HL7 Clinical Quality Information Workgroup
Friday, January 12, 2018– 1-3 PM EDT
Dial in:770-657-9270 Passcode: 217663
https://join.freeconferencecall.com/hl7cqi
CQI Co-chairs:Patty Craig, Floyd Eisenberg, Walter Suarez, KPSethi,Yan Heras
Meeting Chair: Walter
Meeting Scribe: Yan
Agenda
1. Roll call
Walter Suarez / Kaiser /Floyd Eisenberg / iParsimony /
Yan Heras / Optimum eHealth /
Lisa Anderson / The Joint Commission /
Paul Denning / Mitre /
Bryn Rhodes / Database Consulting Group /
Thomson Kuhn / ACP /
Yanyan Hu / TJC /
Angela Flanagan / Lantana /
Ann Phillips / NCQA /
Claudia Hall / Mathematica /
Jenny Brush / ESAC /
Linda Michaelsen / Optum /
Jamie Lehner / PCPI /
Julia Rubini / Mathematica /
Gay Dolin / IMO /
Joe Quinn / Optum /
Matt Tiller / ESAC /
Zach May / ESAC /
Lorraine Constable /
Jenny Brush / ESAC /
2. Business Updates (5 min)
a. Additions / modifications to the agenda
Floyd suggested adding the agenda item for Bryn to give an update about the Connectathon.
3. New Orleans WGM Schedule (15 min)
a. (http://wiki.hl7.org/index.php?title=Clinical_Quality_Information_WG_January_2018,_New_Orleans,_Louisiana)
The group reviewed the agenda items, changes were made directly to wiki.
4. ONC Standards Advisory 2018 (45 min)
a. https://www.healthit.gov/isa/
b. Review variance from formal HL7 Comments – CQI Section (see below notes after agenda)
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Notes from HL7 Comments to ONC on 2018 ISA
CQI Components
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D – Clinical Quality Measurement – CQI
· Interoperability Need: Sharing Quality Measure Artifacts for Quality Reporting Initiatives
o We suggest to reference FHIRPath as an emerging standard (previously called FluentPath and now renamed). http://www.hl7.org/implement/standards/product_brief.cfm?product_id=460
NOT ADDRESSED
o We suggest that ONC add a roadmap consideration under Limitations, Dependencies, and Preconditions for FHIR Clinical Reasoning
NOT ADDRESSED
o We suggest that ONC replace HQMF STU 2.1 with HQMF Normative (R1). http://www.hl7.org/implement/standards/product_brief.cfm?product_id=97
NOT ADDRESSED
o We suggest to include in the Applicable Security Patterns Considerations the use of FHIR security labels as described at http://www.hl7.org/fhir/security-labels.html to support compliance with laws, policies, and consent directives governing HIPAA PHI and specially protected information (SPI).
NOT ADDRESSED
E – Clinical Quality Reporting
· Interoperability Need: Reporting Aggregate Quality Data to Federal Quality Reporting Initiatives
o We suggest that ONC update QRDA Category III to STU 2.1 for aggregate reporting in 2018 and 2019. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=405
NOT ADDRESSED
· Interoperability Need: Reporting Patient-level Quality Data to Federal Quality Reporting Initiatives
o We suggest that ONC update QRDA Category I to STU 4 for implementation of eCQMs in 2018 and QRDA Category I STU 5 for implementation of eCQMs in 2019. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=35
PARTIALLY ADDRESSED
· Reporting Patient-level and Aggregate Quality Data for Quality Reporting and Evaluation
o We noticed that this interoperability need reflects the combination of the prior two interoperability needs combined and just lists FHIR. We suggest that this should not be a separate interoperability need, rather that the suggested standards are listed under each of the prior two interoperability needs.
FHIR REFERENCES WERE COMPLETELY REMOVED
o We suggest to include in the Applicable Security Patterns Considerations the use of FHIR security labels as described at http://www.hl7.org/fhir/security-labels.html to support compliance with laws, policies, and consent directives governing HIPAA PHI and specially protected information (SPI.
NOT ADDRESSED
Walter led the discussion of this agenda item. He indicated that it is a concern that why our comments (and HL7 comments) were not addressed by ONC in the final publication.
The final published document is located:
www.healthit.gov/isa/sites/default/files/2018%20ISA%20Reference%20Edition.pdf
As show in this screenshot below, our recommended standards are not reflected in the published 2018 ISA. For example, the new HQMF Normative standard was not referenced at all.
Thom commented that it is possible that there was error in the process when the 2018 ISA were put together that these recommendations were missed. In Jan, we’d like to find out that what’s the reason for having put in so much effort making recommendations but were ignored by ONC.
In our comment, we suggested referencing QRDA III STU 2.1, but this was not included in the final 2018 ISA.
In Our comment, we recommended QRDA STU 4 and also STU 5, but the final 2018 ISA did not mention STU 5.
https://healthit.gov/isa/recent-isa-updates shows recent ISA changes.
“ONC 2018 ISA Input – Analysis” word document is the HL7 Input to 2018 ISA Reference Edition. It includes all comments we submitted to ONC. We will post the document to member only session and share with the listserv of the link.
We will send a short message to summarize 4 major points we recommended that were not addressed; other points that we recommended but not addressed were minor. Walter asked the workgroup if anyone is concerned that we send out a message without a formal motion. No concern was voiced.
5. Update of Connectathon (Bryn)
Connectathon will be on 1/27 and 1/28.
Bryn sent out a meeting invite to cqi listserv for a call on next Tuesday about the Clinical Reasoning Track.
Below was taking from the email that Bryn sent to the listserv for reference.
“We're planning a connectathon orientation meeting in preparation for the New Orleans Clinical Reasoning connectathon. Please join us as we review the track and discuss goals and strategies.
The currently planned scenarios include:
1) Opioid Management decision support from the CDC
2) HEDIS Quality Measurement content from NCQA
3) PlanDefinition content from Zynx and Motive Medical
4) Diabetes mellitus type 2 management decision support from Motive and Edifecs”
6. CQI Project Updates (5 min)
a. HL7 CDA® Release 2 Implementation Guide: Quality Reporting Document Architecture Category I (QRDA I) Release 1, STU Release 4 - US Realm (PI ID: 210)
b. b. HL7 CDA® R2 Implementation Guide: Quality Reporting Document Architecture (QRDA III), Release 1 - US Realm (PI ID: 896)
c. HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), Release 1 (PI ID: 508)
d. HL7 Version 3 Implementation Guide: Quality Data Model (QDM)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 756)
e. HL7 Version 3 Implementation Guide: Clinical Quality Language (CQL)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 1142)
f. HL7 FHIR® Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 (PI ID: 1234) (Co-Primary with CDS)
g. HL7 FHIR® Profile: Quality, Release 1 - US Realm (PI ID: 1125)
h. HL7 CDA® R2 Implementation Guide: Supplemental QRDA Clinical Quality Data Sharing User Guide, Release 1 (PI ID: 1215)
7. Co-sponsored Project Updates (5 min)
a. HL7 Cross-Paradigm Specification: Clinical Quality Language, Release 1 (PI ID: 1108) (CDS Primary, CQI co-sponsor)
b. HL7 Cross-Paradigm Specification: CIMI Logical Models, Release 1 (PI ID: 1253) (CIMI Primary, CQI co-sponsor)
c. HL7 Cross Paradigm Specification: Neutral Mapping Notation, R1 (Project 1237 – FluentPath - Aligning FHIRPath with CQL --- co-sponsoring with CDS, ITS <primary>, FHIR)
d. CrossParadigm IG Medical Device Interoperability (PSS: CrossParadigm_IG_Medical_Device_interoperability.v.4.docx)
No one has updates regarding this.
e. Composite KNART Investigation (PSS: 1336)
Lorraine
f. CrossParadigm_Storyboard_Artifact_Payer_Value_Based_Care (PSS: 1347)
No one has updates regarding this.Haven’t heard much about this.
g. Clinical Decision Support Big Picture Implementation Guide (PI ID: tbd) (Arden Syntax Primary, CQI and CDS co-sponsor)
Lorraine mentioned that it does not seem this is in Jan. ballot.
Follow up with CDS.
h. FHIR Public Health Electronic Case Reporting (eCR) (PI ID: tbd) CQI and CDS co-sponsor with CIMI as an interested party)
i. US FHIR Core Updates PSS (PI ID: 1265) (US FHIR Primary, CQI and CDS co-sponsor with CIMI as an interested party)
Floyd commented that we need to see what changes US Core would make and we will then need to apply to the QI Core.
8. Ballot-Related Deadlines
a. Ballot opens – December 22, 2017 – January 22, 2018
b. FHIR Schedule References: http://wiki.hl7.org/index.php?title=FHIR_Ballot_Prep
9. Other Important Upcoming Dates
a. HL7 WG meeting in New Orleans – January 27 – February 2, 2018
b. Next CQI Workgroup Call: January 19, 2018
Call adjourned at 2:38pm EST.