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Difference between revisions of "Clinical Quality Framework"

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__NOTOC__
 
__NOTOC__
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Return to [[Clinical_Decision_Support_Workgroup|Clinical Decision Support Work Group]]
 
  
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Project Co-Sponsors:
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Return to [[Clinical_Decision_Support_Workgroup|Clinical Decision Support Work Group]]<br>
 +
Return to [http://wiki.hl7.org/index.php?title=Clinical_Quality_Information_Work_Group#CQI_Work_Group_Projects Clinical Quality Information Wiki]
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 +
 
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'''This page has been migrated to the new HL7 Confluence Site:''' https://confluence.hl7.org/display/CQIWC/Clinical+Quality+Framework
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 +
Participating Work Groups:
 +
 
 +
*[[Clinical_Decision_Support_Workgroup|Clinical Decision Support Work Group]]
 
*[[Clinical_Quality_Information_Work_Group|Clinical Quality Information Work Group]]
 
*[[Clinical_Quality_Information_Work_Group|Clinical Quality Information Work Group]]
  
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=Scope=
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=Background=
  
 
The Clinical Quality Framework is a joint effort by the Clinical Decision Support and Clinical Quality Information Work Groups to identify, develop, and harmonize standards that promote integration and reuse between Clinical Decision Support (CDS) and Clinical Quality Measurement (CQM).
 
The Clinical Quality Framework is a joint effort by the Clinical Decision Support and Clinical Quality Information Work Groups to identify, develop, and harmonize standards that promote integration and reuse between Clinical Decision Support (CDS) and Clinical Quality Measurement (CQM).
  
−
The effort began as a public-private initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health IT (ONC) and has since transitioned to a joint effort within HL7 as the stewards of the specifications involved.
+
The effort began as a public-private initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health IT (ONC) and has since transitioned to a joint effort within HL7 as the stewards of the specifications involved. Archived information about the CQF Initiative (charter, members, pilots, and meetings) can be found on the ONC Tech Labs [https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/CQF+Home Clinical Quality Framework Initiative] site.
  
 
The effort focuses on two primary use cases:
 
The effort focuses on two primary use cases:
  
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1. Representation and distribution of knowledge artifacts (rules, order sets, documentation templates, measures, etc)
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#Representation and distribution of knowledge artifacts (rules, order sets, documentation templates, measures, etc)
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2. Evaluation of knowledge
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#Evaluation of knowledge
  
 
==Representation==
 
==Representation==
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For the knowledge representation use case, artifacts such as rules, order sets, and quality measures are represented using three primary components:
 
For the knowledge representation use case, artifacts such as rules, order sets, and quality measures are represented using three primary components:
  
−
1. Metadata - Structured information about the artifact such as description, usage, evidence, stewardship, and catalog information
+
#Metadata - Structured information about the artifact such as description, usage, evidence, stewardship, and catalog information
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2. Patient and Clinical Information - Data models used to represent patient and clinical information within the artifacts
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#Patient and Clinical Information - Data models used to represent patient and clinical information within the artifacts<br>
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3. Expression Logic - Formal representation of logic involved in the artifact such as rule conditions and quality measure population criteria
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#Expression Logic - Formal representation of logic involved in the artifact such as rule conditions and quality measure population criteria
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===Metadata===
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Harmonized metadata requirements for decision support and quality measurement artifacts are described conceptually in [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=391 Clinical Quality Common Metadata Conceptual Model].
 +
 
 +
These metadata are realized concretely in FHIR as the initial group of elements present on all the knowledge resources. For a representative example, see the [http://hl7.org/fhir/plandefinition.html PlanDefinition] elements up to relatedArtifact.
 +
 
 +
===Patient and Clinical Information===
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Harmonized information model requirements for decision support and quality measurement artifacts are described conceptually in [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=378 Health Quality Improvement] (also known as Quality Improvement Domain Analysis Model, QIDAM).
 +
 
 +
These conceptual requirements are then realized as a set of FHIR Profiles in [http://hl7.org/fhir/us/qicore Quality Improvement Core (QI-Core)].
 +
 
 +
For more information on model harmonization efforts, refer to [http://wiki.hl7.org/index.php?title=Harmonization_of_Health_Quality_Information_models Health Quality Information Models Activities] (Includes CMS Quality Data Model (QDM) mapping activities to QI Core).
 +
 
 +
===Expression Logic===
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Harmonized expression logic requirements for decision support and quality measurement artifacts are described conceptually in [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=359 Harmonization of Health Quality Artifact Reasoning and Expression Logic].
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These conceptual requirements are realized in the [http://cql.hl7.org Clinical Quality Language] specification.
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For more information on Clinical Quality Language, refer to the [[Clinical_Quality_Language|Clinical Quality Language]] project page.
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===Artifact Representation===
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Decision support and quality measurement artifacts can then be expressed using these components.
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 +
In FHIR, artifacts are expressed using the resources defined by the [http://hl7.org/fhir/clinicalreasoning-module.html Clinical Reasoning] module.
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In addition, the [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=337 Clinical Decision Support Knowledge Artifact Specification (KAS)] can be used to define decision support artifacts, and the [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=97 Health Quality Measure Format (HQMF)] can be used to define quality measurement artifacts.
  
 
==Evaluation==
 
==Evaluation==
  
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The CDS Hooks specification provides the basis for the evaluation use case. The CQF community participates in the CDS Hooks process in pursuit of decision support evaluation use cases.
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The [http://cds-hooks.hl7.org CDS Hooks] specification provides the basis for the evaluation use case. The CQF community participates in the CDS Hooks process in pursuit of decision support evaluation use cases.
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==Current State==
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The following table depicts standards currently used in the V3 and FHIR families for Clinical Decision Support:
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 +
{| class="wikitable"
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|+Caption: Clinical Decision Support Standards
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|-
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!Component
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!V3-based
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!FHIR-based
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|-
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|Metadata and Structure
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|[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=337 Clinical Decision Support Knowledge Artifact Specification] (aka HeD, and sometimes KNART)
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|[http://hl7.org/fhir/clinicalreasoning-module.html FHIR Clinical Reasoning]
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|-
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|Logic
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|[http://cql.hl7.org Clinical Quality Language (CQL)]
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|[http://cql.hl7.org Clinical Quality Language (CQL)]
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|-
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|Clinical Data
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|[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=338 Virtual Medical Record (vMR)]
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|[http://hl7.org/fhir/us/qicore QI-Core]
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|-
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|Evaluation
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|[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=12 Decision Support Specification (DSS)]
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|[http://cds-hooks.hl7.org CDS Hooks]
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|}
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 +
And the same table for Clinical Quality Measurement:
 +
 
 +
{| class="wikitable"
 +
|+Caption: Clinical Quality Measurement Standards
 +
|-
 +
!Component
 +
!V3-based
 +
!FHIR-based
 +
|-
 +
|Metadata and Structure
 +
|[http://www.hl7.org/implement/standards/product_brief.cfm?product_id=97 Health Quality Measure Format (HQMF)]
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|[http://hl7.org/fhir/clinicalreasoning-module.html FHIR Clinical Reasoning]
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|-
 +
|Logic
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|[http://cql.hl7.org Clinical Quality Language (CQL)]
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|[http://cql.hl7.org Clinical Quality Language (CQL)]
 +
|-
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|Clinical Data
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|[https://ecqi.healthit.gov/qdm-quality-data-model Quality Data Model]
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|[http://hl7.org/fhir/us/qicore QI-Core]
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|-
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|Evaluation
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|[[Quality Reporting Document Architecture]] (QRDA)
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|[http://hl7.org/fhir/clinicalreasoning-module.html FHIR Clinical Reasoning]
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|}

Latest revision as of 18:27, 2 May 2020


Return to Clinical Decision Support Work Group
Return to Clinical Quality Information Wiki


This page has been migrated to the new HL7 Confluence Site: https://confluence.hl7.org/display/CQIWC/Clinical+Quality+Framework

Participating Work Groups:

Background

The Clinical Quality Framework is a joint effort by the Clinical Decision Support and Clinical Quality Information Work Groups to identify, develop, and harmonize standards that promote integration and reuse between Clinical Decision Support (CDS) and Clinical Quality Measurement (CQM).

The effort began as a public-private initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health IT (ONC) and has since transitioned to a joint effort within HL7 as the stewards of the specifications involved. Archived information about the CQF Initiative (charter, members, pilots, and meetings) can be found on the ONC Tech Labs Clinical Quality Framework Initiative site.

The effort focuses on two primary use cases:

  1. Representation and distribution of knowledge artifacts (rules, order sets, documentation templates, measures, etc)
  2. Evaluation of knowledge

Representation

For the knowledge representation use case, artifacts such as rules, order sets, and quality measures are represented using three primary components:

  1. Metadata - Structured information about the artifact such as description, usage, evidence, stewardship, and catalog information
  2. Patient and Clinical Information - Data models used to represent patient and clinical information within the artifacts
  3. Expression Logic - Formal representation of logic involved in the artifact such as rule conditions and quality measure population criteria

Metadata

Harmonized metadata requirements for decision support and quality measurement artifacts are described conceptually in Clinical Quality Common Metadata Conceptual Model.

These metadata are realized concretely in FHIR as the initial group of elements present on all the knowledge resources. For a representative example, see the PlanDefinition elements up to relatedArtifact.

Patient and Clinical Information

Harmonized information model requirements for decision support and quality measurement artifacts are described conceptually in Health Quality Improvement (also known as Quality Improvement Domain Analysis Model, QIDAM).

These conceptual requirements are then realized as a set of FHIR Profiles in Quality Improvement Core (QI-Core).

For more information on model harmonization efforts, refer to Health Quality Information Models Activities (Includes CMS Quality Data Model (QDM) mapping activities to QI Core).

Expression Logic

Harmonized expression logic requirements for decision support and quality measurement artifacts are described conceptually in Harmonization of Health Quality Artifact Reasoning and Expression Logic.

These conceptual requirements are realized in the Clinical Quality Language specification.

For more information on Clinical Quality Language, refer to the Clinical Quality Language project page.

Artifact Representation

Decision support and quality measurement artifacts can then be expressed using these components.

In FHIR, artifacts are expressed using the resources defined by the Clinical Reasoning module.

In addition, the Clinical Decision Support Knowledge Artifact Specification (KAS) can be used to define decision support artifacts, and the Health Quality Measure Format (HQMF) can be used to define quality measurement artifacts.

Evaluation

The CDS Hooks specification provides the basis for the evaluation use case. The CQF community participates in the CDS Hooks process in pursuit of decision support evaluation use cases.

Current State

The following table depicts standards currently used in the V3 and FHIR families for Clinical Decision Support:

Caption: Clinical Decision Support Standards
Component V3-based FHIR-based
Metadata and Structure Clinical Decision Support Knowledge Artifact Specification (aka HeD, and sometimes KNART) FHIR Clinical Reasoning
Logic Clinical Quality Language (CQL) Clinical Quality Language (CQL)
Clinical Data Virtual Medical Record (vMR) QI-Core
Evaluation Decision Support Specification (DSS) CDS Hooks

And the same table for Clinical Quality Measurement:

Caption: Clinical Quality Measurement Standards
Component V3-based FHIR-based
Metadata and Structure Health Quality Measure Format (HQMF) FHIR Clinical Reasoning
Logic Clinical Quality Language (CQL) Clinical Quality Language (CQL)
Clinical Data Quality Data Model QI-Core
Evaluation Quality Reporting Document Architecture (QRDA) FHIR Clinical Reasoning
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