Ushering in a new era of NHSN data modernization, innovation, and collaboration for public health surveillance.

About NHSNCoLab


The NHSN Collaborative, or NHSNCoLab, is a collaboration between public and private stakeholders to test, pilot, implement, and validate new National Healthcare Safety Network (NHSN) healthcare surveillance measures and approaches in alignment with CDC’s Data Modernization Initiative.

The program established a committed network of CDC’s healthcare partners with institutional agreements in place to increase the efficiency and effectiveness of collaboration.

This collaboration will inform new NHSN measures and approaches to healthcare event data collection, assessing the feasibility and validity of new NHSN surveillance concepts that support patient safety, quality reporting, national benchmarking, and public health preparedness and response.

Maximize Data, Minimize Burden: Innovative strategies to strengthen and advance NHSN’s healthcare surveillance capacity by automating data collection, enabling direct data linking between CDC and healthcare partners, and conducting real-world testing

Promote Healthcare Quality
Improve Public Health Surveillance
Support NHSN Partners
How It Works
  • Enroll in NHSNCoLab
    • Facility enrolls in NHSNCoLab by signing the NHSNCoLab Charter Agreement and NHSNCoLab Stipend Acknowledgement.
  • Complete Assessment
    • Facility completes technical assessment.
  • Establish Connectivity in Sandbox
  • Complete NHSN Agreement
    • Facility completes NHSN Agreement to Participate and Consent form.
  • Establish Connectivity in Production
    • NHSN establishes connectivity to facility FHIR R4 API* in EHR Production environment (with PHI/PII data).
  • *HL7, CDA, FHIR and the FHIR [FLAME DESIGN] are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.
    **Some facilities collaborate on exploratory work prior to FHIR implementation.
    EHR: Electronic Health Record, PHI: Protected Health Information, PII: Personally Identifiable Information.

Benefits of Collaboration

Access to optimum healthcare data for national surveillance to improve NHSN-data accuracy, quality, and validity.

Improve speed and efficiency to reduce wait times for data transmission between NHSN and its healthcare partners

Advance new healthcare data exchange approaches (e.g., FHIR®)

  • Move towards fully electronic definitions of healthcare-acquired events
  • Minimize reporting burden for facilities and providers

Integrate user perspectives into NHSN surveillance to increase input and adoption from healthcare partners

NHSNCoLab Supported Measures

Planned Measures during 2022-2024

  • Glycemic Control (Inpatient medication-related hypoglycemia and inpatient hyperglycemia)
  • Hospital-onset, antibiotic-treated C. difficile infection (CDI)
  • Hospital-onset bacteremia (HOB)
  • Hospital-associated venous thromboembolism (HA-VTE)
  • Respiratory pathogen surveillance (RPS)
  • Adult sepsis events (ASE) and sepsis outcome
  • Medication use in hospitalized patients with COVID-19

NHSNCoLab Sites

NHSNCoLab Geographical Locations in the United States
Abbreviations: CDI/HOB = Hospital-onset, antibiotic-treated C. difficile infection (CDI) / Hospital–onset bacteremia/fungemia (HOB), HA-VTE= Healthcare-associated venous thromboembolism *Listing of EHR vendors does not imply endorsement by the vendors. 
Site Site Name EHR Vendor* Measures Site Leads
1 Billings Clinic Oracle/Cerner Glycemic Control Randy Thompson, MD
Lisa Ranes, RD, LN, CDCES
2 Geisinger Epic CDI/HOB, RPS Mark Shelly, MD
3 HCA Healthcare Meditech, Allscripts, Oracle/Cerner CDI/HOB, Glycemic Control Kenneth Sands, MD, MPH
William Gregg, MD, MS, MPH
4 Mass General Brigham Epic Sepsis Sayon Dutta, MD, MPH
Chanu Rhee, MD, MPH
5 Michigan Medicine Epic Glycemic Control,
Michael Lanham, MD
6 Nebraska Medicine Epic Glycemic Control Andjela Drincic, MD
Ron Carson
7 University of California, Davis Medical Center Epic Glycemic Control Greg Maynard, MD, MS, MHM
Yauheni Solad, MD, MHS, MBA
8 University of North Carolina Hospitals Epic CDI/HOB, RPS Lisa Stancill, MPH
9 University of Oklahoma Health Sciences Center Epic HA-VTE Aaron Wendelboe, PhD
Justin Dvorak, PhD
10 University of Rochester Medical Center Epic CDI/HOB Brenda Tesini, MD
11 Yale New Haven Health Epic Glycemic Control Hyung Paek, MD, MSEE


  • 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)


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

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).

For additional information, please contact NHSN@cdc.gov