HL7 Clinical Quality Information January 2018, New Orleans, LA, USA

WGM Minutes

Attendance: Note – The attendance log presented addresses attendance at sessions during which CQI met as the host. For attendance at any quarters during which CQI was hosted by other Workgroups, please see the minutes and schedule of those other workgroups. Note also, the planned Tuesday Q4 and Thursday Q1 sessions were cancelled during the WG meeting.

0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Mon / Tue / Wed
Name / Company / Email / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 / Q4 / Q1 / Q2
Abdulmausk Shaker / HI3 Solutions /
Alex Liu / EPIC /
Amnon Shabo (Shvo) / Philips /
Andrew Gordon / Wolterskluwer / / x
Andrew Simms / Cognitive Medical Systems / / x
Angela Flanagan / Lantana / / x / x / x / x / x / x / X
Ann Phillips / NCQA /
Anne Marie Smith / NCQA / / x / x / x / x / x / x / X
Aruind Jagnathar / Lantana Consulting Group /
Athla Farkas / Canada Health Infoway / / X / X
Avinash Shanbhag / ONC /
Bar Van Den Heurth / Philips / / X / X / x / x / x
Becky Kuhl / Lantana Consulting Group
Brian Alper / EBSCO / / X / x
Brett Marquard / River Rock / / x
Bruce Bray / University of Utah / / X / X
Bryn Rhodes / Database Consulting Group / / x / x / x / X / X / x
Byounct-Kee Yi / Samsung Med Center / / x
Carsten Quinlan / Epic / / x / x / x / x / x / x / x
Chris Hills / IPO / / x
Chris Melo / Philips /
Chris Peck / Cognitive Medical Systems /
Christian Knapp / Furone /
Claude Nanjo / Cognitive Medical Systems /
Claudia Hall / Mathematica /
Craig Parker / Intermountain Healthcare /
Crystal Kallen / Lantana Consulting Group /
Dan Morford / BZ/VA / / x
Daryl Chertroff / HLN Consulting / / x / X
Dave Carson / VHA / / X
David Parker / Defined IT / DoD / VA / / x
David Sundaram-Stukel / Epic / / x / X / x / X
Dennis Patterson / Cerner /
Dennis Polling / Philips /
Doug Martin / Regenstrief /
Egge Clive / Ahdis-HL7 Switzerland / Clive.egge@alonich / x
Emory Fry / Cognitive Medical Systems /
Eric Larson / CDC / AIRA /
Eric Nystrom / Lantana Consulting Group
Floyd Eisenberg / iParsimony / / x / x / x / x / x / x / X
Francis Macary / PHAST /
Gay Dolin / IMO /
Genny Luensman / CDC / NIOSH / / x / X
Greg Linden / Linden Tech Advisors / / x
Guilherme Del Flol / University of Utah / / x / X
Hanhong Lu / Epic / / X
Hans Buitendyk / Cerner / / x
Howard Strasberg / Wolterskluwer / / x / x / x
IL Koh Kim / KNU Korea /
Isaac Vetter / EPIC /
Isabel Gibaud / HL7-France / / x
Jacee Robison / 3M / / x
Jack Wallace / GTRI / / x
James Agnerus / UHN / james@
Jamie Lehner / PCPI /
Jamie Parker / ESAC / / x
James Agnean / Smile CDR / / x
Jared Nichols / Wolterskluwer /
Jeff Danford / Allscripts /
Jerry Goodnough / Cognitive Medical Systems / / x / x
Jennifer Brush / ESAC /
Jessica Strzesak / RSNA /
Jim Harrison / CAP/UVA / / x
Joe Quinn / Optum /
John Loonsk / CGI EBD / APITC / john.loonsk@????.com
Joshua Mandel / Childrens Harvard /
Julia Skapik / Cognitive Medical Systems / / x / x / x / x / x / X
Julie Scherer / Motive Medical Intelligence / / X / x
Juliet Rubini / Mathematica / / x / x / x / X / x / X
Kanwarpreet (KP) Sethi / Lantana Consulting Group / / x / X / X / x / X
Kathy Pickering / Cerner / / x
Katiya Shell / ESAC / / x
Ken Kawamoto / Utah / / x / x / x / X
Kevin Olbrich / McKesson / / x / x
Ken Rubin / VA /
Kent Lemoine / CDC / / x
Kevin Rose / Pionetechs /
Kevin Shekleton / Cerner /
Klingler Andreas / Siemans Health /
Leon Rozenglit / Prometheus Research /
Linda Michaelsen / Optum / / x
Lindsy Hoggle / AND /
Lisa Anderson / The Joint Commission / / x / x / x / x / x
Lorraine Constable / Cognitive Medical Systems /
Lou Bedor /
Mags / IPO /
Maiko Minami / HLN Consulting /
Malcolm Pradhan / Alcidion / / x / X / x / x
Manisha Khatta / DOD / VA IPO / / x
Mark Kramer / MITRE /
Mark Meadows / GA Department Community Health / / x / x
Martin Modera / ACS / / x
Masski Hirai / HL7 Japan / / X
Matthew Dugal / Dynamic Health IT / / x / X / x
Matt Rahn / ONC / / x
Mathew Tiller / ESAC /
May Terry / Flatiron Health / / X / x
Michael Donnelly / Epic /
Michael Holck / ESAC /
Michael Van Der Zel / UMCG / / x
Mike Tushan / Lantana Consulting Group / / x
Muhammad Asim / Philips /
Nancy McQuillen / Health Catalyst / / X
Nancy Orvis / DoD Va IPO / / x
Nick Rador / Optum /
Noam Arzt / HLN Consulting /
Ostem Kurt / Dynamic Health IT / / X / x
Pamela Mahan-Rudolph / Memorial Hermann /
Patrick Langford / Intermountain Healthcare /
Patty Craig / The Joint Commission /
Paul Denning / MITRE / / x / x / x / x
Peter Haug / Intermountain Healthcare / / X / x / x
Phil Langthorne / Prometheus Research, LLC / / x
Piper Ranallo / MDH/Six Aims / / x
Raj Mehra / Cerner / / x
Rebecca Baker / ACC – American College of Cardiology / / x / x
Rhonda Schwarz / ESAC / / x / x
Richard Esmond / PenRad /
Richard Ettema / AEGIS.net, Inc /
Rob McClure / MD Partners /
Rob Samples / ESAC /
Robert Jenders / UCLA / / x / x / X
Robert Lario / VA / U of Utah /
Robonette Renner / NMDD - NCI /
Ron Ross / Clinical Architecture / / x
Russell Ott / DoD VA IPO / / x
Sadamn Takasaka / HL7 Japan /
Sagy Mints / Allscripts / / X / X / X
Sananda McGarvey / Northrop Grumman / / x
Sean Murz / VHA / / x
Serafina Versaggi / BookZurman /
Shah Mur / VHA / / X / x
Shelly Spiro / Phit Collaborative /
Srinath Remak / CDC/CSELS/OK / / x / x / x
Stan Huff / Intermountain Healthcare / / x
Stan Rankins / Telligen /
Steve Bratt / MITRE / / X
Steve Hufnagel / CIMI / / X
Susan Matney / Intermountain Healthcare / / x
Sweta Ladwa / ESAC /
Sylvia Thun / HLA DE / / x
Taima Gomez / ACOG /
Tar Younktm / UC Davis /
Tessa van Stigh / NICTIZ /
Thomson Kuhn / ACP / / x / x / X
Tony Laurie / NHS / / x
Vaspaan Patel / NCQA /
Walter G. Suarez / Kaiser Permanente / / x / x / x / x / x
Wes Rishel /
Yan Heras / Optimum eHealth /
Yukimoni Konishi / HL7 Japan /
Yunwzi Wang / IMO / / x
Zachary May / ESAC /

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HL7 Clinical Quality Information January 2018, New Orleans, LA, USA

WGM Minutes

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

Agenda Topics

  • Welcome
  • CQI BUSINESS MEETING
  • Topics
  • Review January Meeting Schedule
  • Known PSSs and NIBs for May Ballot, if any
  • Known FHIR activities for May Ballot
  • GOM and Decision Making Practices Review/Update

Business Session

  • Review of Agenda for the Week

Minutes/Conclusions Reached:

Business Session

Introductions

Agenda was reviewed:

We will want to talk about what topics we have to talk with OO during our joint meeting in Q3.

We might have a problem attending the Q3 mega workgroup report out due to a shortage of chairs.

Floyd talked about the IP issue between Boston children’s hospital and HL7, and the problems it has caused for NIBs going to ballot.

No changes to agenda currently.

PSSs and NIBs for May Ballot:

CQL based HQMF may need to go for a May ballot to represent new changes like ratios. There are 2 comments out there. Sounds like we may not need a ballot. Might do a STU update. We’ll have to make the decision as a group.

Known FHIR activities for May:

Would be nice to get all CQI FHIR resources up to maturity 4.

Julia Skapik spoke about a registry project that uses FHIR to share data. There will be time left at the end of this session if folks want to hear about it. Julia will introduce this topic at the end of this session.

Decision Making Practices Review:

There is a default DMP. We can review and accept or change if we need to re: Quorum requirements.Default DMP was reviewed. Our Quorum requirements: 2 co-chairs and 3 WG members with none from a single org. Folks felt the default Quorum requirements were a low bar.

Walter made the motion that we continue our current Quorum requirements of 2 chairs and 3 additional WG members from at least 2 different organizations. Anne Smith seconded. Motion passed with 14 affirmative, 0 against, 0 abstain.

Walter made the motion to accept the Electronic voting requirements as is from the default DMP. Anne Seconded. Motion passed with 15 approved, 0 against, 0 abstain.

Walter read through the current Quorum requirements in the CQI DMP.

Julia presented on CIIC (Clinical Information Interoperability Council):

Julia presented on the January 2018 meeting of the CIIC. Refer to Julia’s meeting notes/outcomes and slides for additional projects.

Walter presented on the Da Vinci Project:

Project about creating better mechanisms for payer and providers to exchange data. Refer to slides from Walter. Point of Care Partners.

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

Agenda Topics And Minutes

  • Composite Measure discussion for CQL-based HQMF IG

Stan Rankins (Telligen – CMS Measure Authoring Tool) joined by freeconferencecall.com to participate in the discussion about CQL-based HQMF issues regarding composite measures. The slide deck will be uploaded to the CQI document site. The discussion is based on input from Telligen, Mathematica and National Committee for Quality Assurance (NCQA) to address composite measures.

Example component measures:

  • Screening for breast cancer –
  • Screening for colorectal cancer – same issue
  • Pneumococcal vaccination – same issue
  • All-or-none: Simplest case: Patient-based, proportion scoring composite measure – All preventive services met
  • All or nothing – the patient must meet all criteria – in the denominator if they are in the denominator of any of the composite measures, they are in the numerator only if they meet the numerator criteria for all component measures.
  • Example – a patient is in 4 of 5 component measures – thus, the patient does not meet numerator criteria for one of the component measures and therefore, that patient fails the numerator. Hence, this “All or none” example might not be the best approach unless all component measures have the same denominator, or if all patients meet all component measure denominators. If all or nothing is chosen, the denominators should incorporate potential exclusions. In this case men would not meet the breast cancer screening denominator and therefore, would fail all-or-none criteria for the preventive screening composite.
  • Opportunity scoring: Second case: Patient-based, proportion scoring composite measure – Who had all preventive services met for whom the patient meets denominator criteria
  • Denominator is opportunities to provide preventive service and numerator is those services completed if there was an opportunity
  • Component-level Linear Combination – percentage of patients who received preventive services
  • Calculate each of the component measure scores and average the total scores
  • Patients are still in the denominators only for those for which they are eligible
  • Weighted Component measures – Each component measure is given a weight to calculate the average.
  • Patient-level Linear Combination: percentage of completed preventive services. Gives Eligible Clinicians (EC) partial credit for meeting the criteria for some, but not all components of the measure
  • Might be handled as a continuous variable measure where the measure observation is a numerator score divided by a denominator score (numerator score is 1 for every numerator and denominator score is 1 for every denominator) – the result is the average of the population.

Clarify in the IG that the patient-level uses linear combination and Weighted combination is used only for component level measures.

Further discussion about types of composites and what can be included:

All examples are about proportion measures. Bryn asked the group for examples of composites of continuous variable measures, composites of ratio measures, or composite of mixed measure type (e.g., a proportion and a continuous variable measure). There are no current such use cases presented by the group present.

Proposal – Ratio and CV composites are allowed, but all component measures must be of the same type

Proposal – All components of a measure are required to have the same subject type (i.e., patient-based or encounter-based or procedure-based. (i.e., not to combine encounter-based and procedure-based and patient-based). E.g., composite for multiple screenings for a single patient over time. Need further examples to determine if a composite may have a mix of subject types.

Proposal: Human readable should be included for all component measures to prevent having to reference components to read the measure.

Next Steps:

  • Enhance examples
  • Plan to enter comments on the CQL-based HQMF STU site and subsequently vote on planned changes to the CQL-based HQMF.
  • Will the discussion need to address how to apply the result reporting to the QRDA. The issue would only impact QRDA Category III – it is not communicating patient data, only the score. Will need to enter comments on the QRDA Category III STU site to accommodate that discussion.
  • Stan Rankin provided an overview of reporting a continuous variable in QRDA Category III (each measure component e.g., measure population, measure observation, etc. is reported.
  • The same examples need to be entered into FHIR tracker for the Clinical Reasoning FHIR component to address measure and measure report in FHIR.
  • Bryn has worked up the CQL example of the continuous variable – Stan will evaluate if it works in the MAT
  • No changes are needed in Harmonization – the same terms we now have will work
  • The functionality for CQL-based HQMF may be substantive and therefore may need to be balloted (instead of an Update). Timing for such a ballot will be discussed this week during the WG meeting. If the changes are to be present in the CMS Measure Authoring Tool (MAT) in September, the ballot would need to occur in May 2018.
  • QI Core Ballot Reconciliation
  • Discussed Comment 41 – Genny Leunsmann was present (requested in person resolution). The addition of occupational data was deemed significant and important by measure developers in the room and is also significant for clinical decision support. The WG agreed that moving forward will depend on how occupational data (ODH) is finalized in the FHIR STU 4 ballot in May. Genny agreed the WG could vote on such a disposition later this week without her present. No vote was taken this session.

Business Session

NA

Time: Monday Q3 – Hosted by OO
Facilitator / N/A / Scribe / N/A
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: OO Hosting

Agenda:

Discussed options for when it is appropriate to use DiagnosticReport Vs Observation. The work will require a lot of communication among OO, CIMI, PC, etc. to assure ambiguity is resolved.

Need to focus on data capture with the end in mind, meaning that the groups should meet together.

OO and CQI co-chairs will work together to help resolve challenges. Need to address USCore as well.

  • Address OO FHIR resources used by CQI

Minutes/Conclusions Reached:

See OO meeting minutes for more information.

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

Agenda Topics

  • QRDA Data Sharing User Guide
  • QI Core - QDM Alignment
  • HSPC, CIIC and Cancer Registry Interoperability Initiative Update (Richard)

Minutes/Conclusions Reached:

  • QRDA Data Sharing User Guide
  • User Guide redline document and comments from the ballot were reviewed
  • There was one set of comments from TJC that need to be verified as to appropriate resolution
  • Need to double-check about the publication process, once the reconciled resolutions are accepted
  • Recommendation is to put publish this as a final white paper
  • Motion by Floyd: that the WG give until Feb 9 to the two commenters to respond, following which we will vote on publication on Feb 17, pending verification of publication procedures with HL7
  • Richard second -
  • 11 approvals; 2 abstentions
  • QI Core - QDM Alignment
  • Brief orientation of the QI Core Ballot
  • QI Core Profiles, can take any one of those, and go to the Mapping of its data between QI Core and QDM
  • In some cases then looking at the mapping, there are one-to-many relationships (from QDM to QI Core); there are also issues when there is a 1:1 relationship, where QI Core includes more than one interpretation or option. There is specific metadata in QI Core that expands and is different from the data being noted in the QDM
  • The group reviewed various examples where there are issues with the mapping, including procedure, order; procedure, recommended; medication, discharge
  • Need feedback on all of these items
  • Action:
  • To utilize the excel file with all the QDM Attributes and QI Core Metadata, prioritize into 1) Major Issue with Mapping; 2) Minor Issue with Mapping; and 3) No Issue with Mapping – do you agree with mapping?
  • Floyd will generate the Excel file and send it to the WG
  • Since we plan to go back to ballot in September with QI Core (not in May), there would be less urgency; however, some decisions will need to be made by May, so it gets reviewed by the Methods Control;
  • Will split it into topics, deal with them during conference calls, asking people to review the ‘topics for the call’.
  • HSPC, CIIC and Cancer Registry Interoperability Initiative Update (Richard)
  • Part of CIMI – 2 projects working on Breast Cancer and Lung Cancer
  • Need to develop a clinician-driven app to facilitate the transition from spreadsheet-based artifacts to workflow process, and facilitate clinicians to comment on them
  • Richard presented an app developed to fulfill this issue
  • Trying to capture the clinical aspects of the model, not the modeling aspects of the model, to facilitate clinicians’ review and input
  • At this point is a prototype for use by CIMI and anyone trying to map data models to FHIR resources, including, for example, CQL

More on this will be provided at an upcoming call in about 1 month.

Business Session

NA

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

Agenda Topics

  • DoD presentation of use cases - potential gap in quality standards
  • QI Core
  • Add PPS review of CIC Common Clinical Registry Framework presented to DESD January 29
  • DESD follow up

SS

Supporting Documents - None

Minutes/Conclusions Reached:

  • DoD presenters were unable to attend.
  • Agenda updated to address QI Core ballot reconciliation this quarter
  • Since DoD presenters are not available, will cancel Q4 session

Discussed DESD Discussion from January 29:

  • TSC recommends preserving 4 domains. DESD will be called “Clinical” domain
  • Workgroups in the domain would remain the same with possible addition of CDS and Clinical Statement and Orders & Observations.
  • Announced that CQI is among healthy workgroups that have been healthy for the past 3 WG meetings

CIC Common Clinical Registry Framework PSS Review for consideration as co-sponsor