Overview

The content of The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Digital Quality Measures (dQMs) Content Package Implementation Guide (IG) defines the standards for reporting the initial population and supplemental data elements needed for calculating metrics for the CDC NHSN dQMs Content Package IG. This IG does not define how to calculate a specific NHSN dQM or event of interest.

This IG complies with the NHSN dQM Reporting IG, published by Health Level Seven International (HL7®) International for general requirements for submissions to NHSN. The NHSN dQM Reporting IG specifications will be revised in accordance with any changes to NHSN reporting requirements. The figure below shows how the CDC NHSN dQM IG fits into the broader landscape of HL7 FHIR and NHSN IGs.

Figure 1 illustrates the hierarchical relationship between the core HL7 FHIR implementation guidance, the CDC NHSN Digital Quality Measures (dQM) Content Package IG, and specific NHSN measure definitions. Figure 1 shows how the NHSN dQM Content Package IG extends and specializes the HL7 Framework IG. It situates individual NHSN measure definitions and their associated FHIR profiles and CQL logic within the context of the overall reporting framework required for electronic quality measurement and public health surveillance.

CDC Surveillance and Quality Measurement is supported by the balloted framework IG HL7 NHSN dQM Reporting IG, which defines the general framework for digital quality measure reporting. The dQM Reporting IG includes the foundational FHIR structures and conformance expectations upon which NHSN’s content builds, including definitions for generalized submission bundle requirements. The HL7 NHSN dQM Reporting IG inherits the core profiles and normative guidance from the balloted HL7 Framework IG.

Beneath this framework layer is the NHSN content package IG CDC NHSN dQM IG. This box contains two labeled subsections for measure groupings are ACH Monthly Profiles and CQL (indicating a group of acute care hospital [ACH] monthly measure profiles accompanied by their associated Clinical Quality Language [CQL] definitions) and ACH Daily Profiles and CQL (indicating a corresponding group of ACH daily measure profiles with CQL). Each of these measures is connected to the respective ACH measure group which defines one or more FHIR profiles and corresponding CQL logic contained in the content package within the CDC NHSN IG.

The CDC NHSN dQM IG contains specific NHSN measure concepts defined in protocols and metrics that relate to the Initial Population Measures. The listed measures are Glycemic Control, Adult Sepsis, Bacteremia and Fungemia, C. difficile Infection, and Respiratory Pathogens Surveillance (RPS).

The figure shows the source dependencies on the left side of the diagram:

1. HL7 balloted Framework IGs - indicating the set of formally balloted HL7 IGs that define general FHIR quality and measure reporting frameworks upon which the NHSN dQM Reporting IG depends.
2. NHSN Content Package IGs - indicating the NHSN-specific content package that includes measure profiles and definitions conformant to the reporting framework.
3. NHSN Protocols and Metrics - representing the underlying clinical protocols, surveillance definitions and metric specifications established by NHSN that drive measure logic and patient–level data requirements.

At the bottom of the diagram, a horizontal label Patient-level Data spans the width of the figure, signifying that all of the measure reporting artifacts and profiles ultimately relate to patient-level data extraction, representation, and submission for quality measurement.

Purpose

These specifications define the data content requirements for submissions for the CDC NHSN dQMs Content Package to NHSN through NHSNLink.

Relationships to Other Standards

This IG has the following dependencies:

1. HL7 FHIR Release 4
2. US Core 6.1.0
3. US Core 3.1.1
4. QI Core 6.0.0
5. HL7 NHSN dQM 1.0.0
6. HL7 CRMI 1.0.0
7. Quality Measure IG 5.0.0
8. Clinical Quality Framework Common FHIR Assets 4.0.1
9. Data Exchange for Quality Measures (DEQM) 5.0.0

Audience

The audience for this work is all developers who want to enable their software systems to report surveillance data to the NHSN via FHIR dQMs.

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	Rick Geimer	Lantana Consulting Group	rick.geimer@lantanagroup.com
Primary Editor	Corey Spears	Lantana Consulting Group	corey.spears@lantanagroup.com
Primary Editor	Aaron Nusstein	Lantana Consulting Group	aaron.nusstein@lantanagroup.com
Co-Editor	Andrea Benin	CDC	aqb4@cdc.gov
Co-Editor	Kristina Betz	CDC	rly7@cdc.gov
Co-Editor	Amrit Kerr	Lantana Consulting Group	amrit.kerr@lantanagroup.com
Co-Editor	Sheila Abner	CDC	sha8@cdc.gov
Co-Editor	Nadine Shehab	Lantana Consulting Group	ftn0@cdc.gov
Co-Editor	Jennifer Watkins	CACI	nub7@cdc.gov
Co-Editor	Raymond Dantes	CDC	vic5@cdc.gov
Co-Editor	David deRoode	Lantana Consulting Group	david.deroode@lantanagroup.com
Co-Editor	Zabrina Gonzaga	Lantana Consulting Group	zabrina.gonzaga@lantanagroup.com
Co-Editor	Sean McIlvenna	Lantana Consulting Group	sean.mcilvenna@lantanagroup.com
Co-Editor	Lynn Perrine	Lantana Consulting Group	lynn.perrine@lantanagroup.com
Co-Editor	Kim Figueroa	Lantana Consulting Group	kim.figueroa@lantanagroup.com
Co-Editor	Mary-Margaret Richter	Lantana Consulting Group	mm.richter@lantanagroup.com
Co-Editor	Shanai Thornton	Lantana Consulting Group	shanai.thornton@lantanagroup.com