HL7 Clinical Quality Information Jan 2017 San Antonio WGM Minutes

Attendance:

Mon / Tue / Wed / Thur
Name / Company / Email / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q1 / Q2
Angelica Garcia Guitierrez / Transcend Insights / Humana / / x / x / x / x
Anne Marie Smith / NCQA / / x / x / x / x / x / x / x / x / x
Austin Kreisler / Leidos / / x
Benjamin Flessner / Epic / / x
Bruce Bray / University of Utah / / x / x / x / x
Bryn Rhodes / Database Consulting Group / / x / x / x / x / x / x / x
Calvin Beebe / Mayo Clinic / / x
Caterina Lasome / Ion Informatics / / x
Chris Markle / ESAC / / x / x / x / x / x / x / x / x / x / x / x
Chris Melo / Philips / / x / x / x / x / x
Claude Nanjo / Cognitive Medical Systems / / x
Daniel Chaput / ONC / / x
David Sundardam - Stukel / Epic / / x / x / x / x / x / x / x / x / x / x / x
Emory Fry / Cognitive Medical Systems / / x
Floyd Eisenberg / iParsimony / / x / x / x / x / x / x / x / x / x
Galen Mulrooney / VA / / x
Gay Dolin / IMO / / x
George Cole / Allscripts / / x
Guilherme Del Flol / University of Utah / / x / x
Howard Strasberg / Wolter Kluwer / / x
Isaac Vetter / Epic / / x
Juliet Rubini / Mathematica / / x / x / x / x / x / x / x / x / x / x
Kanwarpreet (KP) Sethi / Lantana Consulting Group / / x / x / x / x / x / x / x / x
Ken Kawamoto / University of Utah / / x / x / x / x / x / x / x
Ken Lord / VA / / x
Kevin Shekleton / Cerner / / x
Kurt Allen / Penrad / / x
Linda Michaelsen / Optum / / x / x / x
Lindsy Hoggle / AND / / x
Lisa Nelson / LOTS / / x
M’lynda Owens / Cognosante / / x / x
Marc Hadley / MITRE / / x / x / x
Margaret Dittloff / Academy Nutrition and Dietetics / / x
Mark Kramer / MITRE / / x
Marten Smits / Furore / / x
Michael Holck / ESAC / / x / x / x / x / x / x / x / x
Oliver Krauss / University of Upper Austria / / x
Patty Craig / The Joint Commission / / x / x / x / x / x / x / x / x / x / x / x
Paul Denning / MITRE / / x / x / x / x / x / x / x / x / x / x / x
Peter Gilbert / MHPlan / / x / x
Reshma Patel / ESAC / / x / x / x / x / x / x / x / x / x / x
Richard Esmond / Pen Rad / / x / x
Richard Ettema / AEGIS.net, Inc / / x
Rick Geimer / Lantana Consulting Group / / x
Robert Jenders / UCLA / / x / x
Russel Off / Deloitte Consulting / / x
Steve Fine / Cerner / / x
Thomson Kuhn / ACP / / x / x / x
Tony Laurie / Nurdian / / x
Tracy Angeles / Conduent / / x / x
Walter G. Suarez / Kaiser Permanente / / x / x / x / x / x / x

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HL7 Clinical Quality Information Jan 2017 San Antonio WGM Minutes

Time: Monday Q1
Facilitator / Floyd Eisenberg / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • Welcome/Introductions
  • Agenda planning
  • WG Agenda Review and Update
  • New Proposals

Supporting Documents – CQI HL7 Wiki agenda ( )

Minutes/Conclusions Reached:

Business Session

  • Agenda Review Planning and Update
  • Reviewed agenda on Wiki
  • Switched HQMF Normative ballot reconciliation (Mon Q4) with CQL-based HQMF ballot reconciliation (Mon Q2)
  • Mon Q3 – changed agenda item from HQMF Normative ballot reconciliation to CQL-based HQMF ballot reconciliation
  • Tues Q2 - added the topic “Review FHIR Maturity Model for Clinical Reasoning”
  • Wed Q1 - added the topic “CDC CDS RFI Reponse”
  • Wed Q4 - added the topic “CQL-based HQMF Ballot reconciliation” for joint review with CDS
  • Thur Q4 – removed joint meeting with CIC (CIC hosting), CQI will not have a meeting this quarter
  • Discussed potential new proposals
  • US Core is fairly small compared to QI Core
  • QI Core has 10-12 more profiles than US Core
  • The path to move things from QI Core to US Core is unclear
  • Ultimately CIMI will replace QI Core, but that will take a while
  • Do not need a PSS for QRDA R5.
  • Will require a ballot
  • Need to add QDM 5.0x
  • Ability to have direct reference codes
  • Other changes
  • Need to create a diagram depicting the “pieces” – CIMI, US Core, QI Core, etc
  • Will work on this later

Time: Monday Q2
Facilitator / Floyd Eisenberg / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • HQMF Normative ballot reconciliation

Supporting Documents – HQMF Normative ballot reconciliation spreadsheet (

Minutes/Conclusions Reached:

Business Session

  • HQMF Normative ballot reconciliation
  • Difficult to update because it is using the V3 tools.
  • Received a number of new functionality for the standard to handle. Options are:
  • Update the current standard before Normative publication
  • Could be handled as a STU on the normative HQMF standard
  • Could be added to the FHIR Measure Resource and not handle in HQMF
  • Workgroup decided to look at all of the comments to make a decision.
  • HQMF Normative ballot reconciliation
  • All ballot reconciliation dispositions are documented within the ballot reconciliation spreadsheet and have not been duplicated within these meeting minutes.
  • Block Vote #1 - Item Numbers:
  • Item #1 – Considered for Future Use

BrynRhodes moved to approve this disposition and WalterSuarez seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 14

Approved

  • Block Vote #2 - Item Numbers:
  • Item #2 – Persuasive with Mod (will add documentation to explain how to use the MeasureDescription section)

Bryn Rhodes moved to approve this disposition and Walter Suarez seconded

Additional Discussion:

* Need to refer to the MAT team to ensure they can implement as specified

* Added language to disposition: “In addition, we will remove the constraint that prevents inclusion of multiple measure descriptions.”

Opposed: 0; abstentions: 0; approved: 15

Approved

  • Block Vote #3 - Item Numbers:
  • Item #3 – Considered – No action required

Bryn Rhodes moved to approve this disposition and Anne Marie Smith seconded

Opposed: 0; abstentions: 0; approved: 14

Approved

  • Block Vote #4 - Item Numbers:
  • Item #4 – Considered – No action required

Bryn Rhodes moved to approve this disposition and Juliet Rubini seconded

Opposed: 0; abstentions: 0; approved: 14

Approved

  • Block Vote #5 - Item Numbers:
  • Item #5 – Considered for Future Use

Walter Suarez moved to approve this disposition and Anne Marie Smith seconded

Opposed: 0; abstentions: 0; approved: 15

Approved

  • Block Vote #6 - Item Numbers:
  • Item #6 – Considered – No Action Required

Walter Suarez moved to approve this disposition and Anne Marie Smith seconded

Opposed: 0; abstentions: 0; approved: 15

Approved

Time: Monday Q3
Facilitator / Walter Suarez / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • CQL-based HQMFballot reconciliation

Supporting Documents – CQL-based HQMF ballot reconciliation (

Minutes/Conclusions Reached:

Business Session

  • CQL-based HQMF ballot reconciliation

Total comments received: 66

  • Negative: 45
  • Affirmative: 21
  • A-C:
  • A-S: 7
  • A-Q: 5
  • A-T: x5
  • Blank: 4

In person disposition: 22 * It was noted that the column for ‘In Person Disposition’ was hidden in the spreadsheet, so there may be more requests for in person disposition.

  • CQL-based HQMF ballot reconciliation
  • All ballot reconciliation dispositions are documented within the ballot reconciliation spreadsheet and have not been duplicated within these meeting minutes.
  • Block Vote #1 - Item Numbers:
  • Items #13, #41, #59 – Persuasive, all are typos and will be fixed as recommended

Juliet Rubini moved to approve these dispositions and Anne Marie Smith seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #2 - Item Numbers:
  • Item #51 – Persuasive with Mod

Anne Marie Smith moved to approve this disposition and Juliet Rubini seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #3 - Item Numbers:
  • Item #58 – Persuasive

Chris Markel moved to approve this disposition and Juliet Rubini seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #4 - Item Numbers:
  • Item #1 – Not Persuasive

Chris Markel moved to approve this disposition and Anne Marie Smith seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #5 - Item Numbers:
  • Item #5 –Persuasive with Mod

Chris Markel moved to approve this disposition and Juliet Rubini seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #6 - Item Numbers:
  • Item #9 – Persuasive

Chris Markel moved to approve this disposition and David Sundardam - Stukel seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

  • Block Vote #7 - Item Numbers:
  • Item #12 – Persuasive with Mod

Floyd Eisenberg moved to approve this disposition and David Sundardam - Stukel seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

Time: Monday Q4
Facilitator / KP Seith / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • CQL-based HQMF ballot reconciliation

Supporting Documents – CQL-based HQMF ballot reconciliation (

Minutes/Conclusions Reached:

Business Session

  • CQL-based HQMF ballot reconciliationI(continued)
  • All ballot reconciliation dispositions are documented within the ballot reconciliation spreadsheet and have not been duplicated within these meeting minutes.
  • CQI reviewed a number of the comments. It was determined that some of them require other individuals in order to determine a disposition. This includes:
  • Items #26, #66
  • Block Vote #1 - Item Numbers:
  • Item #65 – Persuasive

Chris Markel moved to approve this disposition and Richard Esmond seconded

Discussion: Amended disposition to include Conformance Requirement 11

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote #2 - Item Numbers:
  • Item #60, 61, 62, 63 – Persuasive with Mod

Chris Markel moved to approve this disposition and Paul Denning seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote #3 - Item Numbers:
  • Item #64 – Considered Question Answers

Floyd Eisenberg moved to approve this disposition and Chris Markel seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote 4 - Item Numbers:
  • Item #2 – Persuasive

Walter Suarez moved to approve this disposition and Juliet Rubini seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote 5 - Item Numbers:
  • Item #3 – Persuasive

Floyd Eisenberg moved to approve this disposition and Anne Marie Smith seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote 6 - Item Numbers:
  • Item #4 – Persuasive

The exact “how” the terminology section will be included within CQL-based HQMF will be discussed in conjunction with other similar comments.

Floyd Eisenberg moved to approve this disposition and Richard Esmond seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 12

Approved

  • Block Vote 7 - Item Numbers:
  • Item #6 – Not Persuasive - Retracted by commenter based on workgroup discussion
  • Block Vote 8 - Item Numbers:
  • Item #7 and #8 – Persuasive with Mod

Anne Marie Smith moved to approve this disposition and Juliet Rubini seconded

No future discussion

Opposed: 0; abstentions: 0; approved: 11

Approved

Time: Tuesday Q1 (Hosted Structured Documents)
Facilitator / Floyd Eisenberg / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • HQMF Normative ballot reconciliation
  • QRDA - Managing single codes (direct referenced codes) Vs value sets with CDA
  • QRDA Implementer and receiver real world issues --> fundamental redesign??
  • CCDA Status (Lisa Nelson)

Supporting Documents: HQMF Normative ball reconciliation spreadsheet ( Health Status Observation presentationand QRDA Insights - Jan 2017 HL7 meeting (presented at Jan '17 WGM)

Minutes/Conclusions Reached:

  • Reviewed agenda – no changes
  • HQMF Normative ballot reconciliation
  • Did not have time to discuss – deferred to other conversations.
  • QRDA - Managing single codes (direct referenced codes) vs value sets with CDA
  • Discussion is related toeCQMs released in 2018 and used for 2019 data reporting.
  • There are times when a measure developer is sure that there will only ever be one code used for a specific concept.
  • The issue is related to “hiding” LOINC codes underneath a value set that is “owned” by someone other than Regenstrief.
  • Concern about backward compatibility issue.
  • CQI desires to apply this change alone with the move to CQL-based HQMF and the new Quality Data Model (QDM) version, both of which will require major changes on behalf of both data submitter and data receiver software.
  • The requirement that the OID is submitted with the data was added initially for QRDA. This is a restriction applied by QRDA and does not exist in CCDA.
  • QRDA Implementer and receiver real world issues --> fundamental redesign?? – see slide deck
  • Patty presented the following items that have become an issue for hospital QRDA data submission / receipt for The Joint Commission.
  • Number of Episodes of Care in Single QRDA (XML) File
  • Unique Encounter IDs
  • The Encounter ID should be unique; however, it is known that some EHRs utilize a different method to generate the CDA Encounter IDs because they use an internal method to link components of an episode of care.
  • This issue is not QRDA specific and can cause issues with data interchanged between providers and between hospitals and providers.
  • Same Code in Multiple Value Sets
  • Data Precision
  • There is no limitations within CDA related to the datetimes.
  • Need to evaluate the Quality Data Model (QDM) to see if it is restricting datetimes.
  • Patty will post all items against QRDA I Release 4 so CQI can evaluate and take appropriate action for the next release of QRDA.
  • CCDA Status (Lisa Nelson) – see slide deck
  • Care Plan Framework contains the Health Concerns Sections which includes the Health Status Observation template.
  • The Health Status Observation template contains information about the overall health status of the patient at the specific point in time.
  • A discussion occurred about the nature of information in the Health Status Observation entry to determine if it belongs in the Health Concern section or if it belongs in the Health Status Evaluation and Outcomes section?
  • No conclusion was reached, but the assessment by CQI is that the categorization of this entry does not affect the modeling of information in QDM.
  • So, if QDM was looking for “assessment” information, we think they would look at a Health Status Observation regardless of when the information may be presented in a CDA document.

Time: Tuesday Q2
Facilitator / KP Sethi / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • Review FHIR Maturity Model for Clinical Reasoning
  • HQMF Normative Ballot reconciliation

Supporting Documents:CQL-based HQMF ballot reconciliation ()

Minutes/Conclusions Reached:

  • Reviewed agenda
  • Added QI Core to US Core discussion
  • Added FHIR Tracker comments
  • Added CQL-based HQMF Ballot reconciliation discussion related to the Terminology section
  • QI Core to US Core (Floyd)
  • US Core represents the base set of data that can be expected to be shared in structured form by all EHRs. The goal is for all data usages within the US to work
  • The US Core set needs to evolve over time.
  • QI Core/QUICK includes additional elements that should, over time, be able to migrate into the US Core.
  • Such a mechanism does not exist today, but is in the works.
  • Evolving Standards / Data Model:
  • Quality Data Model (QDM) and Virtual Medical Record (vMR) are inputs into Quality Data Analysis Model Conceptual Model (QiDAM),
  • QiDAM is the input to Quality Information for Clinical Knowledge (QI CORE / QUICK),
  • QI CORE / QUICK is the input to US Common Clinical Data Set (US Core)
  • Data Access Framework (DAF) is the other input into US Core.
  • This means that the PSS we have QI Core is not “valid” because it is international and not US Realm.
  • We need to update the existing PSS to be US Realm
  • Then submit the project results to US Realm for approval for inclusion in US Core
  • Review FHIR Maturity Model for Clinical Reasoning
  • The Maturity Model:
  • 0 - Resource or profile (or artifact) has been published on the current build.
  • 1 – Plus artifact procedures no warnings during the build process.
  • 2 - Plus the artifact has been tested and successfully exchanged at a Connectathon
  • 3 - Plus the artifact has been verified by the workgroup as meeting the STU Quality Guidelines
  • 4 – Plus the artifact has been tested across its scope, published in a formal publication, and implemented in multiple prototype projects.
  • CQI agrees that theCQI Clinical Reasoning artifacts can be at maturity level 3.
  • Bryn needs help expanding definitions of our Resources. Patty has agreed to help.
  • FHIR Tracker comments (HL7GForge, set reviewing workgroup to CQI)
  • Bryn is looking for assistance from CQI members with Items #10165 and #12223.
  • Item #11305 is asking for a name change from “measure” to something else as it is felt that “measure” is too generic.
  • The FHIR “measure” Resource is being developed to use with many types of measures, some not even envisioned today. So the group is concerned about restricting the usage of the Resource with a more clarifying name could be problematic over time.
  • Clem has requested an in-person resolution. There will be an attempt made to have Clem join a future quarter during this meeting.
  • CQL-based HQMF Ballot reconciliation
  • Continued discussion of item #4 on how an example of how the value set information could be removed from the Data Criteria section and placed into a new Terminology section. In addition, includes an example of how a direct referenced code would be included in both sections.
  • Item #4 disposition is that there needs to be a new Terminology section, which was approved on Monday with a follow-up comment that the “how” would be defined separately.
  • Item #53 is also related to the need for a Terminology section. The vote for this item will include the “how” to create and display the new Terminology section and modification to the Data Criteria section.
  • This discussion will continue in Q4.
  • HQMF Normative Ballot reconciliation
  • No HQMF ballot reconciliation occurred
  • Switched HQMF Normative balloting with CQL-based balloting for Tues Q3.
  • Walter joined the joint EHR, CIC, CQI meeting
  • Topic: Usability Project Ballot Reconciliation
  • See EHR minutes for information

Time: Tuesday Q3
Facilitator / Walter Suarez / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • CQL-based HQMF Ballot reconciliation

Supporting Documents:HQMF Normative Ballot reconciliation spreadsheet ( CQL-based HQMF ballot reconciliation(

Minutes/Conclusions Reached:

  • Reviewed agenda
  • Replaced CQL-based HQMF Ballot reconciliation with HQMF Normative Ballot reconciliation
  • HQMF Normative Ballot reconciliation
  • All ballot reconciliation dispositions are documented within the ballot reconciliation spreadsheet and have not been duplicated within these meeting minutes.
  • Block Vote 1 - Item Numbers:
  • Item #7 – Considered future use

Bryn Rhodes moved to approve this disposition and Michael Holckseconded