19 October 2018 CQI Conference call Minutes

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October 19, 2018 - CQI Conference Call Meeting Minutes

HL7 Clinical Quality Information Workgroup
October 19, 2018 – 1-3 PM EDT
Dial in: 770-657-9270 Passcode: 217663
https://join.freeconferencecall.com/hl7cqi
CQI Co-chairs: Patty Craig, Floyd Eisenberg, Juliet Rubini, KP Sethi, Yan Heras
Meeting Chair: Juliet
Meeting Scribe: Yan

October 19 2018 - CQI Conference Call Attendance

Attendee	Attendee's Organization	Attendee's email	Present
Abdul Malik	Hi3 Solutions	abdulmalik.shakir@hi3solutions.com
Abrar Salam	The Joint Commission	asalam@jointcommission.org
Alex Liu	EPIC	aliu@epic.com
Angela Flanagan	Lantana Consulting Group	angela.flanagan@lantanagroup.com
Ann Phillips	NCQA	phillps@ncqa.org	yes
Anne Smith	NCQA	smith@ncqa.org
Ben Ghahhari	CMS	benjamin.ghahhari@cms.hhs.gov
Ben Hamlin	NCQA	hamlin@ncqa.org	yes
Bo Borgnakke	Michigan Shared Services Network	borgnakke@mihin.org
Bob Dieterle	Enable Care, LLC	rdieterle@enablecare.us
Bob Keyes	Telligen	bkeyes@telligen.com	yes
Brett Marquard	River Rock Associates	brett@riverockassociates.com
Brian Alper	EBSCO	balper@ebsco.com
Bryn Rhodes	ESAC	bryn@databaseconsultinggroup.com
Chana West	ESAC Inc	chana.west@esacinc.com	yes
Claudia Hall	Mathematica	chall@mathematicampr.org	yes
Crystal Kallem	CK Consulting	crystal.kallem@ckconsultingllc.com
Dan Donahue	ESAC	dan.donahue@esacinc.com
Floyd Eisenberg	iParsimony, LLC	FEisenberg@iParsimony.com
Gay Dolin	IMO	gdolin@imoonline.com	yes
Hafsa Subhan	The Joint Commission	hsubhan@jointcommission.org
Howard Strasberg	Wolters Kluwer	howard.strasberg@wolterskluwer.com
Humberto Mandirola	Biocom	hmandirola@biocom.com
iIkka Kunnamo	Duodecim	jilkkakunnamo@duodecim.fl
James Bradley	Mitre	jhbradley@mitre.org
Jamie Lehner	PCPI	jamie.lehner@thepcpi.org	yes
Jeff Schmitz	Health eFilings	jschmitz@healthefilings.com
Jenny Brush	ESAC	jennifer.brush@esacinc.com
Joe Kunisch	Memorial Hermann	kunisch@memorialhermann.org
Joe Quinn	Optum	joseph.quinn@optum.com
John Damore	Diameter Health	jdamore@diameterhealth.com	yes
Julia Skapik	Cognitive Medicine	jskapik@cognitivemedicine.com	yes
Juliet Rubini	Mathematica	jrubini@mathematicampr.com	yes
Kanwarpreet Sethi	Lantana Consulting Group	kp.sethi@lantanagroup.com
Kathleen Connor	US Dept of Veterans Affairs	kathleen_connor@comcast.net
Linda Michaelsen	Optum	linda.michaelsen@optum.com	yes
Lisa Anderson	The Joint Commission	landerson@jointcommission.org
Lisa Nelson	Life Over Time Solutions, LLC	LisaRNelson@cox.net
Lizzie Charbonneau	Mitre	lizzie@mitre.org
Lorraine Constable	HL7 Canada	lorraine@constable.ca
Luke Osborne	MITRE	lwosborne@mitre.org
Matthew Tiller	ESAC	matthew.tiller@esacinc.com
Mike Hunt	Experian	mike.hunt@experian.com
Mia Nievera	The Joint Commission	mnievera@jointcommission.org
Mitra Biglari	The Joint Commission	mbiglari@jointcommission.org
Nick Radov	UHC	nradov@uhc.org	yes
Pamela Mahan-Rudolph	Memorial	pamela.mahanrudolph@memorialhermann
Patty Craig	The Joint Commission	pcraig@jointcommission.org
Paul Denning	MITRE	pauld@mitre.org	yes
Ping Jiang	The Joint Commission	pjiang@jointcommission.org
Rathore Garima		rathore.garima1@gmail.com
Rebeccah Baer	NCQA	baer@ncqa.org
Rich Boyce		codehop.dev@gmail.com
Rob McClure	MD Partners Inc	rmcclure@mdpartners.com	yes
Robert Samples	ESAC Inc	robert.samples@esacinc.com	yes
Rukma Joshi	ESAC Inc	rukma.joshi@esacinc.com
Ryan Clark	NCQA	ryan@ncqa.org	yes
Sam Sayer	Mitre	ssayer@mitre.org	yes
Stan Rankins	Telligen	SRankins@telligen.com	yes
Steve Hufnagel		steve.hufnagel.hl7@gmail.com
Sue Kent	CCF	kents@ccf.org
Sweta Ladwa	ESAC inc	sweta.ladwa@esacinc.com
Thomas Reese	U of Utah	thomas.reese@hsc.utah.edu
Thomson Kuhn	ACP	tkuhn@acponline.org	yes
Viet Nguyen	Strata Metrics	vietnguyen@stratametrics.com
Walter Suarez	Kaiser Permanente	walter.g.suarez@kp.org
Yan Heras	Optimum eHealth	yanheras@gmail.com	yes
Yanyan Hu	The Joint Commission	yhu@jointcommission.org	yes
Zach May	ESAC Inc	zachary.may@esacinc.com	yes

Meeting Minutes

• Roll call and agenda review
  • Juliet reminded the group that the meeting minutes of Baltimore WG meeting are available for review.
  • FHIR Data Exchange for Quality Measures (project 1429) traker items agenda topic is deferred to next meeting.

• Closing the Referral Loop document code value set discrepancy - Gay Dolin
  • The CDA examples task force is working on examples for representing “Closing the referral loop” with C-CDA documents and we are concerned about a challenge with this measure.
  • In CMS50v7 Closing the Referral Loop: Receipt of Specialist Report, the measure asks for (would query for) document codes to represent the numerator using SNOMED CT codes. However, all CDAs require LOINC for document codes.
  • Gay showed the group how the value set Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006) uses SNOMED CT, while in C-CDA, LOINC code is required for document codes. Gay thinks this could be problematic for a couple reasons: minimally, this would represents a mapping challenge for implementers; rquires dissemination into the implementer community education that they will need to use translation code to represent the SNOMED CT codes in a C-CDA (particularly for systems that query a database of C-CDAs for measure information); altered document management system queries of EHRs
  • Gay suggests to change the Consultant Report value set. She asks that if the group is aware of the issue and what are the thoughts for going forward.
  • Jamie commented that the rationale for this is that since this is Communication data type, the recommended vocabulary for Communication for eCQMs is SNOMED.
  • Jamie also commented that she is not aware of the issue has been brought up before.
  • Gay will enter an ONC JIRA item reporting this issue as suggested by Jamie

• Composite related harmonization item - Rob McClure
  • Improvement notation
  • Initial submission due 10/25; Next harmonization meeting 11/9
  • Rob presented the harmonization proposal for adding three new codes to the ObservationValue Code System. One abstract code _MeasuremetnImprovementNotation, and two new codes under this new abstract code. The two new improvement notation codes are IncrIsImp (for increased score indicates improvement) and DecrIsImp (for decreased score indicates improvement). The rationale for this is the requested change supports HQMF interoperability and also provides coded concepts that can be used for other measurement tracking to indicate improvement notation.
  • Codes were created in FHIR for improvement notation previously. Rob made it clear that this harmonization proposal is not to require FHIR to make changes (however, he would recommend to do so). The request here is to vote for approval of this harmonization proposal, so changes to HQMF could be made in the future, the vote is not asking changes be made to HQMF today.
  • Rob made motion to approve this harmonization proposal for submitting to this upcoming harmonization meeting, Julia Skapik seconded. Approve/Abstain/Opposed: 18/0/0
  • Rob also mentioned that in the offline email communication thread with Bryn, et al, he reminded that Bryn needs to make a couple modifications to the tracker items based on what's in the proposal because he made some changes after the tracker items were created. He also thinks the data type needs to be changed from coding to code. Rob suggested to make this an action item to follow up with Bryn. Below are the two tracker items related to this harmonization issue that this is referring to:
    • Tracker #19445 change to FHIR
    • Tracker #19446 for FHIR to align with the HL7 code system once it is available
  • Rob also discussed the tracker item# 11169 briefly. He suggests to add this as a future agenda item to further discuss the value set issue related to this tracker item. Below are links to some additional relevant information related to this issue:
    • FHIR discussion thread related to DetectedIssue.category for preventative care encounter gap.
    • FHIR Detected Issue Category value set
    • Add Detected Issue Category code for gap in care tracker item# 15924
    • V3 Act Code

• Confluence is coming!
  • 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 - Review agenda for meeting room reservations - consider invites from EHR Group?
  • This agenda item was very briefly mentioned during the call. Juliet will follow up with Patty offline for some details.
    • 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 CDS (larger room)
    • Wed Q3: CDS host CQI
    • 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)
• Balloting Milestones
  • October 14, 2018 – PSS deadline (submit to Steering Division and Project Management Office) - DEADLINE HAS PASSED
  • October 28, 2018 – Notice for Intent to Ballot (NIB) Deadline
    • NIB for Gaps in Care is postponed at this point.
  • 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
  • November 6, 2018 – Final Harmonization Proposal Deadline
  • November 8 – Harmonization meeting

• Meeting adjourned at 1:57pm ET. Next CQI WG meeting will be on Oct. 26th, 2018