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04 January 2018 CQI Conference call Minutes

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DRAFT January 4, 2019 - CQI Conference Call Meeting Minutes

HL7 Clinical Quality Information Workgroup
January 4, 2019 – 1-3 PM EDT
Dial in: 770-657-9270 Passcode: 217663
CQI Co-chairs: Patty Craig, Floyd Eisenberg, Juliet Rubini, KP Sethi, Yan Heras
Meeting Chair: Juliet
Meeting Scribe: Floyd

January 4, 2019 - CQI Conference Call Attendance

Attendee Attendee's Organization Attendee's email Present
Abdul Malik Hi3 Solutions
Abrar Salam The Joint Commission
Alex Liu EPIC
Andrey Soares U C Denver yes
Angela Flanagan Lantana Consulting Group yes
Ann Phillips NCQA
Anne Smith NCQA yes
Ben Ghahhari CMS
Ben Hamlin NCQA yes
Bo Borgnakke Michigan Shared Services Network
Bob Dieterle Enable Care, LLC
Bob Keyes Telligen
Brett Marquard River Rock Associates
Brian Alper EBSCO
Bryn Rhodes ESAC yes
Chana West ESAC Inc yes
Claudia Hall Mathematica yes
Craig Newman Altartum yes
Crystal Kallem CK Consulting
Dan Donahue ESAC
David Sundaram-Stukel EPIC yes
Dipti Ghandi The Joint Commission yes
Durwin Day BCBSA dday@bsbsil yes
Eric Askegaard UHG yes
Floyd Eisenberg iParsimony, LLC yes
Fareeda Nazeer The Joint Commission
Gay Dolin IMO yes
Hafsa Subhan The Joint Commission
Howard Strasberg Wolters Kluwer
Humberto Mandirola Biocom
iIkka Kunnamo Duodecim jilkkakunnamo@duodecim.fl
isabel Zaru-Roque ESAC
James Bradley Mitre
Jamie Lehner PCPI
Jeff Schmitz Health eFilings
Jenny Brush ESAC
Joe Kunisch Memorial Hermann
Joe Quinn Optum yes
John Damore Diameter Health
Julia Skapik Cognitive Medicine
Juliet Rubini Mathematica yes
Kanwarpreet Sethi Lantana Consulting Group yes
Kathleen Connor US Dept of Veterans Affairs
Kurt Allen US Dept of Veterans Affairs
Ken Hall Veradigm Health yes
Lenel James BCBSA yes
Linda Michaelsen Optum yes
Lisa Anderson The Joint Commission yes
Lisa Nelson Life Over Time Solutions, LLC
Liz Hartley-Sommers BCBSA yes
Lizzie Charbonneau Mitre
Lorraine Constable HL7 Canada
Luke Osborne MITRE
Lynn Perrine Lantana yes
Matthew Tiller ESAC yes
Michael Okeefe MITRE
Mike Ballie UHC yes
Mike Hunt Experian
Mia Nievera The Joint Commission yes
Mitra Biglari The Joint Commission
Michelle Mish Turner UHC yes
Nancy Whipple GE
Nick Radov UHC yes
Pamela Mahan-Rudolph Memorial pamela.mahanrudolph@memorialhermann
Patty Craig The Joint Commission
Paul Denning MITRE yes
Ping Jiang The Joint Commission
Rathore Garima
Rebeccah Baer NCQA
Rich Boyce
Rob McClure MD Partners Inc
Robert Samples ESAC Inc yes
Rukma Joshi ESAC Inc
Ryan Clark NCQA yes
Sam Sayer Mitre
Serafina Versaggi JP Systems yes
Stan Rankins Telligen yes
Steve Hufnagel
Sue Kent CCF
Sweta Ladwa ESAC inc
Thomas Reese U of Utah
Thomson Kuhn ACP yes
Viet Nguyen Strata Metrics yes
Walter Suarez Kaiser Permanente
Wendy Talbot NCQA yes
Yan Heras Optimum eHealth yes
Yanyan Hu The Joint Commission yes
Zach May ESAC Inc yes
Zabrina Gonzaga Lantana Consulting Group

Meeting Minutes

  • Roll call and agenda review
  • Secondary use of CDAs from provider EHR or from local-to-provider HIEs for Reporting Quality Measure Information - Attachments Workgroup invited for presentation [Wendy Talbot (NCQA] - NCQA Audit Supplemental Data Presentation
    • Questions addressed by the presentation:
      • What is role of primary and supplemental data for quality reporting under HEDIS?
      • What is the NCQA audit process?
      • Why is a C-CDA considered supplemental and how are payers & ACOs audited
      • What is the current and planned NCQA approach for “validating HIE data feeds” with C-CDA in 2019
    • See slide deck provided by Wendy Talbot. The primary issue is the need to validate the original source of information. Once a reviewer/auditor has reviewed a specific source, the information can be considered "standard" when checked in subsequent years. If 2 sources are using the same EHR, can the answer work for two different providers. The requirement is to assure the data are coming from the right place within the program. The effort is to assure NCQA is receiving the information expected (provenance, correct fields, etc.). Without validation back to the source causes challenges with reliability and validity of data. Claims are also validated, not just C-CDAs. To avoid receiving information about ordered procedures Vs completed procedures, QDM and/or FHIR profiles can increase eCQM specificity that may help with the need to audit in the future. The auditors also work with plans and vendors to address issues identified.
    • C-CDA Attachments Supplemental Guide - This AWG-published HL7 standard and guide includes an entire Chapter 7 on added constraints for C-CDA R2.1 identified by the major US payers, including CMS, UHC and BCBS Plans. These conformance constraints have been proposed and submitted to be part of the HIPAA Attachments rule and are deemed critical to provide key constraints on C-CDA to help ensure better quality and better consistency in document creation. Perhaps some or many of the same constraints would provide comparable value for quality reporting.
    • Some health plans capture a lot of information, not only those required for specific measured. Therefore, all the information is passed through a C-CDA.
    • C-CDA provenance not necessarily included in files. C-CDA elements allow author, performer, dateTime, recorder but these are not necessarily shared at the data level.
    • Sharing of the logs of issues found by NCQA auditors would help with standards reviews. These issues can be shared at the Implementation-a-thon.
    • Provenance is not the major problem, it is more an issue of building C-CDAs. Feedback will be very helpful to encourage better implementations. The C-CDA scorecard will not be sufficient. The Examples Task Force provides another path to provide standard examples. C-CDA Scorecard
    • NCQA meets with the auditors next week and will bring information for discussion at the San Antonio WGM. The Examples Task Force is also meeting Saturday Evening 1/12/2019 as another venue for reviewing the issues identified.
  • STU Comment Review (Monthly)
    • QRDA Category I R4 - No new comments as of Wednesday, January 2, 2019
    • QRDA Category I R5
      • Comment 1699 - indicating 404 error - not a standards question - referred to Webmaster. No vote required.
    • QRDA Category I R5.1 - No new comments as of Wednesday, January 2, 2019
    • QRDA Category III R2.1 - No new comments as of Wednesday, January 2, 2019
    • QDM-based HQMF R1.4 - No new comments as of Wednesday, January 2, 2019
    • CQL-based HQMF R2 - No new comments as of Wednesday, January 2, 2019
    • CQL-based HQMF R2.1 - No new comments as of Wednesday, January 2, 2019
    • CQL-based HQMF R3 - No new comments as of Wednesday, January 2, 2019
    • FHIR Tracker Items for Clinical Reasoning:
      • 19855 - Discussed a need for FHIR Measure IG which will require a PSS. To ballot in May or September 2019, we will need to start the process during the San Antonio WGM for approval within 4 weeks prior to the May WGM. Note - this comment was not resolved during the meeting today.
    • No new CQI (i.e., measurement-related) FHIR Tracker Items for FHIR Clinical Reasoning as of Wednesday, January 2, 2019
  • Finalization of CDS and CQI Comments for the HL7 Policy Committee on ONC Draft for Public Comment "Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs" - CDS Workgroup invited for comment review
    • email from Bryn Rhodes (12/20/2018 7:17 PM ET) with last set of comment edits (to be attached to agenda announcement)
    • The CQI WG reviewed the comments available thus far and had no additions or corrections.
    • Floyd Eisenberg moved to submit the comments to the HL7 Policy Committee; Anne Marie Smith seconded. 18 Approve, 0 Opposed, 1 Abstention.
    • Final CQI and CDS Comments submitted to the HL7 Policy Committee uploaded to CQI Document Site
  • Reminder: Sub groups for ballot content refinement reviewed. Meeting information below:
    • Sub groups include: Composite scoring (Tuesdays at 1015a ET)
    • QUICK (to be scheduled post discussion at the HL7 WGM in San Antonio)
    • FHIR measures (time: potentially use second half Friday CQI meetings
  • Reviewed and updated San Antonio schedule
    • Found on confluence here
  • Confluence is coming!
    • Confluence will replace the Wiki for agendas and the HL7 work group page for document posting
    • CQI WG members reminded to sign up for an account here
    • Draft confluence page available here
  • Project Updates
  • Notifications and Announcements
    • Cancel January 11, 2019 meeting due to travel to San Antonio WGM
    • Next CQI WG meeting - at San Antonio HL7 WGM
    • Balloting Milestones
      • December 7, 2018 – January 7, 2019 – NOTE BALLOT COMMENT DEADLINE January 7, 2019
  • Meeting Adjourned at: 2:56 PM ET, Friday, January 4, 2019