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NHSN Digital Quality Measures (dQMs) and NHSNLink
In alignment with CDC’s Data Modernization Initiative, NHSN is developing fully electronic and, where feasible, fully automated measures for patient safety, quality reporting, and public health preparedness and response. NHSN digital quality measures (dQMs) are intended to minimize reporting burden on facilities and providers, improve accuracy, validity, and quality of data collected by NHSN, and increase speed and efficiency of public health surveillance. NHSN dQMs are reported using Healthcare Level Seven International (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) application programming interfaces (APIs).
NHSN FHIR dQMs enable automated, patient-level data reporting, which minimizes delays in data collection and provides access to crucial healthcare data. This new approach to data collection and event determination provides many benefits to facilities, infection preventionists, healthcare epidemiologists, patient safety and quality improvement staff, and other NHSN users. Please see the list of dQMs under development for NHSN.
| With Manual or Semi-Automated Measures | With Digital Quality Measures |
|---|---|
| Data standards are specific to the measure and the organization to which they are reported | Data are represented using nationally recognized standards across the EHR vendors, facilities, and agencies |
| Data are pushed (NHSN waits for the facility to transmit data) | Data can be pulled, making real-time surveillance feasible |
| Data are often aggregated, facility-level risk adjustment is typical | Data are at the patient level, patient-level risk adjustment is possible |
| Measures are pre-determined before transmission | Measures can be adapted after data transmission |
Healthcare facilities can use FHIR application programming interfaces (APIs) to report digital quality measures (dQMs) to NHSN. FHIR dQMs enable automated, patient-level data reporting, which minimizes long implementation cycles and provides access to crucial healthcare data. FHIR dQMs can be implemented in various information systems and healthcare settings, and across different electronic health record (EHR) vendors.
Is Your Facility FHIR Ready?
If you are a healthcare facility interested in reporting data to NHSN via FHIR, start by talking to your IT staff to determine if your facility is FHIR-ready.
Designate an NHSN dQM Implementation Coordinator to lead key readiness activities [PDF – 89 KB], coordinate stakeholders, and oversee implementation of FHIR dQMs.
- Confirm EHR FHIR compatibility — your EHR should support FHIR R4 (or later) and align with US Core version 6.1.0 and US QI Core version 6.0.0 standards.
- Complete governance approvals for NHSNLink to access requested FHIR APIs [PDF – 255 KB] and align with the NHSN FHIR Implementation Guides.
- Maintain clinical data mappings using standardized terminologies [XLS – 26 KB] such as LOINC, SNOMED CT, and RxNorm.
Please visit the dQM Readiness page for specific actions your facility can take to report dQMs to NHSN, including Key Action Items for Reporting dQMs to NHSN [PDF – 89 KB].
About NHSNLink
NHSNLink is CDC’s FHIR application for reporting digital quality measures to NHSN, published under the Apache 2.0 open-source license.
Housed behind the CDC firewall, NHSNLink has a multi-component architecture that uses an extensible and configurable query engine to connect NHSN to a healthcare facility’s EHR securely via the FHIR API, extract data, and submit it to the NHSN’s back-end analytic environment.
NHSNLink is accessible to any clinical data application with a FHIR Release 4 (or later) API, irrespective of EHR vendor or third-party application. NHSNLink queries the EHR for the patient census, extracting the data required to calculate the measure for each reporting period.
Once securely connected to the facility FHIR API, NHSNLink uses HL7 FHIR quality measure specifications to create a MeasureReport Bundle composed of a patient list and respective FHIR resources for those patients. The MeasureReport bundle is then sent to the NHSN application for data quality processes and measure calculation, risk adjustment, stratification, and other operations.
The measure results are provided back to the healthcare facility via the NHSN web-based public interface, allowing NHSN users to further analyze and interpret their surveillance data to identify targets for quality improvement and patient safety.
- NHSN Application confirms facility enrollment in a digital measure reporting plan (DMRP)
- NHSNLink determines Patients of Interest based on the digital quality measure (dQM); acquires and normalizes data required by dQM.
- NHSNLink evaluates data as defined by dQM.
- NHSNLink submits MeasureReport bundle to meet DMRP requirements
- NHSN ingests MeasureReport bundles and publishes metrics to NHSN user interface
