Actors and Use Cases

National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting Implementation Guide
1.0.0 - STU 1 United States of America flag

This page is part of the National Healthcare Safety Network (NHSN) Digital Quality Measure (dQM) Reporting Implementation Guide (v1.0.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Page standards status: Informative

Actors
Use Cases

Actors

This implementation guide (IG) defines the following actors. Note, it is possible for a given system to play the role of multiple actors. For example, an EHR could be both the Data Source and dQM Evaluation Engine when calculating a measure internally. Likewise a system residing at NHSN that queries the Data Source remotely, evaluates those data, produces MeasureReport bundles, and validates the result may be both the dQM Evaluation Engine and MeasureReport Recipient.

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

dQM Evaluation Engine— A system that retrieves data from the Data Source and evaluates those data against one or more measures retrieved from the Measure Source. The resulting MeasureReport bundle and related resources are then sent to the MeasureReport recipient. The dQM Evaluation Engine acts as a US Core Client, a DEQM Reporter Client, and implements the $evaluate-measure operation.
Data Source— A system containing data (typically patient data, but could be situational awareness data) that will be evaluated against one or more measures. This may be a FHIR server, an EHR with a FHIR endpoint (facade), an internal data store when the Data Source and dQM Evaluation Engine actors are played by the same system such as an EHR that does its own measure evaluation, or it may be a system containing other data such as situational awareness data reporting via CSV or other format. When FHIR enabled, the Data Source acts as a US Core Server
Data Aggregator— For some example use cases, data from multiple Data Source actors may be aggregated by a single system before measure evaluation. A Data Aggregator also plays the role of a Data Source once aggregation is complete. An example would be a state public health agency aggregating data from all facilities in the state before using those data to produce a MeasureReport containing specified data for the entire state. When FHIR enabled, a Data Aggregator acts as a US Core Server when playing the role of a Data Source after aggregation. During aggregation, the Data Aggregator acts similar to the Situational Awareness for Novel Epidemic Response (SANER) IG options for aggregation, but implements its own CapabilityStatement due to the incompatibilities between DEQM and SANER.
Measure Source— A system at NHSN that stores FHIR resources such as Measure, Library, ValueSet, etc. used for dQM Reporting. The dQM Evaluation Engine queries the Measure Source for the latest Measure content before querying the Patient Data Source and performing measure evaluation. The Measure Source acts as a QMIG Publishable Measure Repository
MeasureReport Recipient— A system at NHSN that receives MeasureReport bundles from the dQM Evaluation Engine and validates the result against the profiles in this IG, and potentially other measure-specific profiles distributed with the measures themselves (NHSN refers to this kind of validation as “pre-qualification”). The MeasureReport Recipient acts as a DEQM Receiver Server, provides write access to Bundle resources containing MeasureReport and other related resources, and implements the $validate operation.

Use Cases

This IG will serve a wide variety of use cases for NHSN. The measures in this IG are examples only and a separate IG will define NHSN specific measures.

Use Case 1: Acute Care Hospital (ACH)

Description

The NHSN Acute Care Hospital (ACH) digital quality measure (dQM) allows facilities to report line-level data electronically to NHSN for the following modules that provide monthly event rates back to the facility: glycemic control (hyperglycemia and medication-related hypoglycemia); healthcare facility-onset, antibiotic-Treated Clostridioides difficile (C. difficile) infection (HT-CDI); hospital-onset bacteremia & fungemia (HOB), 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), and opioid-related adverse events (ORAE) (under development). NHSN protocols for these measures will soon be available at https://www.cdc.gov/nhsn/acute-care-hospital/index.html.

Patients of Interest

The facility will work with NHSN to define a patients of interest (POI) list. This is often the entire in-patient 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).

Initial Population

The initial population in the ACH dQM is defined as 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.