HL7 Clinical Quality Information Oct 2015 Atlanta WGM Minutes

Attendees:

Mon / Tuesday / Wednesday / Thur
Name / Company / Email / Q4 / Q1 / Q2 / Q4 / Q1 / Q2 / Q3 / Q1 / Q2
Andrew McIntyre / Medical-Objects / / x / x / x
Anne Marie Smith / NCQA / / x / x / x / x / x / x / x / x / x
Austin Kreisler / Leidos / / x
Beau Bannerman / Lantana Consulting Group / / x / x
Benjamin Flessner / Epic / / x
Bobby Jones / The Lazy Company / / x / x / x / x / x / x / x
Brett Marquard / River Rock Associates / / x
Brian Reinhold / LNI/PCHA / / x / x
Brian Scheller / Healthwise / / x / x
Bruce Bran / U of Utah / / x / x / x
Calvin Beebe / Mayo Clinic / / x / x
Carsten Quinlan / Epic / / x / x / x / x / x / x / x / x / x
Chris Melo / Philips / / x
Chris Millet / The Lazy Company / / x / x / x / x / x / x / x
Christina Knotts / FBD / / x
Claude Nanjo / Cognitive Medical Systems / / x
Colin Rhodes / eHealth Technologies / colin.rhodes@ehealthtechnologies / x / x
Crystal Kallem / Lantana / / x / x / x / x / x / x
David Sundardam - Stukel / Epic / / x / x / x / x / x / x / x / x
Emory Fry / Cognitive Medicine / / x
Eric Larson / NGC / CDC / / x
Floyd Eisenberg / iParsimony / / x / x / x / x / x / x
Gay Dolin / IMO / / x
George Cole / Allscripts / / x / x
Guilherme Del Fiol / U of Utah / / x / x
Gunther Meyer / Allscripts / / x
Howard Strasberg / Wolter Kluwer / / x / x / x
Jaleann Matos McClurg / Aetna / / x
Jason A. Walonoski / Mitre / / x / x / x / x / x / x
Jeff Brown / ASCO / / x
Jeffery Ting / Systems Made Simple / / x
Joshua Mandel / Children's Hospital Harvard / / x
Joy Lamy / Aegis / / x
Julia Skapik / ONC / / x / x / x / x
Juliet Rubini / Mathematica / / x / x / x / x / x / x / x / x
Justin Schirle / Epic / / x / x / x / x / x / x / x / x / x
Karsten Fehre / Medextes / / x / x
Keith Boone / GE / / x / x
Ken Kawamoto / University of Utah / / x / x / x
Kendra Hanley / AMA-PCPI / / x / x / x / x / x
Kimberly Smuk / AMA-PCPI / / x / x / x / x / x / x / x / x / x
KP Sethi / Lantana / / x / x / x / x / x / x / x / x / x
Lisa Nelson / Lantana Consulting Group / / x
Lloyd McKenzie / Gevity / / x
M’Lynda Owens / Cognosante / / x
Marc Hadley / MITRE / / x / x / x / x
Mark Kramer / MITRE / / x / x / x
Mark Shafarman / Shafarman Consulting / / x
Martin Madera / AJCC / / x
Micheal Brody / Micheal Brody / / x
Michel Rutten / Furore / / x
Mike Henderson / OSEHRA / / x
Miriam Makhlouf / Philips / / x / x / x
Patty Craig / Joint Commission / / x / x / x / x / x / x / x / x / x
Peter Gilbert / Meridian Health Plan / / x / x / x
Peter Haug / Intermountain Healthcare / / x
Peter Hendler / Kaiser Permanente / x
Phil Coczan / UK (UCLP) / / x
Rachel Burke / PenRad / / x / x / x / x
Richard Esmond / Pen Rad / / x / x / x / x / x / x / x
Rick Geimer / Lantana Consulting Group / / x
Robert Jenders / UCLA / / x / x
Ross Esmond / PenRad / / x
Sarah Gaunt / Lantana Consulting Group / / x
Scott Brown / Advault, Inc / / x
Swapna Bhatia / ESAC, Inc / / x / x / x / x / x
Tessa van Stijn / NICTIZ / / x / x / x / x / x / x / x / x / x
Thomson Kuhn / ACP / / x / x
V. Jagannathan / M*Modal / / x / x / x / x
Vaspaan Patel / NCQA / / x / x / x / x / x / x / x / x / x
Vinayak Kulkarni / Siemens Healthcare / / x
Walter G. Suarez / Kaiser Permanente / / x / x / x / x / x / x
Yan Heras / Lantana Consulting Group / / x / x / x / x / x
Zachary May / ESAC, Inc / / x / x / x

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HL7 Clinical Quality Information Oct 2015 Atlanta WGM Minutes

CQI joined EHR and other workgroups
Time: Monday Q3
  • Each of the attending workgroups provided a brief update on their workgroup and their current projects.
  • CQI’s presentation has been uploaded to CQI’s documents webpage.
  • See EHR meeting minutes for more information.

Time: Monday Q4
Facilitator / Crystal Kallem / 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
  • Agenda review
  • Review Strategic Plan/ 3 year plan / SWOT - updated in Paris
  • Timing of Project Scope Statement Approvals (throughout the week)
  • Expiring standards
  • PBS Metrics and WG Health
  • CQI WG co-chair election
  • Update on current ballot - number of comments and planned ballot reconciliation
  • New Projects

Supporting Documents – CQI HL7 Wiki agenda

Minutes/Conclusions Reached:

Business Session

  • Agenda Planning
  • Added
  • HQMF Normative discussion to Tue Q1 with SD
  • Project discussion with FHIR and CDS on Thur Q2
  • Walter discussed the modification made to CQI’s 3-Year Plan during the spring 2015 Paris WGM.
  • It was determined that additional updates need to be made based on changes that have occurred during the summer.
  • CQI co-chairs will update the document to current state and bring it back to CQI for discussion.
  • Walter discussed the modification made to CQI’s SWOT during the spring 2015 Paris WGM.
  • CQI co-chairs will review the group’s SWOT and determine if changes are needed based upon updates to the 3-Year Plan.

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

Agenda Topics

  • Hosted Structured Documents
  • QRDA DSTU comments that overlap with C-CDA (if any)
  • Moving QRDA and HQMF to normative status
  • PSS Update for HQMF
  • DSTU Extension (expiring standards that are broadly used i.e. QRDA 1 R2)
  • QRDA implementation experiences
  • Others

Supporting Documents: QRDA Cat I R2 DSTU webpage

Minutes/Conclusions Reached:

  • Reviewed agenda and added the following topics:
  • Update on QRDA Negation issue
  • Value Set Stewardship
  • QDM Feedback and alignment
  • QRDA DSTU comments that overlap with C-CDA
  • Discussed issues around errata and DSTU updates to C-CDA and QRDA templates. Specifically QRDA Cat I R2 DSTU ID 745.
  • Added a comment that the result for C-CDA R2.0 DSTU comment ID 548 applies to QRDA Cat I R2 DSTU ID 745.

Floyd Eisenberg moved to approve the QRDA Cat I R2 DSTU comment and David Sundardam - Stukelseconded

No Further Discussion

Opposed: 0; abstentions: 3; approved: 39

Approved

  • Per Austin (SD co-chair): Items marked as a persuasive errata on a DSTU comment page are not official, they are in a pending status. They still need to be published formally.
  • Some Workgroups update their standards to CDA R2 DSTU errata before they are formally published. This is OK as long as the group realizes that their updates are pending the formal publication of the CDA errata.
  • QRDA Category I R3 is scheduled to be updated to the newest version of QDM. This would be a good time to make updates to the QRDA templates based upon C-CDA changes; however, the updates need to be formally published.
  • Trifolio can be updated for pending errata before they are formally published.
  • SD believes that the ‘Version Implemented’ date on the DSTU comment page is when Trifolio is updated, which is not necessarily when it has been officially published.

Trifolio cannot maintain multiple versions, so a thought is that we should be putting versions that need to be maintained within GForge.

  • Update on QRDA Negation issue
  • An implementer may add QRDA Cat I R2 DSTU ID 696 comment as a DSTU comment against C-CDA R2.0 and R2.1. SDWG will not add the comment themselves.
  • QDM Feedback and alignment
  • QDM was changed to be aligned with CMS’ legal definition of Principal Diagnosis and Procedure.
  • QRDA implementation experiences
  • If a patient sees two providers with different EHR vendors, the patient’s individual episodes do not meet the Initial Population of the measure; however, individually they do not. This can occur when patients cross settings or change providers.
  • CQI is exploring if documenting experiences the community is having with QRDA should become a Whitepaper.
  • Moving QRDA and HQMF to normative status
  • US Realm taskforce is ‘encouraging’ CQI to take QRDA Category III to normative.
  • There are a handful of templates that are CDA based, so the discussion about pending C-CDA R2 errata could be an issue when CQI updates QRDA Category III.
  • SD is fine with QRDA Category III going to normative status.
  • Discussion occurred concerning QRDA Cat III DSTU ID 738 no disposition was determined.

Time: Tuesday Q2
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

  • Updates on National and Federal Initiatives Impacting Quality
  • PCPI
  • ONC
  • MIPS
  • Meaningful Use
  • CMS Core Clinical Data Elements
  • CQF Data Element Alignment
  • eCQI Resource Center
  • ONC 2016 Standards Advisory
  • Kaiser Permanente
  • Other National Efforts (NCQA, NQF, others)

Supporting Documents: AMA-PCPI Overview slide deck (PDF), The Future of HHS Quality and Payment Policies as of 10_06_2015 (PowerPoint), Oxford RDFox and SNOMED for Quality Measures Overview (PowerPoint).

Minutes/Conclusions Reached:

  • Reviewed agenda
  • No changes
  • Walter handed out CQI’s stars for ‘healthiest workgroup’.
  • Kendra Hanley provided an update on the AMA-PCPI and their usage of HQMF and QRDA standards. Slide deck has been uploaded to CQI’s documents webpage.
  • Julia Skapik provided an update on the future of HHS Quality and Payment Policies as of 10/06/2015. Slide deck has been uploaded to CQI’s documents webpage.
  • Julia’s presentation will be completed later in the week.
  • Peter Handler from Kaiser Permanente provided an update on their usage of the Oxford RDFox to evaluate the HEDIS Diabetes measures. Slide deck has been uploaded to CQI’s documents webpage.
  • Peter believes this platform is a better way to evaluate SNOMED data for patients.
  • In order to do this, the data has to be in the ontology such that you know its shape. Every EHR vendor would have to put it into the same ontology.
  • This would require quality measures to be developed only from data that already exists.

CQI joined PC and CDS
Time: Tuesday Q3
  • Agenda included discussion of semantics of clinical status such as ‘remission’ and ‘relapse’ states and verification status such as “differential”, “provisional, working”, “confirmed”, etc.
  • See PC meeting minutes for more information.

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

Agenda Topics

  • Reconciliation: Electronic Clinical Quality Measure (eCQM), Release 1 FHIR Profile

Supporting Documents:

Minutes/Conclusions Reached:

  • Reviewed agenda
  • None
  • Floyd brought up that the FHIR folks want FHIR ballot comments to be in GForge.
  • Reconciliation: Electronic Clinical Quality Measure (eCQM), Release 1 FHIR Profile
  • This ballot is not in GForge tracker, therefore the comments are being managed within a spreadsheet.
  • Summary of ballot reconciliation: 165 total comments
  • 22 Neg-Mj
  • 77 Neg-Mi
  • 11 A-C
  • 25 A-S
  • 19 A-T
  • 11 A-Q
  • 0 A-A
  • CQI performed 7 blocks of reconciliation voting on the QRDA Ballot.
  • Block 1 contained items #131 and 132.

Jason Walonoskimoved to approve Block 1 and Floyd Eisenberg seconded

No Further Discussion

Opposed: 0; abstentions: 1; approved: 21

Approved

  • Block 2 contained item #128.

Jason Walonoskimoved to approve Block 2 and Robert Esmond seconded

No Further Discussion

Opposed: 0; abstentions: 2; approved: 20

Approved

  • Block 3 contained item #129.

Jason Walonoskimoved to approve Block 3 and Julia Skapik seconded

No Further Discussion

Opposed: 0; abstentions: 1; approved: 21

Approved

  • Block 4 contained item #130.

Jason Walonoskimoved to approve Block 4 and Juliet Rubini seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 22

Approved

  • Block 5 contained item #120.
  • Comment: The FHIR extension mechanism does not appear to have been developed with the intention of supporting such extensive profiles as, e.g., measure artifacts. The resulting XML serialization is both verbose and difficult to read. Recommend making these profiles first class FHIR resources instead so that they may use a more reasonable XML format.
  • Recommendation: Any future release change MeasureArtifact and MeasureReport into first class FHIR resources and not use profiles and extensions.
  • Will be further discussed in Thur Q2.
  • Block 6 contained item #122.
  • Issue: Stratification is missing from the metadata component of the MeasureArtifact.
  • Recommendation: Future release contains a SHALL to auto-generated human-readable narrative (<text/> section) to include all fields in the resources. This requires all fields to have matching descriptions in the “metadata” section, to include stratification.

Jason Walonoskimoved to approve Block 6 and Julia Skapik seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 22

Approved

  • Block 7 contained item #121.
  • Future release will “shared” resources/profiles/extensions that are unused by CQM. Similar vote in CDS ballot pending.
  • Will be further discussed in Wed Q1.

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

Agenda Topics

  • Hosting CDS and Structured Documents
  • Reconciliation: Electronic Clinical Quality Measure (eCQM), Release 1 FHIR Profile
  • Other topics

Supporting Documents:

Minutes/Conclusions Reached:

  • Reviewed agenda
  • No changes
  • CQI performed 10 blocks of reconciliation voting on the QRDA Ballot.
  • Block 1 contained item #121.
  • Discussed in Tuesday Q4 and it was decided this would come to this meeting.
  • Reviewed item with CDS.

Jason Walonoski moved to approve Block 1 and Marc Hadley seconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 37

Approved

  • Block 2 contained item #33.

Jason Walonoski moved to approve Block 2 and Floyd Eisenberg seconded

No Further Discussion

Opposed: 0; abstentions: 1; approved: 37

Approved

  • Block 3 contained item #85.

Jason Walonoski moved to approve Block 3 and Juliet Rubiniseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 32

Approved

  • Block 4 contained item #112.

Jason Walonoski moved to approve Block 4 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 32

Approved

  • Block 5 contained item #86.

Jason Walonoski moved to approve Block 5 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 31

Approved

  • Block 6 contained item #32.

Jason Walonoski moved to approve Block 6 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 31

Approved

  • Block 7 contained item #73 and 114.

Jason Walonoski moved to approve Block 7 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 31

Approved

  • Block 8 contained item #89.

Jason Walonoski moved to approve Block 8 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 30

Approved

  • Block 9 contained item #90.

Jason Walonoski moved to approve Block 9 and Ken Kawamotoseconded

No Further Discussion

Opposed: 0; abstentions: 0; approved: 29

Approved

  • Block 10 contained item #76 and 158.
  • This will be discussed on a future CQI workgroup call.

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

Agenda Topics

  • QRDA implementation experiences and varied use cases
  • HQMF Implementer Experiences
  • CQL WG Wiki maintenance / organization

Supporting Documents:

Minutes/Conclusions Reached:

  • Reviewed agenda - no changes
  • A QRDA implementation experiences and varied use cases discussion occurred. This discussion included:
  • A provider that has information applicable to a measure that was received from another entity could use this data to satisfy a measure (e.g., the patient is at risk and had a mammogram at another site).
  • Data from C-CDA files received throughout the year should be pulled into the QRDA document as appropriate.
  • The complete patient picture will be not be provided because QRDA files are expected to only be generated if the patient falls into the IPP of appropriate measure(s) and it is expected to only contain the data required for the measure(s).
  • C-CDA cannot contain all of the data specified within the HQMF because there is data such as ED Wait Time is not available in the C-CDA, but can be sent in the QRDA file.
  • The QRDA standard includes discussions about ‘smoking gun’ and ‘scope and filter’.
  • CQI has determined that there is enough issues related to using QRDA files for providing data between providers that a Whitepaper is appropriate.
  • A PSS will be developed and presented during Thursday Q1.

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

Agenda Topics

  • Hosting CDS
  • Reconciliation: HL7 FHIR® Profile: Electronic Clinical Quality Measure (eCQM), Release 1
  • Reconciliation: HL7 FHIR® Implementation Guide: Clinical Decision Support, Release 1
  • Ballot planning for Jan 2016 (PSSs)
  • Balloting QUICK in Jan

Supporting Documents:

Minutes/Conclusions Reached:

  • Reviewed agenda
  • Added: Discussion about DAF
  • CQI and CDS discussed DAF, QICore, and QUICK. Discussion included:
  • Challenging to keeping the different models in synch
  • Question was raised about how will we relate to detailed profiles, such as the items being worked on by CIMI – no answer was determined
  • Some individuals see QUICK as a logical model and QUICK prime is the logical/physical model.
  • Discussion occurred related to FHIR and QUICK concerning how the logical model is generated.
  • Recommendation that CQI/CDS should be using the basis FHIR resources instead of our derived QICore resources. Also, that FHIR resources need to capture the data required by CQI/CDS. However, this is problematic if the owners of the base resources are unwilling to add data needed for CDS/CQI purposes.
  • Should we be updating QUICK to reflect updates to QICore?
  • CQL requires a data model and, if CDS/CQI purposes, that data model was considered to be QUICK.
  • Suggested that we submit a DSTU update to QICore profiles to put back the ‘informative’ data model view of QUICK.
  • Floyd moved that we go forward on a DSTU ballot on QUICK, Julia seconds.
  • Keith counter moved that we table the DSTU ballot on QUICK.
  • No consensus was reached. Discussion will occur in later meetings / calls.
  • No ballot reconciliation occurred.

CQI did not meet
Time: Wednesday Q4
Time: Thursday Q1
Facilitator / Crystal Kallem / Scribe / Patty Craig
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document.
Quorum Requirements Met: Yes

Agenda Topics

  • Next Steps
  • Quality Exchange use case PSS
  • Additional time for Updates on National and Federal Initiatives Impacting Quality
  • Standards Advisory / MU3 Final Rules (Julia)
  • Joint Commission (Patty)
  • NCAQ (Anne)

Supporting Documents:

Minutes/Conclusions Reached:

  • Reviewed agenda
  • Deferred to a future call: Additional time for Updates on National and Federal Initiatives Impacting Quality
  • Joint Commission (Patty)
  • NCAQ (Anne)
  • 2016 Interoperability Standards Advisory draft for comment
  • HL7 has requested Workgroup comments to inform HL7s comments
  • Comments are due to ONC by 11/6.
  • The document lists the standards and ONC is requesting comments on:
  • Are these the correct standards?
  • Are any standards missing?
  • Is the format understandable and easy to read?
  • Workgroup walked through the standards and
  • HQMF and CQL are not listed – is this on purpose or by accident?
  • Standards are not marked as being Normative
  • Further discussion will occur on a future call.
  • Quality Exchange use case PSS
  • Project Scope:
  • Data sharing with organizations besides the “reporting end point” e.g., not CMS or The Joint Commission
  • Data sharing with organizations that are the “reporting end point” such as CMS or The Joint Commission
  • Solutions are not limited to QRDA and may possibly apply to FHIR based approaches to measure reporting
  • Should support adherence to evidence based clinical guidelines
  • Recommendations may include the need to revise existing standards or create new standards
  • Project Need
  • The ONC 2015 Health IT Certification Program Final Rule defines certification criteria for clinical quality measures record/export and clinical quality measure import/calculate requires exchange of QRDA documents between entities other than reporting endpoints. The current QRDA Category I IG Vol 1 provides guidance on what a QRDA document should contain when being submitted to the reporting endpoint. While this guidance doesn’t prohibit other use cases, it doesn’t help the industry move forward in a standard way. It would be useful to detail what extra data might be needed for some different common use cases. As other use cases gain important (based on industry needs or regulation), we run into a situation where systems need to communicate information using QRDA documents but the requirements defining how the documents are created can vary with each exchange. Information from this white paper will help the Workgroup determine if the QRDA I IG should give guidance to standardize how QRDA documents should be constructed.

Walter Suarezmoved to approve PSS and Floyd Eisenberg seconded