Example ACH Monthly Submission Subject Bundle 3 - CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG v2.0.0

This page is part of the NHSN Digital Quality Measures (dQM) Content Package Implementation Guide (v2.0.0: Release) based on FHIR (HL7? FHIR? Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Bundle: Example ACH Monthly Submission Subject Bundle 3

Profile: NHSN Subject Bundle

Bundle bundle-example-ach-monthly-subject-ach-pass3 of type collection

Entry 1 - fullUrl = http://nhsnlink.org/fhir/MeasureReport/measurereport-example-individual-ach-monthly-pass3

Resource MeasureReport:

Profiles: NHSN Individual MeasureReport, DEQM Individual MeasureReport Profile
Extension Definition for MeasureReport.supplementalData for Version 5.0: Condition Acute sinusitis (disorder)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Condition Enterocolitis due to Clostridium difficile
Extension Definition for MeasureReport.supplementalData for Version 5.0: Coverage: identifier = Member Number: 0945345; status = active; type = preferred provider organization policy; subscriberId = 7843574536; relationship = Self
Extension Definition for MeasureReport.supplementalData for Version 5.0: Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051035?(use:?usual,?); type = Intermittent venous compression system pump (physical object)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a?(use:?usual,?); status = finished; class = inpatient acute (ActCode#ACUTE); type = In-person encounter; period = 2024-02-02 16:43:00-0500 --> 2024-02-03 19:58:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a?(use:?usual,?); status = in-progress; class = short stay (ActCode#SS); type = Hospital admission, elective (procedure); period = 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500; reasonCode = Diarrhea, unspecified
Extension Definition for MeasureReport.supplementalData for Version 5.0: Location ACH Monthly Medical Critical Care
Extension Definition for MeasureReport.supplementalData for Version 5.0: Location ACH Monthly Medical-Surgical Ward
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833?(use:?usual,?); status = not-done; category = Inpatient; medication[x] = 0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; effective[x] = 2024-02-02 21:04:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888321?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-01 21:02:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888322?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-02 21:09:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888323?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-03 09:09:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892?(use:?usual,?); status = active; intent = plan; category = Community; medication[x] = ciprofloxacin 500 MG; authoredOn = 2024-02-01 19:15:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = 0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; authoredOn = 2024-02-01 20:33:00-0500
Extension Definition for MeasureReport.supplementalData for Version 5.0: Observation Clostridioides difficile (organism)
Extension Definition for MeasureReport.supplementalData for Version 5.0: Observation Body height
Extension Definition for MeasureReport.supplementalData for Version 5.0: Observation Body weight
Extension Definition for MeasureReport.supplementalData for Version 5.0: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
Extension Definition for MeasureReport.supplementalData for Version 5.0: Procedure Transfusion of red blood cells (procedure)
Extension Definition for MeasureReport.supplementalData for Version 5.0: ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay
Extension Definition for MeasureReport.supplementalData for Version 5.0: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500
DEQM Measure Scoring Extension: Cohort
identifier: http://example.org/fhir/measurereport/id/123456789-pass3
status: Complete
type: Individual
measure: NHSN dQM Acute Care Hospital Monthly Initial Population version: 2.0.0
subject: Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN:?1601191901010308?(use:?usual,?))
date: 2024-02-05 21:04:29+0000
reporter: Organization Example NHSN Submitter
period: 2024-01-05 00:00:00+0000 --> 2024-02-04 00:00:00+0000
improvementNotation: Increased score indicates improvement
group
Populations
- Code Count
* Initial Population 1
evaluatedResource:
Condition Acute sinusitis (disorder)
Condition Enterocolitis due to Clostridium difficile
Coverage: identifier = Member Number: 0945345; status = active; type = preferred provider organization policy; subscriberId = 7843574536; relationship = Self
Device: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#100051035?(use:?usual,?); type = Intermittent venous compression system pump (physical object)
Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a?(use:?usual,?); status = finished; class = inpatient acute (ActCode#ACUTE); type = In-person encounter; period = 2024-02-02 16:43:00-0500 --> 2024-02-03 19:58:00-0500
Encounter: identifier = urn:oid:2.16.840.1.113883.19.5.1.698.8#10005104253a?(use:?usual,?); status = in-progress; class = short stay (ActCode#SS); type = Hospital admission, elective (procedure); period = 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500; reasonCode = Diarrhea, unspecified
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833?(use:?usual,?); status = not-done; category = Inpatient; medication[x] = 0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; effective[x] = 2024-02-02 21:04:00-0500
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888321?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-01 21:02:00-0500
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888322?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-02 21:09:00-0500
MedicationAdministration: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#1018888323?(use:?usual,?); status = completed; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; effective[x] = 2024-02-03 09:09:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888892?(use:?usual,?); status = active; intent = plan; category = Community; medication[x] = ciprofloxacin 500 MG; authoredOn = 2024-02-01 19:15:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = 0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500
MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; authoredOn = 2024-02-01 20:33:00-0500
Observation Clostridioides difficile (organism)
Observation Body height
Observation Body weight
Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
Procedure Transfusion of red blood cells (procedure)
ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay
Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 2 - fullUrl = http://nhsnlink.org/fhir/Patient/patient-example-ach-monthly-pass3

Resource Patient:

Profile: Cross-Measure Patient Profile
Security Label: Restricted (Details: Confidentiality code R = 'Restricted')
Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
Active: true
Contact Detail
ACHtestcase@testcase.com
5678 Sesame Lansing Lansing MI 48864 US
Language: Chinese
US Core Ethnicity Extension:
ombCategory: Race & Ethnicity - CDC: 2186-5 (Not Hispanic or Latino)
text: Non Hispanic or Latino
US Core Birth Sex Extension M
US Core Race Extension:
ombCategory: Race & Ethnicity - CDC: 2028-9 (Asian)
text: White

Entry 3 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass3-acute

Resource Encounter:

Profile: ACH Monthly Event Encounter
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/10005104253a?(use:?usual,?)
status: completed
class: inpatient acute
type: Critical care visit
subject: Pass3 ACH
Locations
- Location Period
* ACH Monthly Medical Critical Care 2024-02-02 16:43:00-0500 --> 2024-03-02 19:58:00-0500

Entry 4 - fullUrl = http://nhsnlink.org/fhir/Encounter/encounter-example-ach-monthly-pass3-short-stay

Resource Encounter:

Profile: ACH Monthly Event Encounter
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/10005104253a?(use:?usual,?)
status: In Progress
class: short stay
type: Hospital Admission, Elective Procedure
subject: Pass3 ACH
Diagnoses
- Condition
* No display for Encounter.diagnosis.condition (reference: ->Enterocolitis due to Clostridium difficile)
Locations
- Location Period
* ACH Monthly Medical-Surgical Ward 2024-02-01 14:12:00-0500 --> 2024-02-02 16:43:00-0500

Entry 5 - fullUrl = http://nhsnlink.org/fhir/Location/location-example-ach-monthly-crit-part

Resource Location:

Profile: ACH Monthly Event Location
identifier: http://www.example.com/location/2936
status: Active
name: ACH Monthly Medical Critical Care
description:
ACH Monthly Medical Critical Care

type: Medical Critical Care
partOf: Location ACH Monthly Medical Critical Care

Entry 6 - fullUrl = http://nhsnlink.org/fhir/Location/location-example-ach-monthly-medsurg

Resource Location:

Profile: ACH Monthly Event Location
identifier: http://www.example.com/location/2935
status: Active
name: ACH Monthly Medical-Surgical Ward
description:
ACH Monthly Medical-Surgical Ward

type: Medical-Surgical Ward

Entry 7 - fullUrl = http://nhsnlink.org/fhir/Coverage/coverage-example-ach-monthly-pass3

Resource Coverage:

Profile: ACH Monthly Event Coverage
identifier: Member Number/0945345
status: Active
type: preferred provider organization policy
subscriberId: 7843574536
beneficiary: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
relationship: Self

Entry 8 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass3-problem

Resource Condition:

Profile: ACH Monthly Event Condition
clinicalStatus: Resolved
verificationStatus: Confirmed
category: Encounter Diagnosis, Problem List Item
code: Acute sinusitis
subject: Pass3 ACH
onset: 2024-01-21 07:32:00-0500
abatement: 2024-02-02 16:43:00-0500

Entry 9 - fullUrl = http://nhsnlink.org/fhir/Condition/condition-example-diagnosis-ach-monthly-pass3

Resource Condition:

Profile: ACH Monthly Event Condition
clinicalStatus: Active
verificationStatus: Confirmed
category: Encounter Diagnosis
code: Enterocolitis due to Clostridium difficile
subject: Pass3 ACH

Entry 10 - fullUrl = http://nhsnlink.org/fhir/Device/device-example-ach-monthly-pass3-ivcs-pump

Resource Device:

Profile: ACH Monthly Event Device
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/100051035?(use:?usual,?)
type: Intermittent venous compression system pump

Entry 11 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-enoxaparin

Resource MedicationAdministration:

Profile: ACH Monthly Event MedicationAdministration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888833?(use:?usual,?)
status: not-done
category: Inpatient Medication
subject: Pass2 ACH
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888833?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = 0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe; authoredOn = 2024-02-02 12:21:00-0500
Dosages
- Text Site Route Dose
* 0.4ml subcutaneous once daily in abdomen Subcutaneous tissue structure of anterior abdominal wall (body structure) Oral 4000 uL (Details: UCUM codeuL = 'uL')

Entry 12 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-1

Resource MedicationAdministration:

Profile: ACH Monthly Event MedicationAdministration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/1018888321?(use:?usual,?)
status: completed
category: Inpatient Medication
subject: Pass2 ACH
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; authoredOn = 2024-02-01 20:33:00-0500
Dosages
- Text Route Dose
* 5mg tablet by mouth twice daily Oral 5 mg (Details: UCUM codemg = 'mg')

Entry 13 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-2

Resource MedicationAdministration:

Profile: ACH Monthly Event MedicationAdministration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/1018888322?(use:?usual,?)
status: completed
category: Inpatient Medication
subject: Pass2 ACH
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; authoredOn = 2024-02-01 20:33:00-0500
Dosages
- Text Route Dose
* 5mg tablet by mouth twice daily Oral 5 mg (Details: UCUM codemg = 'mg')

Entry 14 - fullUrl = http://nhsnlink.org/fhir/MedicationAdministration/medadmin-example-ach-monthly-pass3-metronidazole-3

Resource MedicationAdministration:

Profile: ACH Monthly Event MedicationAdministration
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/1018888323?(use:?usual,?)
status: completed
category: Inpatient Medication
subject: Pass2 ACH
request: MedicationRequest: identifier = urn:oid:2.16.840.1.113883.19.5.1.798#101888832?(use:?usual,?); status = active; intent = order; category = Inpatient; medication[x] = metroNIDAZOLE 500 MG; authoredOn = 2024-02-01 20:33:00-0500
Dosages
- Text Route Dose
* 5mg tablet by mouth twice daily Oral 5 mg (Details: UCUM codemg = 'mg')

Entry 15 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-cipro

Resource MedicationRequest:

Profile: ACH Monthly Event MedicationRequest
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888892?(use:?usual,?)
status: Active
intent: Plan
category: Home Medication
subject: Pass2 ACH
encounter: Short Stay
authoredOn: 2024-02-01 19:15:00-0500
requester: Patient Identified
dosageInstruction
text: 500mg tablet by mouth twice daily
timing: 2 per 1 day
route: Oral
DoseAndRates
- Type Dose[x]
* calculated 500 mg (Details: UCUM codemg = 'mg')

Entry 16 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-enoxaparin

Resource MedicationRequest:

Profile: ACH Monthly Event MedicationRequest
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888833?(use:?usual,?)
status: Active
intent: Order
category: Inpatient Medication
subject: Pass2 ACH
encounter: Critical care visit
authoredOn: 2024-02-02 12:21:00-0500
requester: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
dosageInstruction
text: 0.4ml subcutaneous once daily in abdomen
timing: Once per 1 day
site: Subcutaneous tissue structure of anterior abdominal wall (body structure)
route: Oral
DoseAndRates
- Type Dose[x]
* calculated 4000 uL (Details: UCUM codeuL = 'uL')

Entry 17 - fullUrl = http://nhsnlink.org/fhir/MedicationRequest/medicationrequest-example-ach-monthly-pass3-metronidazole

Resource MedicationRequest:

Profile: ACH Monthly Event MedicationRequest
identifier: urn:oid:2.16.840.1.113883.19.5.1.798/101888832?(use:?usual,?)
status: Active
intent: Order
category: Inpatient Medication
subject: Pass2 ACH
encounter: Short Stay
authoredOn: 2024-02-01 20:33:00-0500
requester: Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:?1601191903010308?(use:?usual,?))
dosageInstruction
text: 5mg tablet by mouth twice daily
timing: 2 per 1 day
route: Oral
DoseAndRates
- Type Dose[x]
* calculated 5 mg (Details: UCUM codemg = 'mg')

Entry 18 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-cdiff

Resource Observation:

Profile: ACH Monthly Event Lab Result Observation
basedOn: ServiceRequest Clostridioides difficile toxin A [Presence] in Stool by Immunoassay
status: Final
category: Laboratory
code: C. Diff.
subject: Pass3 ACH
encounter: Hospital Admission, Short Stay
effective: 2024-02-01 19:02:00-0500
issued: 2024-02-02 15:30:00-0500
value: Positive (qualifier value)
specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 19 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-vitals-height

Resource Observation:

Profile: ACH Monthly Event Observation - Vital Signs
status: Final
category: Vital Signs
code: Height
subject: Pass3 ACH
encounter: Short Stay
effective: 2024-02-01 19:21:00-0500
issued: 2024-02-01 19:21:00-0500
value: 176.8 cm (Details: UCUM codecm = 'cm')

Entry 20 - fullUrl = http://nhsnlink.org/fhir/Observation/observation-example-ach-monthly-pass3-vitals-weight

Resource Observation:

Profile: ACH Monthly Event Observation - Vital Signs
status: Final
category: Vital Signs
code: Weight
subject: Pass3 ACH
encounter: Short Stay
effective: 2024-02-01 19:21:00-0500
issued: 2024-02-01 19:21:00-0500
value: 54.4 kg (Details: UCUM codekg = 'kg')

Entry 21 - fullUrl = http://nhsnlink.org/fhir/Procedure/procedure-example-ach-monthly-pass3-transfusion

Resource Procedure:

Profile: ACH Monthly Event Procedure
identifier: urn:oid:2.16.840.1.113883.19.5.1.698.8/100051035264?(use:?usual,?)
status: Completed
code: Transfusion of red blood cells (procedure)
subject: Pass3 ACH
encounter: Critical care visit

Entry 22 - fullUrl = http://nhsnlink.org/fhir/ServiceRequest/servicerequest-example-ach-monthly-pass3-cdiff

Resource ServiceRequest:

Profile: ACH Monthly Event ServiceRequest
identifier: Placer Identifier/1019631826?(use:?usual,?)
status: Completed
intent: Original Order
category: Laboratory procedure
code: No display for ServiceRequest.code (concept: Clostridioides difficile toxin A [Presence] in Stool by Immunoassay)
quantity: 1
subject: Pass3 ACH
encounter: Hospital Admission, Short Stay
occurrence: Code , Events: 2024-02-01 18:12:00-0500 , Count 1 times, Once
authoredOn: 2024-02-01 18:12:00-0500
specimen: Specimen: identifier = urn:oid:2.16.840.1.113883.19.5.1.798.32#C104082905,urn:oid:2.16.840.1.113883.19.5.1.798.800#C10408290:45; type = Bloody stool specimen (specimen); receivedTime = 2024-02-01 19:12:00-0500

Entry 23 - fullUrl = http://nhsnlink.org/fhir/Specimen/specimen-example-ach-monthly-pass3-stool

Resource Specimen:

Profile: ACH Monthly Event Specimen
identifier: urn:oid:2.16.840.1.113883.19.5.1.798.32/C104082905, urn:oid:2.16.840.1.113883.19.5.1.798.800/C10408290:45
type: Bloody stool specimen (specimen)
subject: Pass3 ACH
receivedTime: 2024-02-01 19:12:00-0500
Collections
- Collected[x] BodySite
* 2024-02-01 19:02:00-0500 No display for Specimen.collection.bodySite (concept: Entire rectum (body structure))

Entry 24 - fullUrl = http://nhsnlink.org/fhir/Organization/organization-coverage-example-nationfirst

Resource Organization:

Profile: US Core Organization Profile version: 6.1.0
active: true
name: Nation First Health Care