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 CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package Implementation Guide (IG)

Release 3.0.0

This section lists the changes to the IG compared with Release 2.0.0. This release adds Long-term Care (LTC) Monthly reporting, updates Acute Care Hospital (ACH) Daily and Monthly submission requirements, and revises data selection and returned content. Upgrade planning should address patient identifiers, category coding, laboratory report references, and CQL regression testing.

Impact labels:

  • Breaking change means previously conformant data or system behavior may no longer meet the requirements.
  • Implementation change identifies processing or output changes that require review even when resources remain valid.
  • New capability identifies added functionality.
  • Clarification explains existing requirements.
  • Compatibility review required identifies a change whose effect on conformance needs confirmation before publication.

Use Cases And Reporting Workflows

  • Added LTC Monthly reporting — New capability. Added the LTC Monthly Initial Population Measure, its CQL library, supporting profiles, and submission examples.
    • Supports coverage, encounters, laboratory results, medications, medication administrations, medication requests, and specimens, with pneumonia and urinary tract infection submission scenarios.
    • Implementation impact: Organizations implementing LTC Monthly reporting should review the new data requirements and implement the corresponding extraction, measure evaluation, and submission support.

Profiles And Submission Requirements

  • Required patient medical record identifiers — Breaking change. Added a medical record number (MRN) identifier slice to the Cross-Measure Patient Profile, used across ACH Daily, ACH Monthly, and LTC Monthly reporting.
    • Implementation impact: Ensure submitted patients include an MRN with the required identifier namespace and medical record (MR) identifier-type coding. Update patient mapping and validation tests.
  • Restricted Procedure and ServiceRequest categories — Breaking change. Changed Procedure category bindings from example to required and ServiceRequest category bindings from extensible to required in the ACH Daily and ACH Monthly profiles.
    • Implementation impact: Review category mappings against the bound value sets in the ACH Monthly Procedure and ACH Daily ServiceRequest profiles and their ACH Daily Procedure and ACH Daily ServiceRequest counterparts. These changes restrict permitted category values without making the category elements mandatory.
    • Rationale: The Data Dictionaries attribute the category restrictions to beta bundle reduction analysis. Related CQL changes filter the resources returned for reporting.
  • Required category coding in conditions and laboratory reports — Breaking change. Required coding within the ACH Monthly Condition US Core category slice and the laboratory category slices of ACH Daily and ACH Monthly DiagnosticReport profiles.
  • Tightened ACH Daily laboratory report references — Breaking change. Updated ACH Daily DiagnosticReport to reference Cross-Measure Patient and ACH Daily Specimen, and to require bundled result references when results are supplied.
    • Implementation impact: Review referenced resource conformance and bundle assembly. The result element remains optional; each supplied result must include the required reference.
  • Relaxed selected ACH Daily constraints — Implementation change. Made the dosage route optional in ACH Daily MedicationRequest, removed NHSN-specific Must Support and bundled-reference constraints from Observation.basedOn, and removed NHSN-specific Must Support from Location.address.use.
    • Implementation impact: Update NHSN-specific validation and support rules. These changes do not prohibit the affected data or remove requirements inherited from base profiles.

Terminology

  • Updated medication reason bindings — Implementation change. Updated ACH Daily MedicationRequest and LTC Monthly MedicationRequest reason bindings and ACH Monthly MedicationAdministration reason binding to the Medication Request Reason ValueSet, combining US Core condition codes and QI-Core negation reason codes.
    • Implementation impact: Review reason-code mapping for the affected medication profiles, including reasons a medication was not requested or administered.
  • Aligned specimen and laboratory terminology requirements — Compatibility review required. The Data Dictionaries record a change from required to extensible binding for Specimen type in all three reporting use cases, and example-to-extensible binding changes for laboratory Observation method and for ACH Monthly/LTC Monthly laboratory component codes.
    • Implementation impact: Review terminology validation against the applicable profiles. Confirm which entries change IG requirements and which correct the dictionaries' descriptions of existing requirements before finalizing compatibility labels.

Measure And CQL Logic

  • Reduced patient and requester/performer content — Implementation change. Updated returned patient content across ACH Daily, ACH Monthly, and LTC Monthly reporting to omit race, ethnicity, tribal affiliation, patient contacts, and communication information. Revised requester/performer content for selected clinical resources.
    • Implementation impact: Update expected bundle content and downstream processing tests. The dictionaries identify additional requester/performer exclusions; confirm their implementation in the released CQL. An exclusion from generated output does not by itself prohibit the element in a FHIR profile.
    • Rationale: The Data Dictionaries identify beta bundle reduction analysis as the reason for the exclusions. The CQL change records document removal of patient fields from the shared resource creation library.
  • Filtered Procedure and ServiceRequest output — Implementation change. Updated ACH Monthly CQL to select Procedures and ServiceRequests by category and ACH Daily CQL to filter ServiceRequests by category.
    • Implementation impact: Test which records are returned, including records with missing or nonmatching categories. For ServiceRequests, the change records identify laboratory procedure, surgical procedure, and imaging categories. Confirm the Procedure category list against the released value set and CQL.
  • Revised ACH Daily lookback selection — Implementation change. Based Observation and DiagnosticReport lookbacks on initial-population timing. Updated pre-admission selection to use Initial Population encounters instead of inpatient encounters alone.
    • Implementation impact: Retest pre-admission and encounter-boundary cases, including observation and location-based encounters. Selected records may change even when submitted resources remain valid.
    • Rationale: The ACH Daily CQL change record states that the pre-admission change captures observation and location-based encounters.
  • Corrected resource construction — Implementation change. Updated ACH Monthly handling of Observation reference ranges and MedicationRequest dosage instructions, ACH Daily Procedure extension handling, and LTC Monthly minimal Patient construction.
    • Implementation impact: Update the measure libraries and regression-test generated resources. The ACH corrections use local resource-construction functions; LTC minimal Patient construction aligns with ACH Daily and Monthly handling.

Narrative Guidance

  • Added NHSN Requirements Code Status Grace Period — Implementation change. Updated the Validation and Pre-Qualification guidance to establish a three-year grace period for terminology validation, allowing previously valid codes that have since become inactive, retired, deprecated, or remapped to remain acceptable when they were valid members of the applicable value set.
    • Implementation impact: Update terminology validation processes to account for historical code validity within applicable value sets rather than relying solely on current code status. Added references to the National Library of Medicine's Value Set Authority Center (VSAC) to support terminology validation.

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:

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:

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

National Center for Emerging and Zoonotic Infectious Diseases