CDC NHSN Situational Awareness Framework for Reporting (NHSN SAFR) Content Implementation Guide
1.0.0 - STU 1.0.0

CDC NHSN Situational Awareness Framework for Reporting (NHSN SAFR) Content Implementation Guide - Downloaded Version 1.0.0 See the Directory of published versions

## NHSN Situational Awareness Framework for Reporting Home

Official URL: http://www.cdc.gov/nhsn/fhirportal/safr/ig/ImplementationGuide/gov.cdc.nhsn.safr | Version: 1.0.0
IG Standards status: Trial-use | Maturity Level: 1 | Computable Name: NHSNSAFR

### Overview

The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network Situational Awareness Framework for Reporting (NHSN SAFR) Implementation Guide (IG) establishes a standardized, FHIR-based approach to support public health decision-making during emergencies. By enhancing situational awareness, this IG aims to provide a real-time, national or jurisdictional view of healthcare system capacity, respiratory disease trends, and other critical public health metrics. The guide is designed to facilitate seamless data exchange between healthcare facilities and public health authorities (federal and/or jurisdictional),thereby strengthening the nation’s emergency preparedness and response capabilities.

### Purpose

This specification seeks to achieve the following objectives:

1. Standardized FHIR Interfaces: Enable interoperable data exchange with the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC) and other federal or jurisdictional public health agencies.
2. Automated Data Collection: Minimize manual intervention through real-time data collection.
3. Increased Situational Awareness: Provide a comprehensive view of healthcare capacity and trends, serving as a foundation for future data reporting needs.

By addressing these goals, NHSN SAFR supports healthcare facilities and public health authorities in reporting critical data efficiently, ensuring patient safety and informed decision-making during public health emergencies.

### Background

The COVID-19 pandemic revealed significant gaps in the ability to monitor healthcare system stress and capacity. This project integrates and generalizes previous initiatives, including SANER - Situational Awareness for Novel Epidemic Response IG (universal realm) and DEQM - Data Exchange for Quality Measure IG (US realm), into a unified framework tailored for the US. Key highlights include:

1. Standardized definitions of healthcare bed capacity and other metrics.
2. Compatibility with existing federal systems and regulatory requirements.
3. Development of at least one IG tailored for US-specific needs, leveraging United States Core Data for Interoperability (USCDI) and US terminology. The NHSN SAFR IG builds upon lessons learned during the pandemic to create a reliable, automated, and standardized reporting framework for the future.

### Audience

This guide is intended for a broad range of interoperability partners, including:

- Healthcare Organizations: Hospitals, acute care centers, and other providers with public health reporting obligations.
- Federal Agencies: CDC, ASTP/ONC, CMS, ASPR, and other federal public health entities.
- Provider HIT Vendors: Developers of provider HIT such as EHRs, administrative, and logistics systems that are the source of NHSN SAFR data.
- Standards Development Organizations: Stakeholders involved in advancing FHIR and other health data standards.
- Public Health Authorities: State, tribal, local, and territorial (STLTs) public health agencies seeking to improve situational awareness and emergency response.

### Design Considerations

The design of NHSN SAFR emphasizes:

- Interoperability: Seamless data exchange between hospitals, jurisdictions, and federal systems via FHIR.
- Scalability: A framework capable of addressing both current and future situational awareness needs.
- Data Uniformity: Consistent definitions and structures to facilitate regional and national collaboration.
- Automated Compliance: Streamlined reporting aligned with federal regulations to reduce the administrative burden.

The guide ensures alignment with existing initiatives, such as SANER and DEQM, while addressing US-specific requirements and terminology.

### Relationship to Other Standards

The NHSN SAFR IG harmonizes with and extends the following standards:

1. US Situational Awareness Framework for Reporting (US SAFR) Establishes a standardized, FHIR-based approach to support public health decision-making during emergencies and is designed to facilitate seamless data exchange between healthcare facilities and public health authorities (federal and/or jurisdictional),thereby strengthening the nation’s emergency preparedness and response capabilities.
2. Situational Awareness for Novel Epidemic Response (SANER) (Universal Realm): Provides the foundation for situational awareness reporting globally. NHSN SAFR adapts SANER for US-specific requirements while maintaining interoperability.
3. Data Exchange For Quality Measures (DEQM) (US Realm): Ensures alignment with existing US-specific quality measurement standards.
4. NHSN Bed Connectivity Initiative: Standardizes real-time bed capacity reporting across hospitals and jurisdictions.
5. Hospital Respiratory Data Reporting: Establishes reporting standards for COVID-19, influenza, RSV, and related data.
6. National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting: Defines the standard framework for reporting patient line-level clinical data using a digital Quality Measure (dQM). Whereas, NHSN SAFR focuses on situational awareness reporting excluding protected health information.

By aligning with these standards, NHSN SAFR supports a unified reporting framework for healthcare capacity and situational awareness data.

Other FHIR standard related dependencies:

IG | Package | FHIR | Comment
--- | --- | --- | ---
CDC NHSN Situational Awareness Framework for Reporting (NHSN SAFR) Content Implementation Guide | gov.cdc.nhsn.safr#1.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#7.1.0 | R4 | Automatically added as a dependency - all IGs depend on HL7 Terminology
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4 |
US Situational Awareness Framework for Reporting (US SAFR) Implementation Guide | hl7.fhir.us.safr#1.0.0 | R4 |
US Core Implementation Guide | hl7.fhir.us.core#6.1.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#5.0.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#1.0.0 | R4 |
Bulk Data Access IG | hl7.fhir.uv.bulkdata#2.0.0 | R4 |
SMART App Launch | hl7.fhir.uv.smart-app-launch#2.1.0 | R4 |
VSAC | us.nlm.vsac#0.11.0 | R4 |
Structured Data Capture | hl7.fhir.uv.sdc#3.0.0 | R4 |
PHINVads | us.cdc.phinvads#0.12.0 | R4 |
IHE FormatCode Vocabulary | ihe.formatcode.fhir#1.1.0 | R4 |
Clinical Quality Framework Common FHIR Assets | fhir.cqf.common#4.0.1 | R4 |
Clinical Practice Guidelines | hl7.fhir.uv.cpg#1.0.0 | R4 |
Canonical Resource Management Infrastructure Implementation Guide | hl7.fhir.uv.crmi#1.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology#5.5.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 |
Quality Measure Implementation Guide | hl7.fhir.us.cqfmeasures#5.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.0.2 | R4 |
Using CQL with FHIR | hl7.fhir.uv.cql#1.0.0 | R4 |
Data Exchange For Quality Measures Implementation Guide | hl7.fhir.us.davinci-deqm#5.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.3.0 | R4 |
VSAC | us.nlm.vsac#0.22.0 | R4 |
QI-Core Implementation Guide | hl7.fhir.us.qicore#6.0.0 | R4 |
fhir.dicom | fhir.dicom#2024.1.20240120 | R4 |
HL7 Terminology (THO) | hl7.terminology#5.4.0 | R4 |
Extensions for Using Data Elements from FHIR R5 in FHIR R4 | hl7.fhir.uv.xver-r5.r4#0.1.0 | R4 |
FHIR Tooling Extensions IG | hl7.fhir.uv.tools.r4#1.1.2 | R4 | for example references

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.bulkdata#2.0.0 FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Nov 26, 2021 05:56+1100+11:00)

Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. This includes two components: * Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains. *Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package ihe.formatcode.fhir#1.1.0 Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00)

Package hl7.fhir.us.core#6.1.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Fri, Jun 30, 2023 14:02+0000+00:00)

Package hl7.fhir.uv.cpg#1.0.0 Implementation guidance for creating Clinical Practice Guidelines with formal artifacts to facilitate sharing and implementation of the guideline (built Thu, Feb 11, 2021 20:29+0000+00:00)

Package fhir.cqf.common#4.0.1 This implementation guide contains common FHIR assets for use in CQFramework content IGs, including FHIRHelpers and the FHIR-ModelInfo libraries. (built Fri, Nov 12, 2021 16:25+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.crmi#1.0.0 This implementation guide defines profiles, operations, capability statements and guidance to facilitate the content management lifecycle for authoring, publishing, distribution, and implementation of FHIR knowledge artifacts such as value sets, profiles, libraries, rules, and measures. The guide is intended to be used by specification and content implementation guide authors as both a dependency for validation of published artifacts, and a guide for construction and publication of content. (built Fri, May 31, 2024 16:38+0000+00:00)

Package hl7.fhir.uv.cql#1.0.0 This implementation guide defines profiles, operations and guidance for the use of CQL with FHIR, both as a mechanism for querying, as well as inline and integrated usage as part of knowledge artifacts. (built Fri, May 31, 2024 14:18+0000+00:00)

Package hl7.fhir.us.cqfmeasures#5.0.0 The Fast Healthcare Interoperability Resource (FHIR) Quality Measure Implementation Guide (this IG) describes an approach to representing Quality Measures (QMs) using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) in the US Realm. However, this Implementation Guide can be usable for multiple use cases across domains, and much of the content is likely to be usable outside the US Realm. (built Mon, Nov 4, 2024 20:07+0000+00:00)

Package hl7.fhir.us.qicore#6.0.0 The QICore Implementation Guide defines a set of FHIR profiles with extensions and bindings needed to create interoperable, quality-focused applications. The profiles in this implementation guide derive from and extend the US Core profiles to provide a common foundation for building, sharing, and evaluating knowledge artifacts across quality improvement efforts in the US Realm. (built Fri, Mar 1, 2024 18:46+0000+00:00)

Package hl7.fhir.us.safr#1.0.0 US Situational Awareness Framework for Reporting (US SAFR) (built Wed, Apr 1, 2026 02:56+1100+11:00)

Package hl7.fhir.uv.xver-r5.r4#0.1.0 Extensions for Using Data Elements from FHIR R5 in FHIR R4 (built Fri, Mar 20, 2026 15:40+1100+11:00)

Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

### Out of Scope

Subscriptions is not covered in this IG currently, but future versions will plan to incorporate FHIR Subscriptions R5 Backport to support emergencies that require rapid changes in reporting.

### Acknowledgements

Lantana Consulting Group, Inc. produced and developed the content in this IG under contract to the Division of Healthcare Quality Promotion (DHQP) in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC).

Role | Name | Organization | Email Address
--- | --- | --- | ---
Primary Editor | Shanai Thornton | Lantana Consulting Group | shanai.thornton@lantanagroup.com
Primary Editor | Rick Geimer | Lantana Consulting Group | rick.geimer@lantanagroup.com
Primary Editor | Corey Spears | Lantana Consulting Group | corey.spears@lantanagroup.com
Co-Editor | Andrea Benin | CDC | aqb4@cdc.gov
Co-Editor | Kristina Betz | CDC | rly7@cdc.gov
Co-Editor | Arvind Jagannathan | Lantana Consulting Group | arvind.jagannathan@lantanagroup.com
Co-Editor | Beth Golshir | CDC | kqo9@cdc.gov
Co-Editor | Ally Binder | CDC | wpq5@cdc.gov
Co-Editor | Joey Sach | CDC | squ7@cdc.gov
Co-Editor | Jeenal Patel | CDC | ujo2@cdc.gov
Co-Editor | Matt Heym | CDC | twz0.cdc.gov
Co-Editor | Christopher Uga | CDC | uto2@cdc.gov
Co-Editor | Tami Funk | Lantana | tami.funk@lantanagroup.com
Co-Editor | Maggie Dudeck | CDC | xzd7@cdc.gov
Co-Editor | Bass Toure | Leidos | mamadou.b.toure@leidos.com
Co-Editor | Karthick Seshadri | CDC | qax2@cdc.gov
Co-Editor | Heath Dinkins | CDC | ldx6@cdc.gov
Co-Editor | David deRoode | Lantana Consulting Group | david.deroode@lantanagroup.com
Co-Editor | Ming Dunajick | Lantana Consulting Group | ming.dunajick@lantanagroup.com
Co-Editor | Aaron Nusstein | Lantana Consulting Group | aaron.nusstein@lantanagroup.com