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Wednesday 10/3, Quarter 1 - CQI Hosted CIMI and CDS

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Clinical Quality Information Work Group
WGM Information
Clinical Quality Information WG September 2018, Baltimore, MD - Agenda
Clinical Quality Information WG September 2018, Baltimore, MD - Minutes


October 3 2018 - CQI Quarter 1 Meeting at Baltimore WGM

HL7 Clinical Quality Information Workgroup
CQI Co-chairs: Patty Craig, Floyd Eisenberg, Juliet Rubini, KP Sethi, Yan Heras
Meeting Chair: Juliet Rubini
Meeting Scribe: Floyd Eisenberg

October 3 2018 - CQI Quarter 1 Attendance

Attendee Attendee's Organization Attendee's email Present
Abdul Malik Hi3 Solutions abdulmalik.shakir@hi3solutions.com
Abrar Salam The Joint Commission asalam@jointcommission.org
Alex Liu EPIC aliu@epic.com yes
Alexander Ivanov Medlinx ivanov@medlinx.online yes
Amnon Shabo (Shvo) Philips amnon.shvo@gmail.com
Andrew Gordon Wolterskluwer andrew.gordon@wolterskulwer.com
Andrew Simms Cognitive Medical Systems asimms@cognitivemedical.com
Angela Flanagan Lantana Consulting Group angela.flanagan@lantanagroup.com
Ann Phillips NCQA phillps@ncqa.org
Anna Dover FDB adover@fdbhealth.com yes
Anne Smith NCQA smith@ncqa.org yes
Aruind Jagnathar Lantana Consulting Group aruind.jaganathan@lantanagroup.com
Athla Farkas Canada Health Infoway afarkas@infoway.ca
Avinash Shanbhag ONC avinash.shanbhag@hhs.gov
Bas van der Henvel Philips bas.van.der.henvel@philips.com
Becky Kuhl Lantana Consulting Group
Ben Ghahhari CMS benjamin.ghahhari@cms.hhs.gov
Ben Hamlin NCQA hamlin@ncqa.org
Bo Borgnakke Michigan Shared Services Network borgnakke@mihin.org
Bob Dieterle Enable Care, LLC rdieterle@enablecare.us
Bob Keyes Telligen bkeyes@telligen.com
Brett Marquard River Rock Associates brett@riverockassociates.com
Brian Alper EBSCO balper@ebsco.com yes
Bruce Bray University of Utah bruce.bray@hsc.utah.edu
Bryn Rhodes ESAC bryn@databaseconsultinggroup.com yes
Byounct-Kee Yi Samsung Med Center byoungkeeyi@gmail.com
Carsten Quinla Epic carsten@epic.com
Cesar Moreno HL7 Argentina cmoreno2003@gmail.com
Chana West ESAC Inc chana.west@esacinc.com
Chris Hills IPO Christopher.hills@navy.mil
Chris Melo Philips chris.melo@philips.com
Chris Peck Cognitive Medical Systems cpeck@cognitivemedical.com
Christian Knapp Furore c.knaap@furore.com
Claude Nanjo U of Utah claude.nanjo@utah.edu yes
Claudia Hall Mathematica chall@mathematicampr.org yes
Craig Parker Intermountain Healthcare craig.parker@imail.org
Crystal Kallem CK Consulting crystal.kallem@ckconsultingllc.com
Dan Donahue ESAC dan.donahue@esacinc.com
Dan Morford BZ/VA Dan.mortord@bookzurman.com
Daryl Chertroff HLN Consultin daryl@hln.com
Dave Carson VHA dcarlson@xmlmodeling.com
David La Hei Philips david.la.hei@philips.com yes
David Parker Defined IT / DoD / VA David.parker@definedIT.com
David Sundaram-Stukel Epic dsundara@epic.com
Dennis Patterson Cerner dennis.patterson@cerner.com
Dennis Polling Philips dennis.polling@philips.com
Diana Ovelgoenne Siemens dianal.ovelgoenne@siemens-healthineers.com
Doug Martin Regenstrief dkmartin@regenstrief.org
DoYoun Lee Hegel hegel/dy@gmail.com
Egge Clive Ahdis-HL7 Switzerland Clive.egge@alonich
Elizabeth Fitzwater American College of Cardiology efitzwater@acc.org yes
Emory Fry Cognitive Medical Systems eafry@gmx.com
Eric Larson CDC / AIRA vevs@cdc.gov
Eric Nystrom Lantana Consulting Group
Floyd Eisenberg iParsimony, LLC FEisenberg@iParsimony.com yes
Francis Macary PHAST Parncois.macary@phast.fr
Franck Gener Phast Services franck.gener@phast.fr
Galen Mulrooney VA galen.mulrooney@va.gov yes
Gay Dolin IMO gdolin@imoonline.com
Genny Luensman CDC / NIOSH gluensman@cdc.gov
Greg Linden Linden Tech Advisors glinden@lindentechadvisors.com
Guilherme Del Flol University of Utah guilherme.delflol@utah.edu yes
Gustavo Carolo HL7 Argentina gcarolo@garrahan.gov.ar
Hafsa Subhan The Joint Commission hsubhan@jointcommission.org
Hanhong Lu Epic HLu@epic.com
Hans Buitendyk Cerner Hans.buitendijk@cerner.com
Howard Strasberg Wolters Kluwer howard.strasberg@wolterskluwer.com yes
Humberto Mandirola Biocom hmandirola@biocom.com
iIkka Kunnamo Duodecim jilkkakunnamo@duodecim.fl
IL Koh Kim KNU Korea tkkim@knu.ac.ky
Isaac Vetter EPIC Isaac@epic.com
Isabelle Gibaud Phast Services Isabelle.gibaud@phast.fr yes
Jacee Robison 3M jrobison@mmm.com
Jack Wallace GTRI Jack.Wallace@gtri.gatech.edu
James Agnean Smile CDR James.agnew@gwi.com
James Agnerus UHN james@agnerus@uhn.com
James Bradley Mitre jhbradley@mitre.org
Jamie Lehner PCPI jamie.lehner@thepcpi.org
Jamie Parker ESAC Jamie.parker@esacinc.com
Jared Nichols Wolterskluwer jared.nichols@wolterskulwer.com
Jeff Danford Allscripts jeffrey.danford@allscripts.com
Jeff Schmitz Health eFilings jschmitz@healthefilings.com
Jenny Brush ESAC jennifer.brush@esacinc.com
Jerry Goodnough Cognitive Medical Systems JGoodnough@cogmedsys.com
Jessica Strzesak RSNA istrzesak@rsna.org
Jim Harrison CAP/UVA James.Harrison@virginia.edu
Joe Kunisch Memorial Hermann kunisch@memorialhermann.org
Joe Quinn Optum joseph.quinn@optum.com
Joep van Berhel Philips joep.van.berhel@philips.com
John Damore Diameter Health jdamore@diameterhealth.com
John Loonsk CGI EBD / APITC john.loonsk@cgifederal.com
Joshua Mandel Childrens Harvard joshua.mandel@childrens.harvard.edu
Jukhani Munish NHSD munishjukhani@nhs.net
Julia Skapik Cognitive Medicine jskapik@cognitivemedicine.com yes
Julie Scherer Motive Medical Intelligence jscherer@gmail.com
Juliet Rubini Mathematica jrubini@mathematicampr.com yes
Kanwarpreet Sethi Lantana Consulting Group kp.sethi@lantanagroup.com yes
Kathleen Connor US Dept of Veterans Affairs kathleen_connor@comcast.net
Kathy Pickering Cerner Kathy.Pickering@cerner.com
Katiya Shell ESAC Katiya.shell@esacinc.com
Keith Boone WC Holdings keith.boone@ge.com yes
Ken Kawamoto Utah kensaku.kawamoto@utah.edu
Ken Rubin VA kenneth.rubin@va.gov yes
Kent Lemoine CDC IdP5@cdc.gov
Kevin Olbrich McKesson Kevin.olbrich@mckesson.com
Kevin Rose Pionetechs krose@pionetches.com
Kevin Shekleton Cerner kshekleton@cerner.com
Klingler Andreas Siemans Health andreas.klingler@siemens.com
Leon Rozenglit Prometheus Research leon@prometheusresearch.com
Linda Michaelsen Optum linda.michaelsen@optum.com yes
Lindsy Hoggle AND lhoggle@eatright.org
Lisa Anderson The Joint Commission landerson@jointcommission.org yes
Lisa Nelson Life Over Time Solutions, LLC LisaRNelson@cox.net
Lizzie Charbonneau Mitre lizzie@mitre.org
Lorraine Constable HL7 Canada lorraine@constable.ca
Lou Bedor loubedor@earthlink.net
Luke Osborne MITRE lwosborne@mitre.org
Magbool Hussain Sejong University, Korea magbool110@gmail.com
Mags IPO magizhan.tamilerasu@leidos.com
Maiko Minami HLN Consulting maiko@hln.com
Malcolm Pradhan Alcidion Malcolm.pradhan@alcidion.com
Manisha Khatta DOD / VA IPO manisha.khatta.ctr@mail.mil
Mark Kramer MITRE mkramer@mitre.org yes
Mark Meadows GA Department Community Health Mark.Meadows@och.ga.gov
Martin Modera ACS mmadera@facs.org
Masski Hirai HL7 Japan masaaki_hirai@nifty.com
Matt Rahn ONC MatthewRahn@hhs.gov
Matthew Dugal Dynamic Health IT mdugal@dynamichealth.com
Matthew Tiller ESAC matthew.tiller@esacinc.com yes
May Terry MITRE mayt@mitre.org yes
Mia Nievera The Joint Commission mnievera@jointcommission.org
Michael Donnelly Epic michael.donnelly@epic.com
Michael Holck ESAC michael.holck@esacinc.com yes
Michael Van Der Zel UMCG m.van.der.zel@ummeg.nl
Michael Waters FDA michael.waters@fda.hhs.gov yes
Mike Hunt Experian mike.hunt@experian.com
Mike Tushan Lantana Consulting Group mike.tushan@lantanagroup.com
Mitra Biglari The Joint Commission mbiglari@jointcommission.org
Muhammad Asim Philips muhammad.asim@philips.com yes
Nancy McQuillen Health Catalyst nancy.mcquillen@healthcatalyst.com
Nancy Orvis DoD Va IPO Nancy.j.orvis.civ@mail.mil
Nathan Davis Intermountain Healthcare nathan.davis2@imail.org yes
Nick Rador Optum nick.rador@optum.com
Nick Radov UHC nradov@uhc.org
Noam Arzt HLN Consulting arzt@hln.com
Ostem Kurt Dynamic Health IT okurt@dynamichealthit.com
Pamela Mahan-Rudolph Memorial Hermann pamela.mahanrudolph@memorialhermann
Patrick Langford Intermountain Healthcare patrick.langford@imail.org yes
Patty Craig The Joint Commission pcraig@jointcommission.org yes
Paul Denning MITRE pauld@mitre.org yes
Peter Haug Intermountain Healthcare peter.haug@imail.org yes
Phil Langthorne Prometheus Research, LLC phil@prometheusresearch.com
Ping Jiang The Joint Commission pjiang@jointcommission.org
Piper Ranallo MDH/Six Aims Piper.ranallo@sixaims.org
Raj Mehra Cerner r.mehra@ceerner.com
Rathore Garima rathore.garima1@gmail.com
Rebeccah Baer NCQA baer@ncqa.org
Rhonda Schwarz ESAC Rhonda.schwarz@esacinc.com
Richard Boyce U of Pittsburgh rbd20@pitt.edu yes
Richard Esmond PenRad richard@penrad.com
Richard Ettema AEGIS.net, Inc richard.ettema@aegis.net
Richard Zhu Johns Hopkin Medicine zhu@jhm.edu yes
Rick Geimer Lantana rick.geimer@lantanagroup.com
Rob McClure MD Partners rmcclure@mdpartners.com
Rob Samples ESAC Robert.samples@esacinc.com yes
Robert Dieterle Enable Care rdieterle@enablecare.us
Robert Jenders UCLA jenders@ucla.edu yes
Robert Jorden OMS fpworden@me.com yes
Robert Lario VA / U of Utah robert.lario@utah.edu yes
Robonette Renner NMDD - NCI raley@nmds.org
Ron Ross Clinical Architecture Ron.ross@clinicalarchitecture.com
Rukma Joshi ESAC Inc rukma.joshi@esacinc.com
Russell Ott DoD VA IPO rott@deloitte.com
Ryan Clark NCQA ryan@ncqa.org
Sadamn Takasaka HL7 Japan c.takasaka@gmail.com
Sagy Mints Allscripts sagy@allscripts.com
Sam Nicolary HLN Consulting sdn@hln.com
Sam Sayer Mitre ssayer@mitre.org
Sananda McGarvey Northrop Grumman Sananda.mcgarvey@ngc.com
Sean Murz VHA Sean.murz@vha.gov
Serafina Versaggi BookZurman Serafina.versaggi@bookzurman.com
Shah Mur VHA Shah.hur@vha.gov
Shelly Spiro Phit Collaborative shelly@pharmacyhit.org
Srinath Remak CDC/CSELS/OK NNM1@cdc.gov
Stan Huff Intermountain Healthcare stan.huff@imail.org yes
Stan Rankins Telligen SRankins@telligen.com
Stefan Lang HITC Stefan.lang@lang-HITC.de
Steve Bratt MITRE sbratt@mitre.org yes
Steve Hufnagel Apprio steve.hufnagel.hl7@gmail.com yes
Sue Kent CCF kents@ccf.org
Susan Matney Intermountain Healthcare susan.matney@imail.org
Sweta Ladwa ESAC inc sweta.ladwa@esacinc.com
Sylvia Thun HLA DE Sylvia.thun@hsnr.de
Taima Gomez ACOG tgomez@acog.org
Tar Younktm UC Davis tynktm@ucdavis.edu
Tessa van Stigh NICTIZ stijin@nictiz.nl
Thomas Reese U of Utah thomas.reese@hsc.utah.edu
Thomson Kuhn ACP tkuhn@acponline.org
Tony Laurie NHS Anthony.laurie@nordin.com
Vaspaan Patel NCQA patel@ncqa.org
Vassil Paytchev Epic vassil@epic.com
Viet Nguyen Strata Metrics vietnguyen@stratametrics.com
Vincent McCauley Telstrahealth vincem@bigpond.com
Walter Suarez Kaiser Permanente walter.g.suarez@kp.org yes
Wes Rishel wrishel@gmail.com
Yan Heras Optimum eHealth yanheras@gmail.com yes
Yanyan Hu The Joint Commission yhu@jointcommission.org
Yukimoni Konishi HL7 Japan Koni@kisnc.jp
Yunwzi Wang IMO ywang@imo-online.com
Zach May ESAC Inc zachary.may@esacinc.com

Minutes

CQI Hosted CIMI and CDS

  • Roll call and Introductions
  • CIMI Project Update - Stan Huff provided a project update for CIMI HL7 CIMI Wiki Link
    • Capture Interoperability Project
      • Breast Cancer Staging - balloted as FHIR profiles
      • Create lab observations and Lab FHIR observations (Hematocrit, Hemoglobin, Glucose Tolerance Test, Glucose)
      • FHIR Profiles for Office of Population Affairs and American College of Obstetrics and Gynecology (ACOG)
      • Continues work on skin and wound modeling
      • Developed CIMI approval model
      • Common Data Element work (e.g., patient name, sex, birthdate, etc.) - CIMI creates/identifies LOINC codes and value sets
      • Vital signs in FHIR - add qualifying attributes (e.g., body location, position, exercise, etc.) and value sets for qualifiers
      • Works in SOLOR (SNOMED-LOINC-RxNorm) to release as a terminology service and include in VSAC
      • Working with the Clinical Information Interoperability Council (CIIC) regarding registry content for download and use
  • QI Core and FHIR Mapping Review
    • Floyd Eisenberg reviewed the current version of QI Core v3.0. QI Core is an implementation guide for use of FHIR by quality measure developers and clinical decision support artifact developers. To the extent that the content is available in US Core, QI Core defaults to the US Core resource constraints. If the required content is not present in US Core then QI Core uses FHIR resources directly. The current version of QI Core is based on the last published version of US Core. A newer version of US Core is awaiting publication - subsequent to that publication CQI plans to create and publish an Update to QI Core 3.0 that incorporates US Core 3.0. The US Core 3.0 has been completed and the publication request approved; it is awaiting final publication so the QI Core update process can begin using the build version of US Core 3.0.
    • QI Core includes mapping from QI Core resources to QDM for consideration in the US market as well as mapping from QDM to QI Core. Testing in the Connectathon and further discussions at this HL7 WGM suggest some modifications for the QDM to QI Core mapping are prudent. These changes can be included in the proposed QI Core 3.0 Update later in Fall 2018.
    • For consideration of eCQMs currently in use in the US under Centers for Medicare and Medicaid Services (CMS) programs, Floyd also showed a mapping from QDM to Argonaut resources (basically FHIR DSTU 2). The intent of the mapping is to determine which, if any, existing eCQMs might be feasible (or challenged) based on existing implementations of FHIR in Argonaut participants. That QDM to Argonaut mapping is a draft and available at:
    • The QI Core 3.0 publication includes a link to the logical view, currently called Quality Improvement Clinical Knowledge (QUICK).
    • Ken Kawamoto and Julia Skapik discussed the original intent of QUICK, i.e., to provide the logical model. Due to tooling and other constraints, only a logical view is now available, not the logical model. The logical model should ideally inform and produce the QI Core and its logical view rather than the current process to manually create and update QI Core with the following principles:
      • Data elements in the logical model should be available in US EHR Systems (note - QI Core is constrained to US Realm since US Core is at its base and US Core constrains FHIR resources for US use and includes terminology bindings specific to the US)
      • The logical model should address what is used in US eCQMs
      • Since the above 2 bullets represent the business intent, then the logical model should map to current work in the Federal Health Information Model (FHIM).
    • The WG discussed whether current tooling might allow a CIMI based logical model against which eCQM and CDS artifact developers can write CQL expressions, and whether we are considering one logical model Vs a progression from one logical model to another. Note that CQL can use any FHIR model.
      • Problem statement: Using the current QI Core / logical view approach, as FHIR evolves and changes, writing eCQMs and CDS requires changes as FHIR updates. Any two EHRs may have different interpretations of FHIR and it will be difficult to author reusable artifacts against multiple versions of the model. It is preferable to have a stable model against which to write artifacts and allow that model produce the output in the desired version for implementers.
      • Mark Kramer asked about the challenge when people exchange data using other profiles. The group considered that the logical model will allow authorship without the need to map to each potential version and implementation. Susan Matney noted that Intermountain Healthcare has had the same logical model for 20 years and couldn't proceed without it.
      • The group agreed that the single logical model is preferable and that QUICK should be the name of that model. The current logical view should be title QI Core Logical View to avoid confusion about the meaning of QUICK.
      • Motion by Ken Kawamoto, seconded by Julia Skapik: The CDS and CQI and CIMI Workgroups agree to represent the QUICK logical model to meet CDS and CQI use cases using the current CIMI models with adjustments as needed, and to work to convert to and from FHIR artifacts. Until such time as this effort is successful, QI Core generation will continue manually to keep up with FHIR and US Core versions.
        • Vote: Approved/Abstain/Opposed - 29/14/0.
  • Connectathon Report out (Bryn Rhodes) FHIR Connectathon 19 Wiki Page
    • Refer to Power Point Presentation: Clinical Reasoning Connectathon 19 Report Out
    • 2 scenarios used QDM to QI Core mapping to FHIR-based CQL
      • 3 CMS measures for preventive screening
      • Required manual tranform of measures into FHIR (use QDM to QI Core mapping)
      • Evaluated QDM-based measures through run-time translation
      • Mitre provided a Cypress-like utility to allow FHIR realization to evaluate a measure report
      • Apelon assisted with terminology
      • Defined QDM items as custom FHIR resources
    • Achievements
      • Calculated QDM-based CMS measures against FHIR source data
      • Calculated FHIR-based CMS measures
      • Used the Crucible testing engine to compare MeasureReport results from different systems
      • Successful submission of DaVinci Medication Reconciliation (MedRec) event uses $submit-data
    • Mapping Issues:
      • Colorectal Cancer Screening
        • Fecal Occult Blood Testing (FOBT) where effective during Measurement Period
          • The QDM used authorDatetime, which QDM-to-QICore mapping says maps to Provenance
          • That mapping is right in general, but in this case, the authorDatetime in QDM was actually being used to approximate "specimen collection", but what the measure is really looking for is "specimen collection" (Note - QDM Laboratory Test; Performed includes at attribute for dateTime defined as physiologic time or specimen time - Procedure, Performed was noted designed by the QDM conceptual data model to address laboratory tests).
          • This means the QDM implementation will be inconsistent some systems will implement as "when recorded", some as "when collected". It also means the mapping can't be encoded in this case
        • Translations
          • Interventions - Difficult to know how this maps to FHIR resources
          • Had to map some codes/code systems such as Administrative Gender
          • Encounter Mapping - "Encounter, Performed".code should map to Encounter.type, not Encounter.class
        • eCQM Specifications - Measure CQL would be easier to read if terminology declarations were right-aligned:
          • In the human readable, the terminology section should just be a table with hyperlinked value set references
    • Participant comments:
      • athenahealth: All of this would be much easier if we had FHIR-based measure and could just evaluate them directly.
      • DynamicHealthIT: Since we started with a working measure calculator our biggest challenge was converting the FHIR resources into native QDM data elements consumable by the measures
    • Links to specific Connectathon 19 track wikis:
  • Clinical Reasoning Update:
    • 14 comments on CDS Resources (2 negative, 12 affirmative)
    • 2 comments on CQI Resources (2 affirmative)
    • R4 STU Next Steps:
      • Resolve and apply ballot comments
      • Apply QA changes for maturity goals
      • FHIR Ballot Prep R4 Publication Timeline - Key dates:
        • 2018-10-31: Final reconciliation package posted for STU ballot
        • 2018-11-01: Final content freeze for R4 publication
        • 2018-11-11: IG content freeze and QA period start
        • 2018-11-25 – 2018-12-02: QA changes applied
        • 2018-12-07 – 2018-12-21: Recirculation ballot
        • Before 2018-12-31: R4 publication


Deferred due to time:

  • DaVinci Medication Reconciliation
  • Clinical Reasoning Update
  • Consideration of need for implementation guides for FHIR Measure Report and FHIR eCQM (analogous to QRDA and CQL-based HQMF)


  • Notifications - None


  • Meeting Adjourned: 10:30 AM ET
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