection (HAI) surveillance application vendors monitor, evaluate, and test each release of this guide. \n\n\n|-----|-----|-----|-----| \n\n|Primary Editor:|Sarah Gaunt|Lantana Consulting Group|sarah.gaunt@lantanagroup.com| \n|Primary Editor:|Zabrina Gonzaga|Lantana Consulting Group|zabrina.gonzaga@lantanagroup.com| \n|Primary Editor:|Dave deRoode|Lantana Consulting Group|david.deroode@lantanagroup.com| \n|Co-Editor:|Jeneita Bell, MD, MPH|CDC|hpq8@cdc.gov| \n|Co-Editor:|Angella Antilla PhD, MSN|CDC|vtb9@cdc.gov| \n|Co-Editor:|Daniel Pollock, M.D.|CDC|DPollock@cdc.gov| \n|Co-Editor:|Ahmed Tahir|Leidos Consultant to CDC/NHSN|nmn8@cdc.gov| \n|Co-Editor:|Mindy Durrance|Leidos Consultant to CDC/NHSN|mdq1@cdc.gov| \n|Co-Editor:|Sheri Chernetsky Tejedor, MD|CDC|yei9@cdc.gov| \n|Co-Editor:|Sheila Abner|CDC|sha8@cdc.gov| \n|Co-Chair:|Erin Holt MPH|Tennessee Department of Health|erin.holt@tn.gov| \n|Co-Chair:|Laura Rappleye|Altarum|laura.rappleye@altarum.org| \n|Co-Chair:|Craig Newman|Altarum|craig.newman@altarum.org| \n|Co-Chair:|Danny Wise|Allscripts|danny.wise@allscripts.com| \n|Co-Chair:|Joginder Madra|Madra Consulting Inc.|hl7@madraconsulting.com| \n|Co-Chair:|Gaye Dolin M.S.N., R.N. |Intelligent Medical Objects |gdolin@imo-online.com| \n|Co-Chair:|Calvin Beebe|Mayo Clinic|cbeebe@mayo.edu| \n|Co-Chair:|Austin Kreisler|Leidos Consultant to CDC/NHSN|duz1@cdc.gov| \n|Co-Chair:|Andrew Statler|Cerner Corp|andrew.statler@cerner.com| \n|Co-Chair:|Sean McIlvenna| Lantana Consulting Group|sean.mcilvenna@lantanagroup.com| \n|Co-Chair:|Benjamin Flessner|Redox|benjamin@redoxengine.com| \n|Co-Editor:|Beau Bannerman|Lantana Consulting Group|beau.bannerman@lantanagroup.com| \n|Technical Editor:|Diana Wright|Lantana Consulting Group|diana.wright@lantanagroup.com| \n|Technical Editor:|Chris Hannigan|Lantana Consulting Group|chris.hannigan@lantanagroup.com| \n (built Wed, Apr 19, 2023 14:58+0000+00:00)",
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"description" : "### Introduction\nThis HL7® Multiple Chronic Condition (MCC) Care Plan Implementation Guide (IG) defines FHIR R4 profiles, structures, extensions, transactions and value sets needed to represent, query for, and exchange Care Plan information. It defines how to represent coded content used to support the care planning activities focusing on the needs of patients with multiple chronic conditions. This initial version focuses on Chronic Kidney Disease Type 2 diabetes mellitus, common cardiovascular disease (hypertension, ischemic heart disease and heart failure), chronic pain and Long Covid.The profiles defined within this IG were based on data elements of importance identified by the National Institute of Health's (NIH) National Institute of Diabetes and Digestive and Kidney Disease technical expert panels.\n\nA Care Plan is a consensus-driven dynamic plan that represents a patient?s and Care Team Members? prioritized concerns, goals, planned and actual interventions and the resultant care outcomes. It serves as a blueprint shared by all Care Team Members (including the patient, their caregivers, and providers), to guide the patient?s care. A Care Plan integrates multiple interventions proposed by multiple providers and disciplines for multiple conditions. A Care Plan may represent one or more Care Plans and serves to reconcile and resolve conflicts between the various plans developed for a specific patient by different providers. It supports the following use cases:\n \n1. Query for patient data across providers and compile into a consolidated care plan representation.\n2. Encourage capture of and communication of a patient's health concerns and related goals, interventions, and outcomes.\n3. Gather and aggregate patient data for uses beyond the point of care (e.g. public health, population health, quality measurement, risk adjustment, quality improvement, and research.)\n\nThis FHIR IG addresses the needs of multiple audiences. It provides technical artifacts that assist programmers when implementing standards-based FHIR application program interfaces (APIs) for specific purposes. It provides instructive material that explains how FHIR is used to accomplish specific use cases. It also provides general information that helps business analysts and technology decision-makers understand the use cases and benefits associated with achieving specific data exchange capabilities. A FHIR IG is as much a business planning tool as it is an educational resource and a technical specification.\n\n### How to Read this Guide and Cautions\nThis Guide is divided into several pages which are listed in the navigation bar at the top each page. The contents of each page are listed in a yellow \"Contents\" box at the top right of each page.\n\n### Value Set Library\n\nRather than creating nearly 1000 profiles covering important concepts for chronic care coordination for use within the MCC FHIR Care Plan profile, we have created 21 foundation profiles which conform to US Core Profiles (where available) adding constraints or extensions pertinent to their representation within a dynamic FHIR care plan and then creating libraries of value sets pertinent to the base profiles for representing chronic conditions, and their related interventions and goals and outcomes. \nThis project has built and houses its value sets in the National Library of Medicine's (NLM) Value Set Authority Center (VSAC). The value sets are not directly bound within the foundation profiles, but value set library pages are provided with links to the value sets in VSAC and descriptions of where within the profile each value set may be used. Because the value sets are housed in VSAC, it is necessary for implementation sites to obtain a free (for the US) UMLS license. In addition, HL7 FHIR Policies requiring everything to be open source in all realms, may present some implementation validation issues when interfacing with a value set housed in VSAC. This IG will provide guidance for this issue.\n\n### History of the Care Plan and Electronic Care Plans\n\nThe concept of a care plan began as a teaching tool for nursing students to research and document the medical conditions their patients had and identify the associated nursing care and family support needed. This was documented in a structured paper format that fostered the nursing process. The nursing process is the identification of health concerns and related goals, and the interventions needed to meet those goals and then evaluating the meeting of those goals ? the outcomes. Over the years, the care plan evolved from a student teaching tool to something required for most patients in some format by various regulating or certifying bodies, and further, from a nursing care based plan, to an interdisciplinary patient focused tool.\n\nMost major vendors have electronic Care Plan modules, but the degree to which the modules are implemented and actively used is unknown. Few, if any, are exchange standards ready or mapped to exchange standards. The first HL7 standard representing Care Plan was the C-CDA Care Plan document designed to represent an instance of an EHR Care Plan similar to the Continuity of Care (CCD) CDA. Many of the learnings and designs for the FHIR Care Plan Resource and this IG were derived from the C-CDA Care Plan. There is also an IHE [Dynamic Care Planning (DCP)](https://wiki.ihe.net/index.php/Dynamic_Care_Planning_(DCP)) that provides the structures and transactions for care planning, creating, updating and sharing Care Plans that meet the needs of many, such as providers, patients and payers.. The Office of the National Coordinator (ONC) has put into regulation requirements around goals and health concerns which can currently be met by free text. The Dynamic Care Planning (DCP) Profile provides leveraged FHIR Resources to provide the structures and transactions for care planning and sharing Care Plans that meet the needs of many, such as providers, patients and payers. The DCP profile leverages the FHIR Care Plan resource, but does not specify, describe or define the use of it for representing specific conditions or multiple conditions. We are unaware of any real world implementations of it at this time.\n\nWe believe that this IG will be the first fully defined HL7 FHIR IG leveraging the FHIR Care Plan resources as its backbone structure for representing a dynamic care plan and testing its ability to bring together aggregated patient care plan data including patient outcomes.\n\n### Project Overview\n\nMore than 25 percent of Americans have MCC, accounting for more than 65 percent of U.S. healthcare spending. These individuals have complex health needs handled by diverse providers, across multiple settings of care. As a result, their care is often fragmented, poorly coordinated, and inefficient. Therefore, data aggregation is particularly important and challenging for people with MCC. These challenges will increasingly strain the U.S. health system, with the aging of the U.S. population. Projections suggest numbers of adults aged 65 and older will more than double and numbers of those aged 85 and older will triple by 2050.\n \nCare plans are a prominent part of multifaceted, care coordination interventions that reduce mortality and hospitalizations and improve disease management and satisfaction. In addition, proactive care planning promotes person-centeredness, improves outcomes, and reduces the cost of care. By design, care plans take a patient-centered approach, both by making comprehensive health data available across providers and settings and through the incorporation of data elements that have not traditionally been included in health IT systems (e.g., social determinants of health SDOH, patient health and life goals, patient preferences). While Care Plans have been developed, they remain paper-based in many U.S. healthcare settings and are not standardized and interoperable across care settings when electronic. While care plans focused on a single disease or condition are unlikely to be tenable for patients with MCC or their providers, existing care plans infrequently address individuals with MCC. The development of care plans based on structured data has been proposed as a method for enabling electronic systems to pull together and share data elements automatically and dynamically. Such aggregated data would not only provide actionable information to identify and achieve health and wellness goals for individuals with MCC, but also would reduce missingness and improve quality of point-of-care data for use in pragmatic research.\n \nThe Fast Healthcare Interoperability Resources (FHIR) specification is an open-source standard for exchanging healthcare information electronically based on emerging industry approaches. The FHIR workflow specification includes a CarePlan request resource that may facilitate transfer of data for an e-care plan across healthcare settings. SMART (https://smarthealthit.org/) and SMART on FHIR standards include open specifications to integrate applications with health IT systems and may enable the development of an e-care plan application that can integrate with a variety of electronic health record (EHR) systems.\n\nInitiated by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the multiple chronic conditions (MCC) electronic care (eCare) Plan Project aims to develop, test, and pilot an interoperable eCare plan that will facilitate aggregation and sharing of critical patient-centered data across home, community, clinic, and research-based settings for persons with MCC, including chronic kidney disease (CKD), type 2 diabetes mellitus (T2D), cardiovascular disease (CVD), pain with opioid use disorder (OUD), and long COVID. \n\nThe HL7-based activities of the MCC eCare Plan Project include:\n \n - Identified use cases to support the documentation and exchange of MCC eCare plan data within EHRs and related systems.\n - Identified, developed, and prioritized the necessary MCC data elements and clinical terminology standards and FHIR® mappings that will enable the standardized transfer of data across health settings.\n - Develop, test, and ballot an HL7® Fast Health Interoperability Resources (FHIR®) Implementation Guide based on the defined use cases and MCC data elements.\n \nNon-HL7 related activities of the MCC eCare Plan project will be facilitated through the [AHRQ eCare Plan Project Confluence](https://ecareplan.ahrq.gov/collaborate):\n - The project includes the develoment and testing of an open-source clinician and patient facing SMART-on-FHIR eCare plan application for managing persons with MCC.\n\n#### Project Timelines\n - January 2024: A For comment ballot to gather community input prior to the formal STU Ballot\n - September 2024: Formal STU Ballot\n - May 2025 Formal HL7 Publication\n\n\n### Guidance\nThe guidance section provides general implementation guidance and best practices. It describes the relation to and reuse of the US Core Implementation Guide profiles and reuse of its conformance requirements and expectations for the servers and client applications. Vocabulary use and value set binding heuristics are described.\n\n#### Relationship to US Core\n\nThis Implementation Guide reuses US Core profiles either through direct use or by constraining select profiles for representation within a FHIR Care Plan profile. Where US Core does not have a profile or function that is needed for the use cases or data elements, the IG constrains or directly reuses other resources, or profiles defined in other FHIR IGs. \nThis guide will reuse the US Core Care Plan. However, the required US Core CarePlan.text and the required Care.Plan.category:AssessPlan may be limiting factors for this context of use: aggregation of multiple chronic condition care plans and the ability to query for structured data within a structured Care Plan. As such, we recommend adding additional Care Plan categories if deemed more informational to reflect multiple chronic condition care coordination and plans and to hard code ?Multiple Chronic Condition Care Coordination Plan? at CarePlan.text\n\n\n##### General US Core IG Conformance\n\nThis guide will adhere to or build on US conformance requirements, most of its [General Guidance](https://www.hl7.org/fhir/us/core/general-guidance.html), and its [Capability Statements](https://www.hl7.org/fhir/us/core/capstatements.html) where applicable. \n\n##### Provenance\n\nThis IG recommends implementers adhere to guidelines and definitions provided in US Core?s [Basic Provenance Guidance](https://www.hl7.org/fhir/us/core/basic-provenance.html). \n\n##### Must Support\n\nThis IG will adhere to the US Core [Must Support](https://www.hl7.org/fhir/us/core/general-guidance.html#must-support) concept and rules.\n\n### Acknowledgements\nThis Implementation Guide was made possible through the visionary leadership of the [National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ](https://www.niddk.nih.gov/)and the [Agency for Healthcare Research and Quality (AHRQ) ](https://www.ahrq.gov/)with funding from the [Office of the Assistant Secretary for Planning and Evaluation (ASPE)](https://aspe.hhs.gov/collaborations-committees-advisory-groups/os-pcortf/explore-portfolio). The joint NIDDK-AHRQ project team can be found [here](https://cmext.ahrq.gov/confluence/display/EC/Project+Team). We would also like to thank the many clinicians, patients, caregivers, researchers, advocates, and subject matter experts who served on our [Technical Expert Panels](https://cmext.ahrq.gov/confluence/display/EC/Technical+Expert+Panels) and [Contract Monitoring Board ](https://cmext.ahrq.gov/confluence/display/EC/Contract+Monitoring+Board) for their time, insight, and support. \n\nThis Implementation Guide was created under the supervision and review of the [HL7 Patient Care Work Group](https://www.hl7.org/Special/committees/patientcare/index.cfm). This is the HL7 project page for the [Multiple Chronic Conditions e-Care Project.](https://confluence.hl7.org/display/PC/Multiple+Chronic+Conditions+%28MCC%29+eCare+Plan)\n\n (built Fri, Jul 28, 2023 17:45+0000+00:00)",
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