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13 July 2018 CQI Conference Call Minutes

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13 July 2018 - CQI Conference Call Minutes

HL7 Clinical Quality Information Workgroup
Friday, July 13, 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: Floyd
Meeting Scribe: KP


  • Roll call
Attendee Attendee's Organization Attendee's email Present
Abdul Malik Hi3 Solutions
Abrar Salam The Joint Commission
Angela Flanagan Lantana Consulting Group
Ann Phillips NCQA yes
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 EBSCO
Bryn Rhodes ESAC yes
Chana West ESAC Inc yes
Claudia Hall Mathematica yes
Dan Donahue ESAC
Floyd Eisenberg iParsimony, LLC yes
Gay Dolin IMO yes
Hafsa Subhan The Joint Commission
Howard Strasberg Wolters Kluwer
Humberto Mandirola Biocom
iIkka Kunnamo Duodecim jilkkakunnamo@duodecim.fl
James Bradley Mitre
Jamie Lehner PCPI yes
Jeff Schmitz Health eFilings
Jenny Brush ESAC
Joe Kunisch Memorial Hermann
Joe Quinn Optum
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
Linda Michaelsen Optum yes
Lisa Anderson The Joint Commission
Lisa Nelson Life Over Time Solutions, LLC
Lizzie Charbonneau Mitre
Lorraine Constable HL7 Canada
Luke Osborne MITRE
Matthew Tiller ESAC
Mike Hunt Experian
Mia Nievera The Joint Commission
Mitra Biglari The Joint Commission yes
Myron Finseth Medtronic 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
Rukma Joshi ESAC Inc
Sam Sayer Mitre
Stan Rankins Telligen
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
Yan Heras Optimum eHealth yes
Yanyan Hu The Joint Commission yes
Zach May ESAC Inc yes

  • Reminder
    • CQI July 6 Call was cancelled
    • Planned ballots for September 2018:
      • Project 1234 - FHIR Clinical Reasoning - current PSS is valid, does not require Notice for Intent to Ballot as it is part of FHIR STU 4
      • (Project ID 1429) - FHIR IG for Exchange of Data for Quality Measures - still needs NIB

  • Update review for FHIR Exchange of Data for Quality Measures
    • Viet gave a quick review of the project. See slides posted on CQI documents page for complete updates.
    • Viet and Bryn went over the Operations Definitions defined in the project. The operation definitions are posted on the FHIR website with a link.
    • Framework is meant to handle any standard - so will there be additional profiles to handle requirements specific to other organizations.
    • Goal is to have as much of that shared among all orgs. If we have done the framework correctly then they should be able to use the core as is without requiring change to how that happens.
    • It would be appropriate to update the IG if there are operations that are needed for reporting.
    • FMG was concerned about not wanting to see an IG come through for every measure. This IG should address the generic framework and provide some use cases as an example.
    • This is based on STU 4 and will mimic what we expect in R4. Will ask FHIR core how to make it backwards compatible for R3. Versioning is going to be a challenge as STU 2 and Argonaut is so well supported.
    • Viet will make confluence page available and encourages folks to join call. Information provided below:

  • Project meetings for FHIR Exchange for Data for Quality Measures:

  • Notice for Intent to Ballot (NIB) for FHIR Exchange of Data for Quality Measures
    • Floyd went over the NIB for FHIR Exchange of Data for QUality Measures with Viet.
    • Project has approvals from FMG, US Realm and Clinical Steering. TSC will review and (hopefully) approve next week.
    • No questions were raised during the review of the NIB.
    • KP moves to approve the NIB, Viet Seconds. No further discussion.
    • 17 Approved, 0 Abstained, 0 Against

  • Review CQL-based HQMF content for publication (Link to publication version documents sent to CQI Workgroup on Monday, July 9, 2018)
    • Will get a draft out monday at the latest and will seek approval following friday.
    • Primary questions related to comment 87 and 88 around continuous variable measure support
    • Some conformance language was added to address these comments' cconcern.
    • Changed referencing in the measure populations to use IDs so its unique
    • similarly changed referencing of included CQL files to be unique by using a URI and then extension of the CQL file.
    • these are the differences b/w draft shared before to now
    • There were a couple of resolutions that were handled differently in the IG than what was voted on the ballot spreadsheet. We should vote on that change to the spreadsheet resolution.
    • Motion by Bryn and KP Seconded to reopen Comment 53 and 99 for resolution.
      • 18 Approved, 0 abstain, 0 against
    • Comment 53: Changed disposition to not persuasive with mod, as the production examples are now dated compared to the changes introduced in the IG.
      • KP makes the motion to approve the updated disposition, Bryn Seconded.
      • 18 Approved, 0 abstain, 0 against
    • Comment 99: Changed disposition to Considered for future use because no current example exists but will add one when we have a clinically relevant one.
      • Bryn Moved, Paul seconded.
      • 18 Approved, 0 abstain, 0 against
    • Paul made the motion to reopen comments 87 and 88. Bryn seconded.
      • 18 Approved, 0 abstain, 0 against
      • Both 87 and 88 dispositions are changed to Persuasive with Mod. See updated spreadsheet for modified dispositions.
      • Bryn moved to approve the modified dispositions. Paul Seconded.
      • 17 Approved, 0 abstain, 0 against
    • Juliet made the motion to approve the ballot spreadsheet with the updates discussed today. Gaye seconded.
      • 17 Approved, 0 abstain, 0 against

  • Review Harmonization Items under consideration
    • Need to review the harmonization proposals and vote to approve that the CQI group has no comments/concerns.
    • Floyd discussed the proposals posted for this harmonization cycle.
    • No concerns were brought up on the call
    • Floyd asked if the group was comfortable stating that we have no concerns with the proposals and will not be joining.
      • Juliet made the motion that we're satisfied with the proposals. KP Seconded.
      • 17 Approved, 0 abstain, 0 against

  • Suggested modifications to CQI WG Mission and Charter Uploaded to CQI Document Site
    • Minor modifications were recommended which are posted in the document as tracked changes on the documents page. On approval Floyd will send a final update.
    • Mostly stylistic changes so will go to TSC right away.
      • KP makes the motion to approve the changes. Bryn seconded.
      • 16 Approved, 0 abstain, 0 against

  • 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)
      • does not need any management group approvals since doesnot have FHIR or CDA content.
    • HL7 FHIR® Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 (PI ID: 1234) (Co-Primary with CDS)
      • We need to include the Measure Report and Measure Resource in the R4 ballot. no disagreements from the group.
      • Bryn moved that we include the Clinical Reasoning IG in the FHIR R4 ballot. Juliet Seconded.
      • 16 Approved, 0 abstain, 0 against
      • Still some ballot resolutions that are left to go. Will put FHIR tracker items on the agenda to get through them.
    • HL7 FHIR® Profile: Quality, Release 1 - US Realm (PI ID: 1125)
      • Submitted for publication. has gone to FMG before going to TSC. Questions popped up about errors but they do not affect implementability.
    • 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)
    • 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
  • New Project Scope Statements - May 27, 2018
  • Harmonization
    • Initial proposals due - June 22, 2018
    • Final proposals due - July 20, 2018
    • Harmonization meeting - July 25 and 26, 2018
  • Notification for Intent to Ballot deadline - July 15, 2018
  • Initial Content Deadline - July 4, 2018
  • Reconciliation Content Deadline - August 3, 2018
  • Final ballot content due - August 19, 2018
  • Ballot opens – August 24, 2018 – September 24, 2018
  • WGM – September 29 - October 5, 2018 (Baltimore, MD)
  • Next CQI Workgroup Call: July 20, 2018