Clinical Quality Information WGM May 2018, Cologne, Germany - Minutes

Back to CQI Agenda and Minutes Page

Back to CQI Wiki Page

D R A F T - T E M P L A T E for CQI WGM Minutes - Cologne Germany - May 2018

Attendance - DRAFT ATTENDANCE LOG for the full week May 14-18, 2018

CQI May 2018 Workgroup Meeting Attendance

Attendee

Attendee's Organization

Attendee's email

Mon
14 May Q2

Mon
14 May Q3

Mon
14 May Q4

Tue
15 May Q1

Tue
15 May Q2

Tue
15 May Q3

Tue
15 May Q4

Wed
16 May Q1

Wed
16 May Q2

Wed
16 May Q3

Wed
16 May Q4

Thu
17 May Q1

Thu
17 May Q2

Thu
17 May Q3

Thu
17 May Q4

Abdulmausk Shaker

HI3

abdumalil.shaker@hi3solutions.com

.

Abrar Salam

The Joint Commission

asalam@jointcommission.org

.

Alex Liu

EPIC

aliu@epic.com

.

Alex Liu

EPIC

aliu@epic.com

.

Amnon Shabo (Shvo)

Philips

amnon.shvo@gmail.com

.

Andrew Gordon

WoltersKluwer

andrew.gordon@wolterskulwer.com

.

Andrew Simms

Cognitive Medical Systems

asimms@cognitivemedical.com

.

Ann Phillips

NCQA

Phillips@ncqa.org

.

Anne Marie Smith

NCQA

smith@ncqa.org

.

Ben Ghahhari

CMS

benjamin.ghahhari@cms.hhs.gov

.

Ben Hamlin

NCQA

hamlin@ncqa.org

.

Bryn Rhodes

ESAC

bryn@databaseconsultinggroup.com

X

.

X

.

X

.

Chana West

ESAC Inc

chana.west@esacinc.com

.

Claudia Hall

Mathematica

chall@mathematicampr.org

.

Chana West

ESAC Inc

chana.west@esacinc.com

.

Craig Parker

Intermountain Health Care

craig.parker@imail.com

.

X

.

Dan Donahue

ESAC

dan.donahue@esacinc.com

.

Chana West

ESAC Inc

chana.west@esacinc.com

.

Dan Morford

VZ/VA

Dan.morford@bookzurman.com

.

Chana West

ESAC Inc

chana.west@esacinc.com

.

Daryl Chertroff

HLN Consulting

daryl@hln.com

.

X

.

Chana West

ESAC Inc

chana.west@esacinc.com

.

Dave Carson

VHA

dcarlson@xmlmodeling.com

.

X

.

Floyd Eisenberg

iParsimony, LLC

FEisenberg@iParsimony.com

X

.

X

.

X

.

Gay Dolin

IMO

gdolin@imoonline.com

.

Hafsa Subhan

The Joint Commission

hsubhan@jointcommission.org

.

iIkka Kunnamo

.

jilkkakunnamo@duodecim.fl

.

Jamie Lehner

PCPI

jamie.lehner@thepcpi.org

.

Jenny Brush

ESAC

jennifer.brush@esacinc.com

.

Joe Quinn

Optum

joseph.quinn@optum.com

.

Juliet Rubini

Mathematica

jrubini@mathematicampr.com

.

Kanwarpreet Sethi

Lantana Consulting Group

kp.sethi@lantanagroup.com

.

Kathleen Connor

.

kathleen_connor@comcast.net

.

Linda Michaelsen

Optum

linda.michaelsen@optum.com

.

Lisa Anderson

The Joint Commission

landerson@jointcommission.org

X

.

Lorraine Constable

.

lorraine@constable.ca

.

Matthew Tiller

ESAC

matthew.tiller@esacinc.com

.

Mitra Biglari

The Joint Commission

mbiglari@jointcommission.org

.

Pamela Mahan-Rudolph

Memorial Hermann

pamela.mahanrudolph@memorialhermann

.

Patty Craig

The Joint Commission

pcraig@jointcommission.org

X

.

Paul Denning

MITRE

pauld@mitre.org

.

Ping Jiang

The Joint Commission

pjiang@jointcommission.org

.

Robert Dieterle

Enable Care

rdieterle@enablecare.us

.

Robert Samples

ESAC Inc

robert.samples@esacinc.com

.

Stan Rankins

Telligen

SRankins@telligen.com

.

Sue Kent

CCF

kents@ccf.org

.

Sweta Ladwa

ESAC inc

sweta.ladwa@esacinc.com

.

Thomson Kuhn

ACP

tkuhn@acponline.org

.

Walter Suarez

Kaiser

walter.g.suarez@kp.org

X

.

Yan Heras

Optimum Health

yanheras@gmail.com

.

Yanyan Hu

The Joint Commission

yhu@jointcommission.org

.

Zach May

ESAC Inc

zachary.may@esacinc.com

.

Monday, May 14, 2018 CQI WGM Minutes

Q1

No Meeting - HL7 Plenary Session

Q2

Agenda Topics
- CQI Business Meeting
Chair - Walter Suarez; Scribe - Floyd Eisenberg
Discussion:
- Walter reviewed the scope of CQI WG
- Bryn volunteered to act as interim co-chair to support meetings through the week
  - Floyd moved to appoint Bryn Rhodes, Patty seconded, Vote - 10 approve, 0 abstain, 0 opposed
- Walter reviewed the agenda for the week - Floyd updated the agenda as we discussed during the call
- Floyd reviewed the new steering committee structure

Q3

Orders and Observations (OO) hosting CQI
Agenda Topics
- Use of Observation Resources - Design Patterns
- Order Set and Plan Definitions
- Catalog resource definitions
Chairs: Lorraine - See OO agenda for attendance

Discussion

Alerting and Alarms
Order Catalogue
FHIR Tracker items
- FHIR Tracker Items
- 15942 – NutritionOrder – consistent modeling of .status Vs .intent with the rest of FHIR – modeling inconsistent with other FHIR resource modeling. Loraine was able to find the modeling now does include the intent metadata element in the STU 4 ballot. It has been harmonized.
  - Withdrawn by commenter
- 15943 – NutritionOrder – NutritionOrder modeling - differences with ServiceRequest, MedicationRequest . The use case is the ability or order a specific dietary item. Nutrition order is modeled as the ability to order enteral diet, a nutritional supplement, a parenteral diet, etc. (E.g., oral diet - with types that include multiple diet type) - The NutritionOrder is a work in progress - needs to address a specific nutrient. The idea is to describe a nutrient modifier but the question is how to address "notDoneReason" and also to define a specific nutrient at the exclusion of all others.
  - There is always one diet for a patient active at any time, but supplements are different and might be addressed later on. See tracker item: 17164
  - Motion to break into 3 tracker items to follow and resolve each independently: Create tracker to harmonize the NutritionOrder to match the Request Pattern and handle NotDoneReason - see tracker item: 17166
  - Discuss how to handle boundaries and modeling when adding a supplement to an existing diet - do you entirely replace, or add? See tracker item: 17167
  - Motion by Ken McCaslin, second by Floyd Eisenberg - 26 approved, 0 opposed, 3 abstain
- 15945 – SupplyRequest modeling (general) and related to blood products (SupplyDelivery, SupplyRequest, and BiologicallyDerivedProducts). This subject is currently under development. Supply request is not the correct resource. This is on Wednesday Q3 Patient care agenda this week.
  - Motion: Rob Hausam, Second Richard Esmond: Balloters will connect with project team (see link in FHIR traker)to assure use cases are covered in that material. Vote - 29-0-0
- Immunization - the current modeling provides documentation details about immunization administration or a forecast (immunization recommendation) but not an order - referred to Public Health workgroup for follow up.
Order Catalogue
- Claude Nanjo discussed work on Order Catalogue - joined forces with Francios Macary - to define the core FHIR resource to represent the catalog for order entry. Proposal - use composition resource and introduce in a future profile a notion of a catalogue entry - to wrap an item as part of a catalog. This discussion is consistent with managing order sets. The connectathon created a catalog and sought to query for a catalog and elements. The Catalogue profile - needs to capture the business content used in the V2 catalogue for lab which is the most complex in V2. Conceptually, the FHIR resources need to capture identified, contributor, version, status publisher, copyright, title, Catalogue entry (identifier, contributor serviceProvider, orderable, version, status status Date Title, ChargeInforation, SpecimenDefinition, SpecimentToLab, Container, Handling, Lab service, ObservationSpecification, Units. Lorraine showed V2 modeling - some of the details are included in the notes here. ---- Richard Esmond suggested there is parallel with Imaging Requests - work with registries to get LOINC identifiers defined - should join with RadLAC - coordinate with II (Imaging Integration). Needs to also address Appropriate Use Criteria and CDS Hooks - to perform, needs to trace all the way along if there is a recommendation to process and order - and track if the order occurred and how it was handled. This discussion addresses the catalogue of what can be ordered.
- Other material addresses order management - fulfillment has not been sufficiently addressed.
- Claude showed examples of the order catalogue content.Link to Order Catalog

Q4

Agenda Topics
- CQI Meeting - Planning for September
Chairs: Walter Suarez, Scribe: Floyd Eisenberg

Discussion:

Decision Making Process - due to some edits to the default DMP, the CQI WG reviewed our individual WG addendum and believes that the addendum is still required.

Floyd Eisenberg moved to re-affirm our DMP addendum, Patty Craig seconded - Vote 6-0-0

Planning for September
- 30-day Medication Reconciliation PSS under consideration. Plan is to review the PSS Wednesday Q2 and consider an STU ballot for September to address an implementation guide to manage publication of data by the EHR and subscription by a data analytic engine for the data, then aggregation and analysis for reporting to a reporting agency. The STU will use 30-day med reconciliation as the example.
- Evidence-based Medicine (EBM) on FHIR (CDS primary) - approved by CDS and CQI - current plan is to ballot for comment only in September. The project facilitator (Brian Alper) will review with Biological Regulated Research (BRR) for potential co-sponsorship (perhaps during this quarter) and then bring modified PSS to CDS and CQI on Wednesday Q2 for review and possible re-vote if needed, then submit to FHIR Management Group and Clinical Domain for approval.
- FHIR Quality for QI Core to ballot in September (Project 1125) and PSS is up-to-date. The work requires publication of QI Core / QUICK STU 3 based on the completed ballot reconciliation from January 2018. Then we need to update to FHIR STU 4 and US FHIR Core STU 4 for the September ballot.
- No known need for new ballots for CQL-based HQMF (CQI managed) or CQL (CDS managed) but both PSS' are current and active

Tuesday, May 15, 2018 CQI WGM Minutes

Q1
Agenda Topics

CQI Meeting
Chair - Floyd Eisenberg, Scribe - Walter Suarez
Discussion:

From the agenda, we had already completed the project planning and PSS review for September ballots, and had coordinated ballot reconciliation for the week. We focused on the following items:

Floyd and Walter provided a review of the discussion and actions taken during the Steering Division meeting. This was the first meeting under the new Domain Expert structure. CQI is now part of the new Clinical Steering Division (formerly Domain Experts).
CQI has received a request from Arden Syntax to consider supporting their request to move from Infrastructure SD to Clinical SD (as they seem to work closely with CDS and, in some cases with CQI. The feeling among the CQI group was that Arden Syntax seems to be much more of an Infrastructure component of HL7 work, rather than a Clinical working group. Thus, we are deciding to not get involved in the request from Arden Syntax.
During the Steering Division, we were informed of the need to review and update/approve the WG Mission and Charter. We discussed and updated the Mission and Charter - last updated in 2017. Several changes were made, mainly eliminating the detail listing of projects, which seem to be more appropriately moved to our 3-year workplan. The plan is to submit the revised M&C to the CQI List, and review it with the WG during our upcoming calls, and get it completed and approved in the next few weeks, well before the September deadline.
The WG discussed a new issue - how to handle of transition from ED to Inpatient status, when there is an 'observation' period in between. The question is where would that be captured in the current system. We understand that in FHIR this will be addressed. We will do some research and find out with some other people think, and come back to this issue during one of our calls.
We reviewed our next meetings.

Q2
CQI hosts CDS and FHIR
Agenda Topics

CDS Hooks 1.0 ballot reconciliation
FHIR Clinical Reasoning ballot reconciliation (if time)
Chair - Floyd Eisenberg; Scribe - Walter Suarez
Discussion:
- CDS Hooks 1.0 Ballot Reconciliation:
- Main topics: Negative comments about security; comment about analytics; comment about response

Item 106: "prefetch" - recommend specifying that prefetch should only include data allowed within scopes. ## Discussion: Proposal is that this is not persuasive; in the document it is described
1. Moved as Not Persuasive: Josh; second: Bryn; 23 for; 3 abstentions; 0 oppose
Item 120: Current SMART scope specification seems too broad to meet HIPAA for minimum necessary.
1. Discussion: this will be brought up to the larger overarching FHIR group to discuss implications of HIPAA.
2. Moved as Persuasive with Mod. moved by Ken; second by Bryn; 25; 0 against; 1 abstain
Item 150: Issue is that "Client_id" is included in the document, but no reference or description is given.
1. Discussion: in the Jason Web Token (JWT) there is a field "sub" described as "Client_id of the EHR". However, nowhere there is an explanation of what Client_ID is. Our interpretation is that this is the OAuth2.0 identified. However, it is not described anywhere. Recommendation: Persuasive with Mod; recommending to remove the Client_id. We acknowledge that by removing it we would be not in compliance with JWT Profile for OAuth Authentication.
2. Moved as Persuasive with Mod; by Kevin; second by Josh. 26; 0; 0.
Item 115: Issue is about Analytic Endpoint. In general, this feature has not been widely implemented. Comment is that the Analytics Endpoint instead of being and endpoint, should be describe more generically. It should be provided as a part of service metadata. The CDS service should advertise the URL so the EHR knows where to go.
1. Discussion: We recommend Persuasive with Mod, and should remove what little there is on Analytics from the specification, and focus on producing a stronger specification that allows more advanced use cases, and do a testing during an upcoming connectathon.
2. Moved as Persuasive with Mod by Isaac; second by Bryn. 26; 0; 0.
Item 127: Issue is about the CDS services respond to the EHR. CDS response can contain a suggestion. FHIR Clinical Reasoning has a new resource called Detectedissue. So Cards should also support this resource.
1. Discussion: We like the generic notion of allowing Detectedissue to be included as a "suggestion" even though it is not an order. Recommend Persuasive with Mod; the desired functionality is persuasive and this is something we will consider for future use, including exploring other FHIR resources (in addition to the proposed Detectedissue), other card types, other interaction methods, etc.
2. Moved Bryn; second Isaac; 25; 0; 1
Item 134: On the CDS response there can be many cards. There is information about how to prioritize the cards (Info, Warning, Hard Stop). This value set is mixing urgency indicators with user experience.
1. Discussion: we recommend that Info and Warning be considered common priorities; and rename Hard Stop to 'critical' priority.
2. Recommendation: Persuasive with Mod. Rename Hard Stop to Critical. Moved Josh; second Bryn; 25; 0; 0
Item 26: About Prefetch Token. When a CDS service defines a prefeth, the way to represent that is with various elements, including patient ID. It uses certain characters in the string, like french brackets. This is a prefetch token. They must exist at the context level/root level of the entire element. Comment is why the prefetch token must be limited to the content element? Spec is not clear that the prefetch token is limited to the content element.
1. Discussion: The prefetch token must be limited to the content element, except when is referring to a user in context. So, if we move user to in context that would address the issue. Recommendation: Persuasive with Mod. Move the CDS Service request "User" field to the Hook Context and document that each hook author shall include the "user" field to the hook contect field if it is appropriate to the hook. We acknowledge this breaking change but feel now is the time to do this. In doing this, we will address the ballot comment (by clarifying that prefetch templates relat to context parameters) and possibly allow for non-user initiated CDS hooks calls.
2. Moved Josh; second Bryn; Discussion: As we define new hooks, remind people that they have to put it there. All hooks need it. All have user in context. We can add language that the document specify that this is needed. Modification was done and accepted to add that document in the spec that each hook author shall include the "user" field.
3. Vote: 24; 0; 0

Q3

CDS hosts CQI and FHIR
Agenda Topics
- CDS Hooks ballot reconciliation (continued from Q2)
Chairs: See CDS Minutes and attendance - CDS Chairs present - Ken Kawamoto, Robert Jenders, CQI Co-chairs - Floyd Eisenberg, Patty Craig (telephone)
Discussion - items reviewed listed below - see ballot reconciliation spreadsheet for details
- Ballot item # 83
- Ballot item # 99
- Ballot item # 160 (Hooks grouping)
- Ballot item # 130 (Hooks grouping)
- Ballot item # 132 (Hooks grouping)
- Ballot item # 111
- Ballot item # 121 (Discovery endpoint grouping)
- Ballot item # 124 (FHIR grouping)

Q4

Agenda Topics
- CQI Meeting - CQL-based HQMF Ballot Reconciliation
Chairs: Bryn Rhodes (Interim Chair), Scribe: Floyd Eisenberg
Discussion:
- CQL -based HQMF - 152 comments - 124 unique (28 were duplicates)
- The main question on the ballot addressed how to represent the composite - include the HQMFs (option 2), or reference the HQMFs of the component measures (reference the HQMFs)
  - Vote was 4 for option 1, 1 vote for option 2, 1 abstention in the ballot comments
  - There are 23 composite measure support comments on the ballot. Constraints on HQMF currently require change in conformance to the normative standard to accommodate option 1 (and thus more work in the CQL-based HQMF conformance requirements). Option 2 allow use of the HQMF "as is" and provides all information for implementers to calculate. However, Option 2 would need to be constrained to individual-level composites only, not population-based measures. Individual composites combines the component measures but calculates for the individual. Population-based component measures calculate the composite on the results of the component scores - this approach requires population-context expression.
  - Discussion did not lead to a decision due to insufficient representatives to address the issue. Some are leaning to Option 2 - it can be delivered with current tooling but does not have to be fully incorporated in the Measure Authoring Tool. Minimum viable composite measure would have identification of the component measures in the composite measure document - the tooling would need to support the set of component measures whether or not the CQL is incorporated.
    - Step 1 - the implementer would need to find all the component measures - the MAT needs to reference the component measures
    - Step 2 - The tool could include the CQL from the component measures automatically, or the measure developer would need to re-build each component measure expressions within the composite measure.
    - There is no decision today - for review at a subsequent meeting
- All other comments are persuasive and can be most likely managed with a block vote
  - 23 on composite measure support
  - 11 on conformance statements
  - 5 on continuous variable measures - additional clarification on the specifications and calculations
  - 19 errata
  - 6 comments on terminology - some questions referencing invalid OIDs and some on direct reference code clarifying documentation (and whether version should be specified in direct reference codes)
  - 7 comments on updating to QDM 5.4
  - 22 comments on nomenclature (e.g., eCQM not eMeasure)
  - 13 comments on updating references
  - 11 website comments

Wednesday, May 16, 2018 CQI WGM Minutes

Q1 CQI Hosts CIMI and CDS

Topics:
- Clinical activities and needs for standards for CDS and measurement: Pulmonary Embolus (PE) Risk Assessment SMART on FHIR app (Susan Matney)
- CDS KNART Project review (15 minutes)
- CDS Hooks 1.0 Ballot reconciliation (tentative)
- QI Core content review with CIMI and future direction
Chair - Floyd Eisenberg, Scribe - Walter Suarez

Discussion:

CDS KNART:

Claude provided an update on KNART (slides)
Since last meeting: Trial XML compositional schema; errata collection; preliminary abstract; preliminary event mapping and propagation model; initial relationship between composite and components execution defined; KAS and FHIR comparison and mapping started
Next steps: formal conceptual model development; abstract definition of various lifecycles (governance, execution, event propagation); schema update and integration; formalization, model creation, and write uoo
Sharing information about the best practices, what work, what didn't, from implementation sites would be helpful
Information about the KNART calls on Thursdays will be submitted by Claude, for the minutes

PULMONARY EMBOLISM Presentation

Susan presented on the PE Risk Assessment SMART on FHIR app
The application uses a lot of calculations and algorithms, and kicks out an alert message. A list of alert messages is included in the excel file.
Table presents the Alert Message, Order, Test, Result, Recommendation Impression

Q2

CQI hosts CDS
Agenda Topics (proposed):
- (CQL ballot reconciliation)
- Proposal for Evidence-based Medicine (EBM) on FHIR
- Presentation from European clinical sites regarding current activities and needs for standards for CDS and measurement
Chair - Walter Suarez; Scribe - Floyd Eisenberg; Scribe
Discussion:

Q3 CDS hosts CQI

Agenda Topics
FHIR Clinical Reasoning module review
CQL-based HQMF Ballot Reconciliation
Chairs: See CDS Minutes
Discussion

Q4

CDS hosts CQI and CIMI
Agenda Topics
QI Core content review with CIMI and future direction
CIMI for Quality
Chairs: See CDS Minutes
Discussion:

Thursday, May 17, 2018 CQI WGM Minutes

Q1

No Planned Meeting - Notes from PC meeting
Agenda Topics
Chair - n/a, Scribe - n/a
Discussion:

Clinical Quality Information WGM May 2018, Cologne, Germany - Minutes

Contents

Attendance - DRAFT ATTENDANCE LOG for the full week May 14-18, 2018

CQI May 2018 Workgroup Meeting Attendance

Monday, May 14, 2018 CQI WGM Minutes

Tuesday, May 15, 2018 CQI WGM Minutes

Wednesday, May 16, 2018 CQI WGM Minutes

Thursday, May 17, 2018 CQI WGM Minutes

Navigation menu

Personal tools

Namespaces

Variants

Views

More

Search

Navigation

groups

meetings

general

Tools