US Situational Awareness Framework for Reporting (US SAFR) Implementation Guide, published by HL7 International / Public Health. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/us-safr/ and changes regularly. See the Directory of published versions
Page standards status: Informative |
This section of the implementation guide (IG) defines the specific conformance requirements for systems wishing to conform to this US SAFR Reporting IG. The bulk of it focuses on evaluating facility data against measure criteria and submitting those data to MeasureReport Recipient (NHSN), though it also provides guidance on privacy, security, and other implementation requirements.
Before reading this formal specification, implementers should first familiarize themselves with two other key portions of the specification:
This implementation guide (IG) uses specific terminology to flag statements that have relevance for the evaluation of conformance with the guide:
SHALL indicates requirements that must be met to be conformant with the specification.
SHOULD indicates behaviors that are strongly recommended (and which may result in interoperability issues or sub-optimal behavior if not adhered to), but which do not, for this version of the specification, affect the determination of specification conformance.
MAY describes optional behaviors that are free to consider but are not a recommendation for or against adoption.
The following rules regarding Must Support elements apply to all Profiles in this guide. The Must Support definitions are not inherited from other IGs, even for profiles in this guide derived from another guide.
Sender:
Receiver:
This specification makes significant use of FHIR profiles and terminology artifacts to describe the content to be shared as part of measure report submissions.
The full set of profiles defined in this IG can be found by following the links on the Artifacts page.
The following reporting scenarios use the Actors defined on the Actors and Use Cases pages.
In this scenario both the Data Source and digital Quality Measure (dQM) evaluation engine reside at the reporting facility, and may be the same system (e.g., an EHR that performs it’s own internal measure evaluation). The dQM Evaluation Engine first retrieves the latest FHIR measures and related resources from the measure repository and extracts the data requirements for each measure. The dQM Evaluation Engine and queries the Data Source for data that it will evaluate against a measure and prepares Bundle containing MeasureReport and supporting resources, then sends it to the MeasureReport Recipient (NHSN).
In this scenario the dQM Evaluation Engine SHALL perform a FHIR POST or PUT to push the measure report bundle to the MeasureReport Recipient (NHSN).
Retrieve Measure Bundle: The dQM Evaluation Engine uses an HTTP GET against the measure repository for an USSafrMeasureBundle containing a CQFMContinuousVariableMeasure and related resources. The exact Bundle(s) to retrieve is determined out of band by the facility and MeasureReport Recipient (NHSN) during onboarding and subsequent discussions. After retrieving the Bundle, the dQM evaluation engine parses the contents to determine which resources are needed from the Data Source, then proceeds to step 2.
Query Data Sources:
Submit MeasureReport Bundle The dQM Evaluation Engine uses an HTTP POST to submit the SafrMeasureReportBundle to the MeasureReport Recipient. The MeasureReport Recipient validates the Bundle and proceeds to load the data into other MeasureReport Recipient (NHSN) systems (details of such systems are out of scope for this IG).
Forward to MeasureReport Recipient (NHSN) Systems: The MeasureReport Recipient (NHSN) forwards the validated MeasureReport Bundle content to other back-end MeasureReport Recipient (NHSN) systems (details of such systems are out of scope for this IG).
In this scenario, both the Digital Quality Measure (dQM) Evaluation Engine and the MeasureReport Recipient reside within an Public Health Agency (NHSN) controlled environment, and may be the same system. The dQM Evaluation Engine first retrieves the latest FHIR measures and related resources from the measure repository and extracts the data requirements for each measure. The dQM Evaluation Engine queries the Data Source for data that it will evaluate against a measure and prepares Bundle containing MeasureReport and supporting resources. In this scenario the Data Source SHALL have a FHIR API that at a minimum provides read access to all US Core profiles. Some measures may require additional FHIR resources beyond US Core, such as MedicationAdministration.
Retrieve Measure Bundle: The dQM Evaluation Engine uses an HTTP GET against the measure repository for an USSafrMeasureBundle containing a CQFMContinuousVariableMeasure and related resources. The exact Bundle(s) to retrieve is determined out of band by the facility and MeasureReport Recipient (NHSN) during onboarding and subsequent discussions. After retrieving the Bundle, the dQM evaluation engine parses the contents to determine which resources are needed from the Data Source, then proceeds to step 2.
Query Data Sources:
Submit MeasureReport Bundle The dQM Evaluation Engine uses an HTTP POST to submit the SafrMeasureReportBundle to the MeasureReport Recipient. The MeasureReport Recipient (NHSN) validates the Bundle and proceeds to load the data into other backend systems (details of such systems are out of scope for this IG).
In this scenario, a state/jurisdiction retrieves the measure bundle from NHSN and queries for data for aggregation from one or more healthcare facility before evaluating and submitting the MeasureReport to the Measure Recipient on behalf of the facilities.
In this scenario the state/jurisdiction SHALL have a FHIR API that at a minimum provides read access to all US Core profiles. Some measures may require additional FHIR resources beyond US Core, such as MedicationAdministration.
Retrieve Measure Bundle: The state/jurisdiction dQM Evaluation Engine uses an HTTP GET to retrieve the USSafrMeasureBundle containing a CQFMContinuousVariableMeasure and related resources from the measure repository. The exact Bundle(s) to retrieve is determined out of band by the facility and MeasureReport Recipient (NHSN) during onboarding and subsequent discussions. After retrieving the Bundle, the dQM evaluation engine parses the contents to determine which resources are needed from the Data Source, then proceeds to step 2.
Query Healthcare Facility: The state/jurisdiction query each healthcare facility EHR for data aggregation via FHIR API.
Submit MeasureReport to MeasureReport Recipient The dQM Evaluation Engine uses an HTTP POST to submit the SafrMeasureReportBundle to the MeasureReport Recipient (NHSN). The MeasureReport Recipient (NHSN) validates the Bundle and proceeds to load the data into other backend systems (details of such systems are out of scope for this IG).