NHSN outlines FHIR-based Digital Quality Measures, highlights hypoglycemia module for early adopters in 2026

Christie Champion, a member of the NHSN acute care analytics team, described the agency's plan to roll out automated Digital Quality Measures and gave a preview of a glycemic control module that will measure hypoglycemia in adult inpatients.

Champion said the DQMs are “based upon nationally recognized standards” and aim to reduce reporting burden by cutting time needed for data collection. “It provides patient level data for risk adjustment and stratification,” she said, and added that DQMs can “remove potential biases due to different interpretations,” allowing measures to be adjusted more quickly as clinical practice changes.

The technical backbone for the program is FHIR (Fast Healthcare Interoperability Resources) and a connection Champion called “NHSN Link,” which she described as “our open source public health application for FHIR reporting.” NHSN Link will identify patients of interest at a facility, query the facility EHR for required elements (medications and labs), decouple PHI/PII, link data to identify denominators and glycemic events, and run algorithms to determine measure numerators and denominators. Analytic reports will then be provided to facilities through the NHSN application.

Champion said participation requires a Digital Measure Reporting Plan (DMRP). The DMRP “authorizes NHSN to query the facility's FHIR server to collect EHR data elements per the DQM protocol,” selects the measures and reporting period, and functions similarly to NHSN's existing monthly reporting plans. Facilities must complete an annual NHSN hospital survey by March 1 each year; Champion said facilities will be prevented from entering new DMRPs until applicable surveys are completed.

Using glycemic control as an example, Champion summarized the primary and secondary metrics that will be available in reports. The primary metric, she said, aligns with Centers for Medicare and Medicaid Services reporting requirements and calculates the number of adult inpatient encounters where at least one hypoglycemic medication was administered and a severe hypoglycemic event occurred, over the number of adult inpatient encounters with at least one diabetic medication administered. Secondary metrics include: Metric 2 (hypoglycemia event days), Metric 3 (recurrent hypoglycemia event days within a 24-hour window) and Metric 4 (median time in minutes to resolution, defined as the first blood glucose ≥70 mg/dL after the event).

Champion listed the blood-glucose thresholds that will be used to categorize events: less than 40 mg/dL (severe), 40 to 53 mg/dL (moderate) and 54 to 69 mg/dL (mild). She said reports will include line listings, rate tables, and—over later phases—stratified rate tables and calculations of all secondary metrics. Some reports will be generated from medication-administration data and others from medication-request data depending on which the facility submits.

On the user side, Champion walked users through finding analysis reports in the NHSN interface (Analysis → Reports) and noted filtering, sorting and date-range options. She also demonstrated example variables available in rate tables (organization ID, year/month summary, counts of severe hypoglycemia encounters, hypoglycemic medication encounters, and percent of hypoglycemic-medication encounters with severe hypoglycemia).

Champion said the NHSN glycemic control module is expected to open to early adopters in 2026 and that interested facilities must be able to report via FHIR. “Participation is contingent on NHSN release schedules and meeting technology requirements and is not guaranteed,” she said. She closed by directing attendees to the annual training community or the NHSN help/service desk for follow-up questions and gave an email option for those without a SAMS login.

The presentation reviewed DQM data flow, the purpose of the DMRP, and where analysis reports will appear in NHSN; no formal policy vote or adoption occurred during the session.