CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
3.0.0 - Release 3 - draft United States of America flag

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v3.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

IG Change History

Page standards status: Informative

This provides a list of changes to the NHSN Measures Implementation Guide (IG)

Release 3.0.0

Added Long-term Care (LTC) Profiles and Examples

LTC FHIR Profiles:
LTC FHIR Examples:
LTC CQL Artifacts:

FHIR Profile Updates

ACH Monthly Profile Updates
  • ACH Monthly Event Condition
    • Changed Condition.category:us-core.coding cardinality from 0..* to 1..*.
    • Changed Condition.category:us-core.coding.system and Condition.category:us-core.coding.code cardinalities from 0..1 to 1..1. Existing Must Support designations are unchanged.
  • ACH Monthly Event Diagnostic Report (Lab)
    • Changed DiagnosticReport.category:LaboratorySlice.coding cardinality from 0..* to 1..*, retaining Must Support.
  • ACH Monthly Event MedicationAdministration
    • Removed the (NHSN-MS) annotation from the short description of medication[x]:medicationCodeableConcept.extension:notDoneValueSet. Must Support flags and the invariant prohibiting this extension are unchanged.
  • ACH Monthly Event Procedure
    • Replaced the example binding on Procedure.category with a required binding to the Procedure Category ValueSet. Cardinality remains 0..1.
  • ACH Monthly Event ServiceRequest
    • Replaced the extensible binding on ServiceRequest.category with a required binding to the Service Request Category ValueSet. Cardinality remains 0..*.
ACH Daily Profile Updates
  • ACH Daily Event Diagnostic Report (Lab)
    • Changed DiagnosticReport.category:LaboratorySlice.coding cardinality from 0..* to 1..*, retaining Must Support.
    • Changed the DiagnosticReport.subject reference target from QI-Core Patient to Cross-Measure Patient Profile.
    • Changed the DiagnosticReport.specimen reference target from the base FHIR Specimen resource to ACH Daily Event Specimen.
    • Added bundled aggregation to DiagnosticReport.result and a 1..1, Must Support requirement for DiagnosticReport.result.reference. The parent result element remains optional (0..*).
  • ACH Daily Event Encounter
    • Added an additional extensible binding on Encounter.class to the ACH Daily Encounter Class ValueSet for the initial population. The primary ActEncounterCode binding and existing initial-population invariants are unchanged.
  • ACH Daily Event Location
    • Removed NHSN-specific differential entries for Location.telecom, Location.address, and Location.address.use.
    • Removed Must Support from Location.address.use. Location.telecom and Location.address retain inherited Must Support requirements; cardinalities are unchanged.
  • ACH Daily Event Medication Administration
    • Removed the (NHSN-MS) annotation from the short description of medication[x]:medicationCodeableConcept.extension:notDoneValueSet. Must Support flags and the invariant prohibiting this extension are unchanged.
  • ACH Daily Event Medication Request
    • Added an explicit extensible binding on MedicationRequest.reasonCode to the Medication Request Reason ValueSet. Cardinality remains 0..*, with Must Support retained.
    • Changed MedicationRequest.dosageInstruction.route cardinality from 1..1 to 0..1, retaining Must Support and the extensible SNOMED CT Route Codes binding.
  • ACH Daily Event Observation
    • Removed NHSN-specific Must Support and bundled aggregation constraints from Observation.basedOn.
    • Removed the NHSN-specific 1..1 cardinality and Must Support constraints from Observation.basedOn.reference. The basedOn element remains permitted and optional.
  • ACH Daily Event Procedure
    • Replaced the example binding on Procedure.category with a required binding to the Procedure Category ValueSet. Cardinality remains 0..1.
  • ACH Daily Event ServiceRequest
    • Replaced the extensible binding on ServiceRequest.category with a required binding to the Service Request Category ValueSet. Cardinality remains 0..*.

CQL Updates

ACH Monthly CQL Updates:
  • ObservationLab no longer return the requester or performer.
  • MedicationRequest no longer return the requester or performer.
  • Procedure returns data only when the category is "Surgical procedure" or "Laboratory procedure".
  • ServiceRequest returns data only when the category is "Surgical procedure", "Laboratory procedure", or "Imaging". No longer return the requester or performer.
ACH Daily CQL Updates:
  • MedicationRequest no longer return the requester or performer.
  • ServiceRequest no longer return the requester or performer.
  • Observation lookback times are based on the initial population timing. No longer return the requester or performer.
  • DiagnosticReport lookback times are based on the initial population timing.
LTC Monthly CQL Updates:
  • ObservationLab no longer return the requester or performer.
  • MedicationRequest no longer return the requester or performer.
  • ServiceRequest no longer return the requester or performer.

Release 2.0.0

Updated the following IG dependencies:

This affected the following definitional artifacts:

Apply both US Core 6.1 Condition Profile constraints into a single

US Core 6.1 updates for Acute Care Hospital Daily Profiles:

Update ACH Monthly Profiles per the new Data Dictionary Requirements, in part based on updates to QI Core 6.0.0 and US Core 6.1.0: [MEASDEV-1799]

Updates for Acute Care Hospital Monthly Profiles:

Apply both US Core 6.1 Condition Profile constraints into a single

Update ACH Daily Profiles per the new Data Dictionary Requirements, in part based on updates to QI Core 6.0.0 and US Core 6.1.0: [MEASDEV-1806]

Updates for Acute Care Hospital Daily Profiles:

CQL Updates

ACH Monthly CQL Updates:

  • Condition
    • Condition resources no longer return severity, bodySite, recorder, stage, evidence, and note data elements
  • Coverage
    • Coverage resources no longer return class, policyholder, subscriber, subscriberId, dependent, relationship, order, network, costToBeneficiary, subrogation, and contract data elements
  • Device
    • Device resources no longer return deviceName.type, definition, udiCarrier, statusReason, distinctIdentifier, manufacturer, manufacturerDate, deviceName, specialization, version, property, owner, contact, location, url, note, and safety data elements
  • DiagnosticReport
    • DiagnosticReport category is constrained to only return Radiology, Cardiology, Pathology, and Laboratory codes. DiagnosticReport now prevents any other codes from being returned within the resource
    • DiagnosticReport resources designated with the DiagnosticReport Note profile no longer returns performer, resultsInterpreter, imagingStudy, and presentedForm data elements
  • Encounter
    • Encounter resources no longer return serviceType, priority, length, reasonReference, account, hospitalization.preAdmissionIdentifier, hospitalization.specialCourtesy, hospitalization.specialArrangement, hospitalization.destination data elements
  • Observation
    • Observation resources designated with the Laboratory Observation profile no longer return category.id, category.extension, category.coding.id, and category.coding.extension data elements
    • Observation resources designated with the Vital Signs Observation profile no longer return focus, performer, note, device and referenceRange.text data elements
  • MedicationRequest
    • MedicationRequest resources now specifically return the following data elements for dosageInstruction.timing: event, repeat, and code. Additionally, dosageInstruction.timing.repeat now specifically return the following data elements: bounds, count, countMax, duration, durationMax, durationUnit, frequency, frequencyMax, period, periodMax, periodUnit, dayOfWeek, timeOfDay, when, and offset
  • Procedure
    • Procedure resources no longer return extensions marked as qicore-recorded
    • Updated the code filter for procedure category to use '261004008' instead of '103693007'
  • ServiceRequest
    • ServiceRequest resources no longer return the requester data element

ACH Daily CQL Updates:

  • DiagnosticReport
    • DiagnosticReport category is constrained to only return Radiology, Cardiology, Pathology, and Laboratory codes. DiagnosticReport now prevents any other codes from being returned within the resource
  • Observation
    • Observation resources designated with the Laboratory Observation profile no longer return category.id, category.extension, category.coding.id, and category.coding.extension data elements
  • MedicationRequest
    • MedicationRequest resources now specifically return the following data elements for dosageInstruction.timing: event, repeat, and code. Additionally, dosageInstruction.timing.repeat now specifically return the following data elements: bounds, count, countMax, duration, durationMax, durationUnit, frequency, frequencyMax, period, periodMax, periodUnit, dayOfWeek, timeOfDay, when, and offset
  • Procedure
    • Procedure resources no longer return extensions marked as qicore-recorded
  • ServiceRequest
    • ServiceRequest resources no longer return the requester data element
  • SharedResourceCreation CQL Updates:
  • Patient
    • Patient resources now return extensions marked as tribalAffiliation and sex. Additionally, patient resources no longer return address.id, address.extension, photo, contact.id, contact.extension, communication.id, communication.extension, communication.modifierExtension, generalPractitioner, managingOrganization, and link.id data elements

Release 1.0.0

  • Initial version