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04 May 2018 CQI Conference Call Minutes

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4 May 2018 - CQI Conference Call Minutes

HL7 Clinical Quality Information Workgroup
Friday, May 4, 2018 – 1-3 PM EDT
Dial in: 770-657-9270 Passcode: 217663
CQI Co-chairs: Patty Craig, Floyd Eisenberg, Walter Suarez, KP Sethi, Yan Heras
Meeting Chair: Walter Suarez
Meeting Scribe: Floyd Eisenberg

4 May 2018 - CQI Conference Call Attendance

Attendee Attendee's Organization Attendee's email Present
Abrar Salam The Joint Commission Yes
Angela Flanagan Lantana Consulting Group
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
Brett Marquard River Rock Associates
Brian Alper Yes
Bryn Rhodes ESAC Yes
Chana West ESAC Inc
Claudia Hall Mathematica
Dan Donahue ESAC
Floyd Eisenberg iParsimony, LLC Yes
Gay Dolin IMO Yes
Hafsa Subhan The Joint Commission
iIkka Kunnamo jilkkakunnamo@duodecim.fl Yes
Jamie Lehner PCPI Yes
Jeff Schmitz Yes
Jenny Brush ESAC
Joe Kunisch Memorial Hermann Yes
Joe Quinn Optum
John Damore Diameter Health
Julia Skapik Cognitive Medicine Yes
Juliet Rubini Mathematica
Kanwarpreet Sethi Lantana Consulting Group
Kathleen Connor US Dept of Veterans Affairs
Linda Michaelsen Optum Yes
Lisa Anderson The Joint Commission Yes
Lisa Nelson Life Over Time Solutions, LLC
Lorraine Constable HL7 Canada
Luke Osborne MITRE Yes
Matthew Tiller ESAC
Mitra Biglari The Joint Commission Yes
Pamela Mahan-Rudolph Memorial pamela.mahanrudolph@memorialhermann Yes
Patty Craig The Joint Commission
Paul Denning MITRE Yes
Ping Jiang The Joint Commission
Rebeccah Baer NCQA Yes
Robert Samples ESAC Inc
Stan Rankins Telligen
Sue Kent CCF Yes
Sweta Ladwa ESAC inc
Thomson Kuhn ACP Yes
Walter Suarez Kaiser Permanente Yes
Yan Heras Optimum eHealth
Yanyan Hu The Joint Commission Yes
Zach May ESAC Inc


  • Roll call
    • The WG considered meeting dates May 11 (just before Cologne WGM) and May 18 (at the end of the Cologne WGM). Due to travel to the WGM, the next conference call will be Friday, May 25, 2018
    • No modifications to the proposed agenda items.

  • Cologne WGM Agenda
    • Five people already signed up for the remote access option, CQI WG will be joining this remote access pilot. Any one who is interested, please let the co-chairs know to add to the list.
    • Walter Suarez reviewed the planned agenda for the Cologne meeting.
    • Walter reminded WG members about the Co-Chair Election Process VIA ELECTION RUNNER
      • There will be NO absentee balloting as the Election Runner application allows those members subscribed to the listserv to submit their vote during the normal voting period (Monday 9:00 am – Wednesday 5:00 pm) during the Working Group Meeting regardless of whether they are in attendance at the WGM to submit their vote.
      • On Monday morning of the WGM (May 14, 2018), all members subscribed to the work group’s listserv will receive a message from Election Runner with a link to place their vote. The link is unique to each voter, so passing it along to someone else will not work.
      • The election site will automatically close at 5:00 pm on Wednesday, May 16, 2018. Results will be announced Wednesday evening.
      • NOTE: You must be subscribed to the listserv using the default email in your member record.
      • One member indicated the "Capcha" is broken on the list serve sign up - will notify the webmaster

  • Evidence-Based Medicine on FHIR
    Brian Alper presented a PSS for review by the CQI WG - Consideration for co-sponsorship / Interested party. Link to the PSS: FHR Resources for Evidence-Based Medicine Knowledge Assets (EBMonFHIR). See PSS for full details.
    • The project addresses the evidence processing communities (e.g., Cochrane) and guideline communities perform a substantial amount of effort with respect to knowledge management. There is a large amount of resource duplication without the ability to re-use the work of others. Scope is Universal Realm.
    • The FHIR infrastructure can assist to define the modeling and allow evidence sharing. Hence Evidence Based Medicine (EBM) on FHIR - to determine data exchange needs for knowledge assets and define new FHIR resources or metadata to meet the needs of the evidence development communities and to enable sharing of Risk of Bias, Research Results Data Extraction, Summary of Findings tables and Recommendations
      • Floyd moved to sign on as a co-sponsor with periodic updates, Thom Kuhn seconded.
      • Vote - 23 Approved, 0 Abstain, 0 Opposed - Motion passed unanimously - Brian will submit to Clinical Domain for approval

  • QRDA Data Sharing User Guide
    • Status Discussion and Decision - HL7 CDA® R2 Implementation Guide: Supplemental QRDA Clinical Quality Data Sharing User Guide, Release 1 (PI ID: 1215)
    • Publication version and ballot reconciliation spreadsheet shared with listserve and uploaded to CQI document site April 28 and 29th respectively
    • Julia Skapik reviewed an edited publication version of the QRDA Data Sharing User Guide based on input from Thom Kuhn. The document includes updated examples and changes based on reconciled comments
    • Floyd moved to approve the QRDA Data Sharing User Guide as edited and the reconciled ballot reconciliation spreadsheet as complete. Bryn seconded the motion
    • No further discussion occurred
    • Vote - 23 approved, 0 abstain, 0 opposed - Motion passed
    • Publication Request presented to the WG
      • Floyd moved to approve the publication request, Bryn seconded the motion
      • Vote - 21 Approved, 0 abstain, 0 opposed - Motion passed

  • IPPS Rule Introduction - Discussion
    • CMS published 1 week ago an IPPS proposed regulation - the annual Notice for Proposed Rule-Making (NPRM) regarding payment to hospitals and long-term care facilities
    • Walter presented some highlights of the proposal
      • Promoting Interoperability replaced "Meaningful Use" and adds significant modifications to the program
      • HL7 will be looking to make comments, funneled through the Policy Committee from each of the Workgroups. CQI will likely want to comments on the quality reporting requirements and other related components of the IPPS NPRM. Standards for the 2015 edition address: 2015 standards
      • CQI will be reviewing the content and submitting comments to the Policy Committee
      • Comments are due June 25, 2018 to CMS; All Workgroup submissions will need to occur significantly before that date to the Policy Committee
      • Walter asked the WG if there were any early comments from members attending the call. Discussion included comments about removing a number of measures from the program and modifying the types of measures to be considered for inclusion. Organizations will be able to report on 90 consecutive days rather than a full year; many report on 90 days toward the end of the year. The scoring system will also be modified to a total score of 100 an organization can reach; to avoid penalties (payment adjustments) passing score is 50 out of 100. To achieve a score of 50 requires reporting for all 4 major objectives (ePrescribing, consumer access to health information, health information exchange, and public health) and specifically one or two metrics must be conducted for each of the 4 objectives to reach the 50 points. Changes are focused on simplification and burden reduction. A separate section addresses quality reporting for hospitals (the IQR program) which defines quality measures and metrics to report them.
      • Process will include discussion through email and at the Cologne WGM with further details discussed on the May 25, 2018 and June 1, 2018 CQI WG calls.

  • STU Comment Review
    • QRDA Category III STU 2.1 - There were no new comments as of 4 May 2018
    • QRDA Category III STU 2.0 - There were no new comments as of 4 May 2018
    • QRDA Category I STU 5.0
      • Comment 1572 -
        • Mitra Biglari provided context for the issue. The issue is about providing guidance in the QRDA to defining the time zone in the measure report. The change will allow more accurate time definition and calculation. Clarification guidance will also help that, if no time zone is provided, keep the data without a time zone rather than applying the time zone of the receiving organization. The current guide suggests that the time should be compared to the reporting period. The issue likely affects other interoperability use case application of time zone information. Bryn suggested the disposition approach should reference the time zone behavior and calculation within CQL. Thom suggested we would want general guidance and reference greater detail in another standard (CQL).
        • The CMS Implementation Guide (QRDA Category I) states, "A Coordinated Universal Time (UTC time) offset should not be used anywhere in a QRDA Category III file or, if a UTC time offset is needed anywhere, then it must be specified everywhere a time field is provided."
        • The WG agreed that guidance is needed and should be constructed by referring to the CQL specification. See Comment 1572 for the detailed language of the resolution.
        • Floyd moved to approve the disposition as stated in the disposition field, Thom Kuhn seconded.
        • Vote: 18 approved, 0 abstain, 0 opposed
    • QRDA Category I STU 4.0 - There were no new comments as of 4 May 2018
    • QDM-based HQMF STU 1.4 - There were no new comments as of 4 May 2018
    • CQL-based HQMF STU 2 - There were no new comments as of 4 May 2018
    • CQL-based HQMF STU 2.1 - There were no new comments as of 4 May 2018

  • CQI Project Updates - no updates other than those addressed above
    • 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)

  • Co-sponsored Project Updates - no updates
    • 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)

  • Notifications
    • Ballot CLOSES May 7, 2018
    • WGM – May 12 – 18, 2018 (Cologne, Germany)

Next CQI Workgroup Call: May 25th, 2018
Meeting Adjourned: 2:58 PM ET