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About FHIR and NHSNLink

Making the Connection

The National Healthcare Safety Network’s (NHSN) effort to modernize hospital surveillance through Digital Quality Measures (dQMs) using Fast Healthcare Interoperability Reporting (FHIR) will transform hospital reporting. This page provides information for implementers and hospital staff on how FHIR will utilize NHSNLink to exchange hospital data between facilities and NHSN.

On This Page

About FHIR
About NHSN FHIR dQMs
Is Your Facility FHIR Ready?

About NHSNLink
Data Security and Privacy

About FHIR

Fast Healthcare Interoperability Resources® (FHIR) is a Health Level Seven International® (HL7) standard for exchanging healthcare information electronically between information systems. FHIR has several advantages over other methods of reporting, as shown in the figure below.

Difference between Manual, Semi-Automated, and Digital Quality Measures
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 product 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.

NHSN Digital Quality Measures (dQMs) Under Development

Several concepts are under exploration and development by NHSN as dQMs. Where possible, NHSN will strive to align with future CMS dQM initiatives.

Table 1: NHSN Digital Quality Measures (dQMs) Under Development
Measure	Description
Healthcare facility-onset, antibiotic-treated C. difficile infection (CDI)	Rate of hospital-onset CDI events among hospitalized patients as measured by a combination of laboratory findings and medication treatments
Hospital-onset bacteremia and fungemia (HOB)	Rate of HOB events among hospitalized patients as measured by microbiology findings (irrespective of organism or device)
Healthcare-associated venous thromboembolism (VTE)	Feasibility exploration of using FHIR API to automatically extract and generate VTE prophylaxis and VTE outcome rates
Inpatient medication-related hypoglycemia	Rate of hypoglycemia events among hospitalized patients treated with diabetes medications
Inpatient hyperglycemia	Rate of hyperglycemia events among hospitalized patients with diabetes
Respiratory Pathogen Surveillance	Rate of confirmed positive cases/events of influenza, respiratory syncytial virus, or COVID-19 among hospitalized patients
Sepsis	Feasibility exploration of using FHIR API to automatically extract and generate sepsis-related data elements from an EHR
Late Onset Sepsis / Meningitis (LOS/MEN)	Rate of LOS and MEN events among selected hospitalized infants who meet event criteria as per the NHSN LOS/MEN protocol based on a combination of laboratory findings and medication treatments

Clinical Query Language (CQL)

The NHSN FHIR dQM defines NHSN measure concepts using HL7 clinical query language (CQL). CQL is machine-readable and structured on the FHIR data model. The CDC NHSN dQM definition aligns with the Centers for Medicaid and Medicare Services dQM definition in the CMS Digital Quality Measurement Strategic Roadmap.

The NHSN FHIR dQM CQL defines the following:

Patients of interest eligible for the NHSN dQM, as defined by the NHSN protocol
Data requirements and value sets for identifying the patients of interest that NHSNLink will pull (see About NHSNLink)
Patient-level data required for the patients of interest as defined by the dQM, including the numerator and denominator as defined by the NHSN protocol
Additional patient-level data for stratification, risk adjustment, identifying social determinants of health, and patient matching

See the NHSN dQM Implementation Guide {coming soon} for additional information.

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:

checkmark Are your FHIR R4 APIs deployed to your production environment?

checkmark Do your FHIR R4 APIs conform to the US Core Data for Interoperability standard?

checkmark Do you know your EHR vendor’s policies for access of your FHIR R4 APIs by third-party applications for public health and regulatory reporting?

About NHSNLink

nhsnlink logo

NHSNLink is an open-source FHIR application for public health reporting. It uses a query engine to connect directly to a healthcare facility’s EHR through the FHIR API to identify patients who meet the criteria for an NHSN dQM. It generates patient-level reports with administrative and clinical data in a MeasureReport Bundle and passes the MeasureReport Bundle to NHSN through a FHIR gateway for NHSN quality and analytic applications. Data flow is only one way, with no write-back to the EHR.

NHSNLink obtains data in their source format, normalizes to a standard, evaluates against the dQM definition, validates against HL7 standards, and delivers data into NHSN’s data submission portal. NHSNLink has been (deployed) in Epic and Oracle/Cerner EHRs, and can customize queries when an EHR has unique requirements.

NHSNLink applies criteria from the dQM that can be easily adapted in response to NHSN protocol modifications or external factors (such as changes to the EHR, the FHIR standard, or the technical requirements of NHSN’s data-submission portal) while remaining compatible with the EHR system and NHSN’s data-submission process. The dQMs also apply measure definitions consistently, which decreases variability from individual interpretations of the published NHSN protocols.

How NHSNLink interacts with NHSN and facility environment.

*Signals facility readiness to report digital quality measure and that facility has signed NHSN data-use agreements for secure data-sharing.

API = application programing interface; dQM = digital quality measure; FHIR = Fast Healthcare Interoperability Resources; SAMS = Secure Access Management Services.

Confirm facility enrollment in digital measure reporting plan; request and receive NHSN FHIR dQM
Request and receive Patients of Interest and query data defined by dQM
Evaluate and filter data as defined by dQM
Submit MeasureReport bundle for patients meeting dQM definition
NHSN ingests and analyzes MeasureReport bundles and makes reports available via secure NHSN user interface

Because NHSNLink submits the normalized data to NHSN’s digital reporting tables, it must adhere to certain technical specifications and security protocols. NHSNLink maintains an audit trail of its operations and, where required, includes report-submission metadata to allow downstream analytics.

Digital Quality Measures

FAQs

NHSNCoLab

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