Actors and Use Cases

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

Page standards status: Informative

Actors
Use Cases
Use Case 1: Acute Care Hospital (ACH) Monthly
Use Case 2: ACH Daily
Use Case 3: Long-term Care (LTC) Monthly

Actors

This implementation guide (IG) defines the following actors: a data source, a digital quality measure (dQM) evaluation engine, a measure source, and a data aggregator.

Note: A given system may play the role of multiple actors. For example, an electronic health record (EHR) could serve as both the data source and dQM evaluation engine when calculating a measure internally. Likewise, a system such as NHSNLink, which resides at the National Healthcare Safety Network (NHSN) and queries the data source remotely may act as the dQM evaluation engine and MeasureReport recipient, evaluating the data, producing, and validating MeasureReport bundles.

The actors defined here are used in the Reporting Scenarios section of the Specification page in this IG.

Data Source: The EHRs for facilities reporting to NHSN serve as the data source
Measure Source: NHSN stores Fast Healthcare Interoperability Resources (FHIR) resources used for dQM reporting, such as Measure, Library, ValueSet, etc., that systems can query for the latest measure content before querying the EHR FHIR server and performing measure evaluation
dQM Evaluation Engine: The engine requests and queries patient data from the EHR FHIR server and evaluates the data against the dQM retrieved from the Measure Source. The dQM evaluation engine validates the data against the profiles in this IG
Data Aggregator: NHSN ingests the MeasureReport bundles from the dQM evaluation engine, evaluating the data, producing, and validating MeasureReport bundles

Use Cases

This IG serves a wide variety of NHSN use cases.

Use Case 1: Acute Care Hospital (ACH) Monthly

ACH Monthly Description

The NHSN ACH Monthly dQM enables facilities to electronically report line-level data to NHSN which then provides monthly event rates back to the facility. These dQMs include these modules:

Glycemic Control (includes hyperglycemia and medication-related hypoglycemia events)
Bacteremia & Fungemia Surveillance (includes hospital-onset bacteremia & fungemia events)
Clostridioides difficile Surveillance (includes healthcare facility-onset, antibiotic-treated Clostridioides difficile infection [HT-CDI] events)
Sepsis Surveillance (includes adult community-onset sepsis events)
Venous Thromboembolism (VTE)-related Prophylaxis and event rates (under development)
Late-Onset Sepsis / Meningitis (LOS/MEN) (under development)
Hospital-onset Acute Kidney Injury (HAKI) (under development)
Opioid-related Adverse Events (ORAE) (under development)

ACH Monthly Patients of Interest

The facility works with NHSN to define a patients of interest (POI) list. The POI list is often the facility’s entire inpatient, emergency, and observation population. The data for the patients on the list are then extracted and evaluated against the measure criteria for the initial population.

ACH Monthly Initial Population

All encounters for patients of any age in an emergency department (ED), observation, or inpatient location or all encounters for patients of any age with an ED, observation, inpatient, or short stay status during the measurement period. Once an individual patient meets the population criteria, the line-level data needed to calculate metrics, benchmark, and/or stratify the individual protocol measures is submitted to NHSN.

ACH Monthly Additional Use Case Information References

For specific information on the individual NHSN protocols and metrics see: Acute Care / Critical Access Hospitals (ACH) | NHSN | CDC Example ACH Monthly Initial Population Library (CQL) Example ACH Monthly Measure Library

ACH Monthly Submission Bundle Examples

ACH Monthly MeasureReport Examples

ACH Monthly List Examples

ACH Monthly Device Examples

ACH Monthly Patient Examples

ACH Monthly Encounter Examples

ACH Monthly Location Examples

ACH Monthly Coverage Examples

ACH Monthly Condition Examples

ACH Monthly MedicationAdministration Examples

ACH Monthly MedicationRequest Examples

ACH Monthly DiagnosticReport Examples

ACH Monthly Specimen Examples

ACH Monthly ServiceRequest Examples

ACH Monthly Procedure Examples

Use Case 2: ACH Daily

ACH Daily Description

The NHSN Respiratory Pathogens Surveillance (RPS) module enables the measurement of facility and unit-specific incidence and prevalence of Coronavirus 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV) disease among patients admitted to the hospital (inpatient, observation, or short stay status), and specific associated patient outcomes. The RPS module offers a mechanism for ongoing monitoring of infectious respiratory viral illness among hospitalized patients with minimal human resource expenditure via 100% electronically automated data capture. This initial version of the module is based on electronic data capture and upload of demographic, administrative, and clinical data from the facility’s electronic source systems such as the EHR, patient registration system (admission, discharge, and transfer [ADT] data), laboratory information system, and pharmacy electronic medication administration system.

RPS module data collected via the ACH Daily dQM may be used by facilities for quality improvement and patient care planning purposes, as well as by local, state, and federal public health agencies in coordination and response to public health outbreaks. Facilities will have access to their data via the analysis functions of NHSN.

ACH Daily Patients of Interest

The facility will work with NHSN to define a POI list. This is often the entire inpatient, observation, or short stay population at the facility. The data for the patients in the list are then extracted and evaluated against the measure criteria for the initial population (see below).

ACH Daily Initial Population

All encounters with an inpatient, observation, or short stay status for patients of any age during the measurement period.

ACH Daily Additional Use Case Information References

https://www.cdc.gov/nhsn/acute-care-hospital/index.html

ACH Daily Submission Bundle Examples

ACH Daily MeasureReport Examples

ACH Daily List Examples

ACH Daily Patient Examples

ACH Daily Encounter Examples

ACH Daily Location Examples

ACH Daily Coverage Examples

ACH Daily Condition Examples

ACH Daily MedicationAdministration Examples

ACH Daily MedicationRequest Examples

ACH Daily DiagnosticReport Examples

DiagnosticReport - Example ACH Daily - Initial Population Pass

ACH Daily Specimen Examples

ACH Daily ServiceRequest Examples

ACH Daily Procedure Examples

Procedure - Example ACH Daily Negative PCR Intubation

Use Case 3: Long-term Care (LTC) Monthly

LTC Monthly Description

The NHSN LTC Monthly dQM enables facilities to electronically report line-level data to NHSN for the following modules, which provide monthly event rates back to the facility. These dQMs include:

• Long-term Care Facilities Antimicrobial Use (LTC-AU) Module

LTC Monthly Patients of Interest

The facility works with NHSN to define a patients of interest (POI) list. The POI list is often the long-term care facility’s entire inpatient population. The data for the patients on the list are then extracted and evaluated against the measure criteria for the initial population.