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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/Oppose: 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:
    • 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:


  • 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