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12 October 2018 CQI Conference call Minutes

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October 12, 2018 - CQI Conference Call Meeting Minutes

HL7 Clinical Quality Information Workgroup
Friday, October 12, 2018 – 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: Yan
Meeting Scribe: Floyd

September 14 2018 - CQI Conference Call Attendance

Attendee Attendee's Organization Attendee's email Present
Abdul Malik Hi3 Solutions
Abrar Salam The Joint Commission
Alex Liu EPIC
Angela Flanagan Lantana Consulting Group
Ann Phillips NCQA Yes
Anne Smith NCQA
Ben Ghahhari CMS
Ben Hamlin NCQA
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
Crystal Kallem CK Consulting Yes
Dan Donahue ESAC
Floyd Eisenberg iParsimony, LLC
Gay Dolin IMO
Hafsa Subhan The Joint Commission
Howard Strasberg Wolters Kluwer
Humberto Mandirola Biocom
Humberto Mandirola Biocom
Isabel Zaru-Rouque ESAC Yes
James Bradley Mitre
Jamie Lehner PCPI
Jeff Schmitz Health eFilings
Jenny Brush ESAC
Joe Kunisch Memorial Hermann
Joe Quinn Optum
John Damore Diameter Health
Julia Skapik Cognitive Medicine Yes
Juliet Rubini Mathematica Yes
Kanwarpreet Sethi Lantana Consulting Group Yes
Kathleen Connor US Dept of Veterans Affairs
Linda Michaelsen Optum Yes
Lisa Anderson The Joint Commission Yes
Lisa Nelson Life Over Time Solutions, LLC
Lizzie Charbonneau Mitre
Lorraine Constable HL7 Canada
Luke Osborne MITRE
Matthew Tiller ESAC Yes
Mike Hunt Experian
Mia Nievera The Joint Commission Yes
Mitra Biglari The Joint Commission
Nathan Donato Yes
Nick Radov UHC
Pamela Mahan-Rudolph Memorial pamela.mahanrudolph@memorialhermann Yes
Patty Craig The Joint Commission
Paul Denning MITRE Yes
Ping Jiang The Joint Commission
Rathore Garima
Rebeccah Baer NCQA
Rich Boyce
Robert Samples ESAC Inc Yas
Rukma Joshi ESAC Inc
Ryan Clark NCQA
Sam Sayer Mitre Yes
Stan Rankins Telligen Yes
Steve Hufnagel
Sue Kent CCF
Sweta Ladwa ESAC inc
Thomas Reese U of Utah
Thomson Kuhn ACP
Viet Nguyen Strata Metrics Yes
Walter Suarez Kaiser Permanente
Yan Heras Optimum eHealth Yes
Yanyan Hu The Joint Commission Yes
Zach May ESAC Inc Yes


  • Roll call
    • Yan reviewed the agenda
  • Baltimore WG meeting minutes available for review Baltimore WG Meeting Minutes
    • Yan reviewed the minutes from the WGM - Highlights below:
      • A specific item addressed the Birds-of-a-Feather session for FHIR Reporting which was attended by many CQI, CDS and Public Health members. CQI asked John Loonsk to present further at a subsequent CQI WG meeting. John Loonsk also indicated that he would set up a set of monthly calls to coordinate FHIR reporting across Public Health and clinical care.
      • CQI, CDS and CIMI agreed that the current QI Core and QI Core Logical View should continue to be maintained. The three groups agreed to work on a CIMI-derived logical model (which will be called QUICK) from which QI Core could be derived via tooling. The project requires additional work effort. Claude Nanjo will send out information for regular conference calls to address the issue. Until such time that the CIMI-based output is available, QI Core generation will remain manual and continue.
      • Patient Care sessions helped define use of Procedure or Task resources (task is a workflow item, procedure is an action on or for a patient) - discussion still in process FHIR Tracker Item 19359
      • Patient Care sessions discussed identification of a procedure performed adequately (successfully) - discussion still in process FHIR Tracker Item 17946
      • Patient Care WG weekly calls Thursday 5 - 6:30 PM address FHIR resource issues
      • Regarding QI Core - QDM mappings, general timing for authors or recorded time for messages or documents use FHIR provenance (; timing and source for specific content in messages or documents should reflect the specific resource as detailed in the W5 documentation (who, what, when, where, why) FHIR W5 September 2018 --- this item was discussed on Thursday Q2 in Patient Care Workgroup with USRealm present (October 4, 2018).
      • TSC has indicated that starting with the September 2019 ballot cycle, all new PSS approvals must be completely through the approval process (including TSC) by 4 weeks prior to the previous WGM. [Example, for the September 2019 cycle, all approvals through the TSC must be completed by 4 weeks prior to the May 2019 WGM.] The exception is for investigative projects which are short-cycle projects and require a new PSS to go to full ballot. --- Specific wording of the TSC action = For projects other than investigative and reaffirmations, to submit a NIB, your PSS must have been approved by TSC a minimum of four weeks before the start of the WGM that precedes the NIB deadline---- The WG suggested the CQI WGM minutes be updated for Tuesday Q1 to reflect the discussion of this item (done).
    • QRDA Category 5 update will proceed in the near future
  • FHIR Exchange of Data for Quality Measures (project 1429) - Ballot Reconciliation (Bryn)
    • Block vote items
    • Email with link to Block Vote 1 items sent to CQI listserv on Tuesday October 2nd. The Block Vote 1 tracker items are also listed below:
      • GF#18724 Comment - DeQM #77 Jocylen Keegan Considered - No action required
      • GF#18705 Add Implementation - DeQM #67 Muhammad Asim Persuasive
      • GF#18680 Areas of measure - DeQM #55 John Loonsk Persuasive
      • GF#18660 Spell out all abbreviations with first time use - DeQM #45 Juliet Rubini Persuasive
      • GF#18658 hyperlink to the value sets used - DeQM #44 Hans Buitendijk Persuasive
      • GF#18656 Clarify use case - DeQM #43 Hans Buitendijk Persuasive
      • GF#18651 Clarify actor roles - DeQM #40 Hans Buitendijk Persuasive
      • GF#18647 Change Title - DeQM #38 Hans Buitendijk Persuasive
      • GF#18644 fix links and capability statement - DeQM #31 Emma Jones Persuasive with Mod
      • GF#18642 bad links - DeQM #30 Emma Jones Persuasive
      • GF#18632 bad link? - DeQM #26 Emma Jones Not Persuasive
      • GF#18629 bad link? - DeQM #25 Emma Jones Not Persuasive
      • GF#18623 Section Numbering across pages - DeQM #23 David Burgess Persuasive
      • GF#18620 fix capability statement - DeQM #22 David Burgess Persuasive
      • GF#18617 fix capability statement - DeQM #21 David Burgess Persuasive
      • GF#18608 Where is the MRP MR Profile - DeQM #18 Craig Newman Considered - Question Answered
      • GF#18605 use PRN for Type code - DeQM #17 Craig Newman Considered - Question Answered
      • GF#18602 diagrams mislabeled - DeQM #16 Craig Newman Considered - Question Answered
      • GF#18599 Change column heading - DeQM #15 Craig Newman Persuasive
      • GF#18589 cutoff text - DeQM #12 Craig Newman Persuasive
      • GF#18561 op is idempotent - DeQM #3 Claude Nanjo Not Related
      • GF#18559 :The sentence appears incomplete. - DeQM #2 Claude Nanjo Persuasive
      • GF#18109 fix HEDIS STU3 Profile links Eric Haas Persuasive
      • GF#18105 add validation packages for referenced IGs to downloads page as a convenience for implementers Eric Haas Not Persuasive
      • GF#18098 hide draft operations Eric Haas Persuasive
      • GF#17897 Structure of specification is hard to follow Joshua Mandel Persuasive
      • GF#17818 fix data-requirements inline example Eric Haas None
      • GF#17801 swap labels in figure Eric Haas Persuasive
      • GF#17800 fix example button links Eric Haas Persuasive
    • Bryn moved to approve the block vote - Linda Michaelsen seconded - approve/abstain/opposed - 21/0/0
    • FHIR Tracker 18670 - Motion by Floyd, seconded by KP: DEQM guide should support communicating the result AND the data required, (i.e., include the submit and collect data operations AND optionally add the score as well). Amended as "The Implementation Guide should support communicating the result AND the data required, (i.e., include the submit and collect data operations but add a use case to support exchanging the score as well via the MeasureReport resource)" - Floyd and KP approve the amendment and calling the comment Persuasive and resolution Substantive.
      • Discussion - this modification does not change the submit data and collect data use cases but adding a use case to support exchanging results.
      • Vote - Approve/Abstain/Opposed - 18/0/0.
    • FHIR Tracker 18234
      • Move to approve resolution (persuasive) Bryn Rhodes / Linda Michaelsen - Vote (approve/abstain/oppose) 17/0/0
    • FHIR Tracker 18295
      • Move to approve resolution (persuasive) Bryn Rhodes / Floyd Eisenberg - Vote (approve/abstain/oppose) 17/0/0
    • FHIR Tracker 17585
      • Move to Approve resolution (persuasive with mod) Bryn / Linda Michaelsen - Vote (approve/abstain/oppose) 17/0/0
  • FHIR Quality-Related IGs - Discussion regarding what FHIR implementation guides might be required to support FHIR eCQM and FHIR Reporting (or might FHIR Clinical Reasoning be sufficient).
    • Bryn reviewed the content item-by-item for HQMF and CQL-based HQMF IG volumes 1 and 2 (not volume 3 because that addresses QDM and FHIR eCQMs and FHIR reporting uses QI Core)
      • Context, Definitions and Background - additional items could be added to the FHIR Clinical Reasoning
      • Measure components are effectively covered but might be enhanced
      • Population Criteria - might potentially be enhanced
      • Human readability - already included in FHIR Clinical Reasoning resources
      • Encoding eMeasure Quality Statements are specific to HQMF - not needed in FHIR Clinical Reasoning
      • Measure specifications - represented in FHIR Clinical Reasoning
      • Nothing in the HQMF specification requires an implementation guide - just possibly more explanatory content in the FHIR Clinical Reasoning Measure, Measure Report sections
      • Exceptions in CQL-based HQMF - might need to define some profiles. The WG discussed whether the additional exceptions should that be in the base specifications or in an implementation guide - none is specific to any particular realm (hence does not require US Realm).
    • For FHIR Quality Reporting, the WG recommended that the DEQM facilitators consider an extension of DEQM as the IG for quality measure reporting. The DEQM IG covers the needs of both QRDA I and III. The WG requested a proposal from the DEQM and Gaps in Care facilitators about next steps.
      • Viet requested broad member participation in that effort across CQI.
      • The WG further requested times for a project call (reinstated) for CQI member participation (Viet will provide).
    • FHIR-based eCQM Authoring
      • There is enough content needed to support eCQM authoring that there is a need for a FHIR-based eCQM Authoring IG that covers the content from CQL-Based HQMF IG Vols I and II.and Gaps in Care need to evaluate the overlap and what artifacts the work requires. There may be benefit by having a single IG. And further that Vol III of the CQL-Based HQMF IG is already covered by QI-Core, so there is no need for content there. This IG may need PSS and will require investigation.
  • The deadline for initial content is October 25, 2018
    • November Harmonization Call: Discussions in June and July raised a content item that will require a harmonization proposal. The minutes do no reflect the specifics of the requirement. WG members were asked to notify the WG with any information regarding what the requirement is for harmonization.

Due to time constraints, the following is informational:

  • Confluence is coming! - Informational - not enough time to discuss
    • Confluence will replace the Wiki for agendas and the HL7 work group page for document posting
    • Please sign up for an account here
    • Draft confluence page available here
  • January WGM meeting - Informational - no time to discuss
    • Review agenda for meeting room reservations
      • Mon Q1: CQI only
      • Mon Q2: CQI only
      • Mon Q3: CQI only
      • Tues Q1: CQI only
      • Tues Q2: CQI host CDS and FHIR Infrastructure (larger room)
      • Tues Q3: CDS host CQI
      • Tues Q4: Patient Care host CQI
      • Wed Q1: CDS host CQI
      • Wed Q2: CQI host CQI (larger room)
      • Wed Q4: CQI host CDS and CIMI (larger room)
      • Thur Q4: Learning Health Systems Work Group host CQI
  • Project Updates
    • CQI Project Updates
      • HL7 CDA® Release 2 Implementation Guide: Quality Reporting Document Architecture Category I (QRDA I) Release 1, STU Release 4 - US Realm (PI ID: 210)
      • HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture (QRDA III), Release 1 - US Realm (PI ID: 896)
      • HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), Release 1 (PI ID: 508)
      • HL7 Version 3 Implementation Guide: Quality Data Model (QDM)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 756)
      • HL7 Version 3 Implementation Guide: Clinical Quality Language (CQL)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 1142)
      • HL7 FHIR® Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 (PI ID: 1234) (Co-Primary with CDS)
      • HL7 FHIR® Profile: Quality, Release 1 - US Realm (PI ID: 1125)
      • HL7 CDA® R2 Implementation Guide: Supplemental QRDA Clinical Quality Data Sharing User Guide, Release 1 (PI ID: 1215)
      • FHIR IG for Exchange of Data for Quality Measures (PI ID: 1429) - Currently performing ballot reconciliation from September 2018 ballot
      • Gaps in Care (PI ID: 1427)
    • Co-sponsored Project Updates (5 min)
      • HL7 Cross-Paradigm Specification: Clinical Quality Language, Release 1 (PI ID: 1108) (CDS Primary, CQI co-sponsor)
      • HL7 Cross-Paradigm Specification: CIMI Logical Models, Release 1 (PI ID: 1253) (CIMI Primary, CQI co-sponsor)
      • HL7 Cross Paradigm Specification: Neutral Mapping Notation, R1 (Project 1237 – FluentPath - Aligning FHIRPath with CQL --- co-sponsoring with CDS, ITS <primary>, FHIR)
      • CrossParadigm IG Medical Device Interoperability (PSS: CrossParadigm_IG_Medical_Device_interoperability.v.4.docx)
      • Composite KNART Investigation (PSS: 1336)
      • CrossParadigm_Storyboard_Artifact_Payer_Value_Based_Care(PSS: 1347)
      • Clinical Decision Support Big Picture Implementation Guide (PI ID: tbd) (Arden Syntax Primary, CQI and CDS co-sponsor)
    • FHIR Public Health Electronic Case Reporting (eCR) (PI ID: tbd) CQI and CDS co-sponsor with CIMI as an interested party)
      • US FHIR Core Updates PSS (PI ID: 1265) (US FHIR Primary, CQI and CDS co-sponsor with CIMI as an interested party)
      • Evidence-Based Medicine on FHIR (CDS sponsor, CQI co-sponsor) EBM on FHIR Project Initiation Tasks (Project ID 1422)
  • Notifications
    • Balloting Milestones
      • October 14, 2018 – PSS deadline (submit to Steering Division and Project Management Office)
      • October 28, 2018 – Notice for Intent to Ballot (NIB) Deadline
      • November 5 – December 6 – Sign up period to be included in a ballot consensus group
      • November 11, 2018 – Preview of artifacts and topics to be included in the ballot with CQI
      • November 18, 2018 – Preview and content deadline (V3)
      • November 25, 2018 – Final content available for CQI WG review [consistent with FHIR Core Substantive Change Freeze (must have completed ballot reconciliation if applicable)
      • December 1, 2018 – Final CQI approval of content and submission (consistent with FHIR code freeze and QA, V3 Final content due dates)
      • December 7, 2018 – January 7, 2019 – January ballot open for voting
    • Harmonization
      • October 25, 2018 – Initial Harmonization Proposal Deadline

The meeting adjourned at 3:00 PM October 12, 2018
The next meeting of the CQI WG will be on Friday, October 17, 2018 1-3 PM ET