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NHSN Digital Quality Measure (dQM) Early Adopters
NHSN has invited a select group of healthcare facilities to become Early Adopters for reporting digital quality measures (dQMs) using the Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard. Early Adopters work closely with NHSN, their health system’s leadership, their IT department, and their EHR vendor. They actively participate in an iterative process of learning and improvement to enhance tools, processes and guidance.
Early Adopters play a vital role in shaping the future of automated public health surveillance by refining the dQM reporting process and ensuring workflows are efficient before nationwide implementation.
The phases below guide facilities through the NHSN dQM Early Adopter process. Each phase description includes the goal of that phase, a list of key actions needed to move through the phase, and the recommended participants from the facility who should accomplish the work.
Goal: Facility leadership is engaged and NHSN is aware of your interest.
What You Need To Do
- Ensure that your NHSN Facility Administrator is aware of this work and part of the project leadership team.
- Identify key IT and clinical resources at your facility.
Who Should Participate
- Interested facility staff member who reached out
- dQM Implementation Coordinator
- NHSN Facility Administrator
- Executive Sponsor
Goal: Your Information Technology (IT) team is engaged and prepared for activation of FHIR reporting.
What You Need To Do
- Assign IT staff resources. Ensure at least one IT coordinator with SAMS-authenticated access to the NHSN application (you will need IT support to complete onboarding to the NHSN FHIR application, NHSNLink).
- Confirm FHIR capability by reviewing NHSN dQM FHIR readiness materials, including FHIR API availability [PDF – 255 KB] in Production EHR environment and standard adherence requirements [XLS – 26 KB] for reporting FHIR dQMs to NHSN.
- Review NHSN terminology requirements and ensure NHSN value sets are integrated into local and FHIR workflows.
- Use the Inferno US Core Test Kit and run the test suite “US Core Server v6.1.0.” to confirm your FHIR server has accurately implemented US Core Implementation Guide version 6.1.0.
Who Should Participate
- IT Leadership and IT teams
- dQM Implementation Coordinator
- EHR Vendor Support
Goal: NHSN Facility Administrator signs the NHSN Agreement for Reporting FHIR Data and completes the Digital Measure Reporting Plan (DMRP).
What You Need To Do
- Ensure your facility has accepted the updated NHSN Agreement to Participate and Consent in the NHSN application (dated May 28, 2026 or later).
- Accept the NHSN Agreement for Reporting FHIR Data in the NHSN application.
- Complete the DMRP in the NHSN application.
Who Should Participate
- dQM Implementation Coordinator
- NHSN Facility Administrator
Goal: Facility IT team completes NHSNLink onboarding and successfully generates FHIR data for test patients in Production.
What You Need To Do
- 4A: Connect
Complete connectivity and configuration (e.g., FHIR server) information in NHSNLink Onboarding section of the NHSN application.
- 4B: Configure
Configure Patients of Interest list and identify how the list will be shared with NHSN. Generate Patients of Interest list and attest to validation.
- 4C: Map
Complete mapping from local codes to HL7 standardized terminology for the FHIR data elements:- Encounter.class (HL7 v3 ActCode)
- Encounter.type (SNOMED)
- Location.identifer (HSLOC)
- 4D: Test
Test submission of FHIR bundles for a small number of patients, including completeness of data transmission and successful mapping of all locations in FHIR from local codes to standardized terminology (HSLOC).
Who Should Participate
- dQM Implementation Coordinator
- IT team
- NHSN Facility Administrator
- EHR Vendor
Goal: Your facility successfully generates and transmits monthly FHIR data and patient lists to NHSN.
What You Need To Do
- Monitor errors in data transmission and resolve all identified issues.
- If FHIR data are rejected, resolve and communicate resolutions to NHSN so that data can be re-transmitted.
Who Should Participate
- dQM Implementation Coordinator
- IT team
- EHR Vendor
Goal: Your monthly FHIR data submission passes prequalification.
What You Need To Do
- Review results of Prequalification Report in the NHSN application.
- Resolve issues for any returned or failed items in Prequalification Report.
- Communicate resolution to NHSN so that data can be re-transmitted.
Who Should Participate
- dQM Implementation Coordinator
- IT team
- Clinical or Quality Team
Goal: Your Clinical or Quality team reviews denominator and numerator data from NHSN dQM analysis reports for accuracy and validity relative to EHR data sources.
What You Need To Do
- Review clinical data, similar to how you validate your current NHSN measures, to ensure the accuracy of FHIR-based NHSN analysis reports.
- Work with NHSN, your IT teams, and your EHR vendor to resolve data quality issues.
- Refine any technical issues that affect data quality and completeness.
Who Should Participate
- dQM Implementation Coordinator
- IT team
- Clinical or Quality Team
Support ongoing reporting and continuous improvement by maintaining workflows, identifying and reporting issues, recommending improvements, and sharing feedback and lessons learned to strengthen processes over time.
Early adopters should expect challenges such as data quality gaps and workflow adjustments. These are a normal part of the early implementation process. Your feedback is essential to improving the process of reporting dQMs to NHSN.
