NHSNCoLab

• Provided directly to the institution
• Funds information systems support
• Calibrated to level of institution engagement (ranges from $50,000 to $95,000 for facilities funded to date)

• Provided as Intergovernmental Personnel Act (IPA) agreement to the institution to cover a portion of the faculty time spent on NHSNCoLab work (e.g., 10%-20% of salary and benefits)
• Funds an individual faculty clinician or faculty informaticist who serves as a facility subject matter expert champion or lead
• Covers:
  • Overarching support and oversight for testing within the institution
  • Thought leadership and input into NHSN measure development and testing
  • Participation in user surveys and feedback sessions
• Covers a period of one year, renewable on an annual basis

NHSNLink leverages the FHIR API to streamline public health data reporting and create a pathway to automate public-health data reports, which minimizes long product cycles​ and provides access to crucial line-level healthcare data​.

NHSN uses NHSNLink, an open-source HL7® FHIR® reference application (Figure 1) hosted at CDC that connects securely to a healthcare facility’s EHR system via the facility’s FHIR API.

NHSNLink extracts data, evaluates the data using pre-defined measures, generates measure- and line-level reports, and imports data directly into the NHSN FHIR gateway.

Figure 1: NHSNLink Data and Security Architecture Overview

NHSN has over 20 years of experience in secure and confidential data exchange with over 37,000 U.S. hospitals and other healthcare facilities. Data access and protection provisions are outlined in the NHSN Agreement to Participate and Consent and the NHSN Facility/Group User & Administrator Rules of Behavior. Data are protected by administrative, technical, and physical security controls that safeguard the confidentiality, integrity, and privacy of personal information according to industry-standard policies and federal laws, including the Privacy Act, the Health Insurance Portability and Accountability Act (HIPAA), and the Federal Information Security Modernization Act (FISMA).

Additionally, NHSNLink safeguards information in the following ways:

• Protected by an OAuth2.0 identity-access management (IAM) service delivered by CDC Secure Access Management Services (SAMS), which includes authentication and role-based access control (RBAC).
• Queries only selected, pre-specified FHIR resources that are available only upon authorization from the facility’s server. Access control is provided on a FHIR resource-by-resource basis.
• Data (including internal NHSNLink app communications) are encrypted in-transit through HTTPS/TLS1.2.
• Data are encrypted at-rest using NIST Advanced Encryption Standard 256 (AES 256)[i]

Currently, most of the NHSNCoLab partners are piloting data transmission to NHSN’s FHIR endpoint (NHSNLink) via FHIR R4 API. However, NHSN also has selected use cases where testing involves other methods of data transmission and/or aspects of NHSN measure development and implementation (e.g., early exploration of data elements to support healthcare-associated VTE surveillance via NHSN).

No, only the presence of a FHIR R4 API is required. NHSNLink architecture minimizes Information Technology requirements for the participating facility. NHSNLink works with the facility to identify the initial patient population for which the NHSN measures will be calculated and provide those directly to the NHSN FHIR endpoint.

Both NHSNLink and Electronic Case Reporting (eCR) support CDC’s Data Modernization Initiative by improving data sharing between CDC and its partners, but NHSNLink and eCR have different purposes and serve different public health surveillance needs. NHSNLink support NHSN’s model of national-level surveillance of healthcare events to support quality improvement and benchmarking. eCR supports a model for automated case reporting of reportable public health conditions (e.g., state-reported COVID-19 cases).