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This page provides information for implementers and hospital staff on how FHIR will utilize NHSNLink to exchange hospital data between facilities and NHSN.</p></div></div> <div class="card tp-on-this-page mb-3 tp-on-this-page-large d-block " data-sid=""> <div class="card-header"> <strong>On This Page</strong> </div> <div class="row no-gutters"> <ul class="col-md-6 float-left list-group list-group-flush"> <li class="list-group-item"><a href="#anchor_24110">About FHIR</a></li><li class="list-group-item"><a href="#anchor_01227">About NHSN FHIR dQMs</a></li><li class="list-group-item"><a href="#anchor_14754">Is Your Facility FHIR Ready?</a></li> </ul> <ul class="col-md-6 float-right list-group list-group-flush"> <li class="list-group-item"><a href="#anchor_96959">About NHSNLink</a></li><li class="list-group-item"><a href="#anchor_72781">Data Security and Privacy</a></li> </ul> </div> </div> </div></div><div class="row "><div class="col-12 col-md-12"><div class="card border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_24110" name="About%20FHIR" title="About FHIR"></a><h2 class="card-header h4 bg-primary rounded-0">About FHIR</h2><div class="card-body bg-white"><p>Fast Healthcare Interoperability Resources® (<a href="https://www.hl7.org/fhir/" class="tp-link-policy" data-domain-ext="org">FHIR<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a>) 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.</p> <div class="table-responsive"> <table class="table-bordered table-striped bg-gray-l4 table-hover table-hover-light"> <caption class="sr-only">Difference between Manual, Semi-Automated, and Digital Quality Measures</caption> <thead class="bg-tertiary"> <tr> <th class="p-2"><strong>With Manual or Semi-Automated Measures</strong></th> <th class="p-2">With Digital Quality Measures</th> </tr> </thead> <tbody> <tr> <td class="p-2">Data standards are specific to the measure and the organization to which they are reported</td> <td class="p-2">Data are represented using nationally recognized standards across the EHR vendors, facilities, and agencies</td> </tr> <tr> <td class="p-2">Data are pushed (NHSN waits for the facility to transmit data)</td> <td class="p-2">Data can be pulled, making real-time surveillance feasible</td> </tr> <tr> <td class="p-2">Data are often aggregated, <em>facility</em>-level risk adjustment is typical</td> <td class="p-2">Data are at the patient level, <em>patient</em>-level risk adjustment is possible</td> </tr> <tr> <td class="p-2">Measures are pre-determined before transmission</td> <td class="p-2">Measures can be adapted after data transmission</td> </tr> </tbody> </table> </div> <div class="table-responsive"></div> </div></div><div id="accordion-1" class="accordion indicator-plus accordion-white mb-3" role="tablist"><div class="card bar"><div class="card"><button class="card-header collapsed" tabindex="0" role="tab" id="accordion-1-card-1" data-target="#accordion-1-collapse-1" data-toggle="collapse" aria-expanded="false" data-controls="accordion-1-collapse-1"> <span class="card-title btn btn-link"> <a class="onThisPageAnchor" id="anchor_01227" name="anchor_01227" title="About NHSN FHIR dQMs"></a> <span>About NHSN FHIR dQMs</span> </span> </button> <div aria-labelledby="accordion-1-card-1" class="collapse d-print-block false collapsed" id="accordion-1-collapse-1" role="tab"> <div class="card-body"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>Healthcare facilities can use FHIR application programming interfaces (APIs) to report <a href="https://ecqi.healthit.gov/dqm" class="tp-link-policy" data-domain-ext="gov">digital quality measures<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a> (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.</p> </div></div><div class="card border-0 rounded-0 mb-3"><div class="card-header h4 rounded-0">NHSN Digital Quality Measures (dQMs) Under Development</div><div class="card-body "><p><a id="anchor_98483"></a>Several concepts are under exploration and development by NHSN as dQMs. Where possible, NHSN will strive to align with future CMS dQM initiatives.</p> <table class="table-bordered table-striped bg-gray-l4 table-hover table-hover-light"> <caption class="sr-only">Table 1: NHSN Digital Quality Measures (dQMs) Under Development</caption> <thead class="bg-tertiary"> <tr> <th class="p-2"><strong>Measure</strong></th> <th class="p-2"><strong>Description</strong></th> </tr> </thead> <tbody> <tr> <td class="p-2">Healthcare facility-onset, antibiotic-treated <em>C. difficile</em> infection (CDI)</td> <td class="p-2">Rate of hospital-onset CDI events among hospitalized patients as measured by a combination of laboratory findings and medication treatments</td> </tr> <tr> <td class="p-2">Hospital-onset bacteremia and fungemia (HOB)</td> <td class="p-2">Rate of HOB events among hospitalized patients as measured by microbiology findings (irrespective of organism or device)</td> </tr> <tr> <td class="p-2">Healthcare-associated venous thromboembolism (VTE)</td> <td class="p-2">Feasibility exploration of using FHIR API to automatically extract and generate VTE prophylaxis and VTE outcome rates</td> </tr> <tr> <td class="p-2">Inpatient medication-related hypoglycemia</td> <td class="p-2">Rate of hypoglycemia events among hospitalized patients treated with diabetes medications</td> </tr> <tr> <td class="p-2">Inpatient hyperglycemia</td> <td class="p-2">Rate of hyperglycemia events among hospitalized patients with diabetes</td> </tr> <tr> <td class="p-2">Respiratory Pathogen Surveillance</td> <td class="p-2">Rate of confirmed positive cases/events of influenza, respiratory syncytial virus, or COVID-19 among hospitalized patients</td> </tr> <tr> <td class="p-2">Sepsis</td> <td class="p-2">Feasibility exploration of using FHIR API to automatically extract and generate sepsis-related data elements from an EHR</td> </tr> <tr> <td>Late Onset Sepsis / Meningitis (LOS/MEN)</td> <td>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</td> </tr> </tbody> </table> </div></div><div class="card border-0 rounded-0 mb-3"><div class="card-header h4 rounded-0">Clinical Query Language (CQL)</div><div class="card-body "><p>The NHSN FHIR dQM defines NHSN measure concepts using HL7 <a href="http://cql.hl7.org/history.html" class="tp-link-policy" data-domain-ext="org">clinical query language<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a> (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 <a href="https://ecqi.healthit.gov/sites/default/files/CMSdQMStrategicRoadmap_032822.pdf" target="_blank" class="tp-link-policy" data-domain-ext="gov">CMS Digital Quality Measurement Strategic Roadmap<span aria-label="pdf icon" class="sr-only" role="img"></span><span class="fi cdc-icon-pdf x16 fill-pdf" alt="" aria-hidden="true"></span><span class="file-details"></span><span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a>.</p> <p>The NHSN FHIR dQM CQL defines the following:</p> <ul> <li>Patients of interest eligible for the NHSN dQM, as defined by the NHSN protocol</li> <li>Data requirements and value sets for identifying the patients of interest that NHSNLink will pull (see <a href="/nhsn/fhirportal/about.html#anchor_96959">About NHSNLink</a>)</li> <li>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</li> <li>Additional patient-level data for stratification, risk adjustment, identifying social determinants of health, and patient matching</li> </ul> <p>See the NHSN dQM Implementation Guide <strong>{coming soon}</strong> for additional information.</p> </div></div></div> </div></div></div></div><div class="card border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_14754" name="Is%20Your%20Facility%20FHIR%20Ready?" title="Is Your Facility FHIR Ready?"></a><div class="card-body bg-tertiary"><h2 class="card-title mb-1 h2 mb-4 text-left">Is Your Facility FHIR Ready?</h2><p>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:</p> <p><span><img decoding="async" class="mw-100" src="/nhsn/images/checkmark.png?_=20163" alt="checkmark"></span> Are your FHIR R4 APIs deployed to your production environment?</p> <p><span><img decoding="async" class="mw-100" src="/nhsn/images/checkmark.png?_=20163" alt="checkmark"></span> Do your FHIR R4 APIs conform to the <a href="https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi" class="tp-link-policy" data-domain-ext="gov">US Core Data for Interoperability<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a> standard?</p> <p><span><img decoding="async" class="mw-100" src="/nhsn/images/checkmark.png?_=20163" alt="checkmark"></span> 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?</p> </div></div></div></div><div class="row "><div class="col-md-12"><div class="card border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_96959" name="About%20NHSNLink" title="About NHSNLink"></a><h2 class="card-header h4 bg-primary rounded-0">About NHSNLink</h2><div class="card-body bg-white"><p class="text-center"><span><img decoding="async" class="mw-100" src="/nhsn/images/nhsnlink.png?_=43570" alt="nhsnlink logo"></span></p> <p>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.</p> </div></div><div id="accordion-2" class="accordion indicator-plus accordion-white mb-3" role="tablist"><div class="card bar"><div class="card"><button class="card-header collapsed" tabindex="0" role="tab" id="accordion-2-card-1" data-target="#accordion-2-collapse-1" data-toggle="collapse" aria-expanded="false" data-controls="accordion-2-collapse-1"> <span class="card-title btn btn-link"> <span>How NHSNLink Works</span> </span> </button> <div aria-labelledby="accordion-2-card-1" class="collapse d-print-block false collapsed" id="accordion-2-collapse-1" role="tab"> <div class="card-body"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>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 (<a href="/nhsn/nhsncolab/index.html">deployed)</a> in Epic and Oracle/Cerner EHRs, and can customize queries when an EHR has unique requirements.</p> <p>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.</p> </div></div> <div class="card border-0 rounded-0 mb-3 "><img decoding="async" class="card-img-top img-fluid p-2 rounded-0 img-fluid" alt="How NHSNLink interacts with NHSN and facility environment." title="NHSNLink Interactions" src="/nhsn/fhirportal/img/nhsnlink-interactions.png?_=88990"><div class="card-body image-with-caption"><p>*Signals facility readiness to report digital quality measure and that facility has signed NHSN data-use agreements for secure data-sharing.</p> <p>API = application programing interface; dQM = digital quality measure; FHIR = Fast Healthcare Interoperability Resources; SAMS = Secure Access Management Services.</p> </div></div> <div class="card border-0 rounded-0 mb-3"><div class="card-body "><ol> <li>Confirm facility enrollment in digital measure reporting plan; request and receive NHSN FHIR dQM</li> <li>Request and receive Patients of Interest and query data defined by dQM</li> <li>Evaluate and filter data as defined by dQM</li> <li>Submit MeasureReport bundle for patients meeting dQM definition</li> <li>NHSN ingests and analyzes MeasureReport bundles and makes reports available via secure NHSN user interface</li> </ol> </div></div></div> </div></div></div><div class="card bar"><div class="card"><button class="card-header collapsed" tabindex="0" role="tab" id="accordion-2-card-2" data-target="#accordion-2-collapse-2" data-toggle="collapse" aria-expanded="false" data-controls="accordion-2-collapse-2"> <span class="card-title btn btn-link"> <a class="onThisPageAnchor" id="anchor_72781" name="anchor_72781" title="Data Security and Privacy"></a> <span>Data Security and Privacy</span> </span> </button> <div aria-labelledby="accordion-2-card-2" class="collapse d-print-block false collapsed" id="accordion-2-collapse-2" role="tab"> <div class="card-body"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>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.</p> </div></div></div> </div></div></div></div></div></div><div class="row "><div class="col-md-4"><a href="/nhsn/fhirportal/index.html" class="bg-gray-l2 ds-8 mb-3 nav-btn nav-btn-vertical mb-3 noLinking noDecoration card"><div class="card-icon text-center bg-gray-l2"><span aria-label="book icon" class="sr-only" role="img"></span><span class="fi cdc-icon-book_01 icon icon-fw fill-p x48" alt="" aria-hidden="true"></span></div><div class="card-body bg-gray-l2"><div class="card-title mb-1 h4 mb text-center">Digital Quality Measures</div></div></a></div><div class="col-md-4"><a href="/nhsn/fhirportal/faqs.html" class="bg-gray-l2 ds-8 mb-3 nav-btn nav-btn-vertical mb-3 noLinking noDecoration card"><div class="card-icon text-center bg-gray-l2"><span aria-label="question icon" class="sr-only" role="img"></span><span class="fi cdc-icon-question_01 icon icon-fw fill-p x48" alt="" aria-hidden="true"></span></div><div class="card-body bg-gray-l2"><div class="card-title mb-1 h4 mb text-center">FAQs</div></div></a></div><div class="col-md-4"><a href="/nhsn/nhsncolab/index.html" class="bg-gray-l2 ds-8 mb-3 nav-btn nav-btn-vertical mb-3 noLinking noDecoration card"><div class="card-icon text-center bg-gray-l2"><span aria-label="users solid icon" class="sr-only" role="img"></span><span class="fi cdc-icon-users-solid icon icon-fw fill-p x48" alt="" aria-hidden="true"></span></div><div class="card-body bg-gray-l2"><div class="card-title mb-1 h4 mb text-center">NHSNCoLab</div></div></a></div></div><div class="row "><div class="col-md-12"></div></div> </div> </div> </div> <div class="row d-none d-lg-block"> <div class="col pca"> <B>Error processing SSI file</B><BR> </div> </div> <div class="row share-row last-reviewed-row"> <div class="col-md last-reviewed"> Last Reviewed: <span id="last-reviewed-date">April 24, 2024</span> <div class="d-none 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