Mon / Tue / Wed / Thur
Name / Company / Email / Q1 / Q2 / L / Q3 / Q4 / Q1 / Q2 / L / Q3 / Q4 / Q1 / Q2 / L / Q3 / Q4 / Q1 / Q2 / L / Q3 / Q4
Alex Connor / Pareto Intelligence / / x / x
Andrew Statler / Cerner / / x
Angela Flanagan / Lantana / / x / x / x / x / x / x / x / x
Anne Marie Smith / NCQA / / x / x / x / x / x / x
ArvindJugannathan / Lantana Consulting Group / / x
Benjamin Flessner / Epic / / x
Brian Scheller / Healthwise / / x / x
Bruce Bray / University of Utah / / x
Bryn Rhodes / Database Consulting Group / / x
Calvin Beebe / Mayo Clinic / / x
Chris Millet / Lazy / / x / x / x / x / x / x / x
Floyd Eisenberg / iParsimony / / x / x / x / x / x / x
Gay Dolin / IMO / / x / x
George Cole / Allscripts / / x
Howard Strasberg / Wolter Kluwer / / x / x
Jay Lyle / / x
Joshua Mandel / Harvard / / x
Julia Skapik / ONC / / x / x / x / x / x
Justin Schirle / Epic / / x / x / x / x / x / x / x / x
Ken Kawamoto / University of Utah / / x / x / x / x
Kurt Allen / Penrad / / x
Linda Michaelsen / Optum / / x / x / x / x / x / x
Lisa Nelson / Lots LLC / / x
Marc Hadley / MITRE /
Mark Kramer / MITRE / / x
Martin Rosner / Philips / / x
Matt Aschoff / HL7 Germany / M.aschoff@.g-nsw.ch / x
Matthew Rehn / ONC / / x
Richard Ettema / AEGIS.net, Inc / / x
Rick Geimer / Lantana Consulting Group / / x
Peter Haug / Intermountain Healthcare / / x / x / x
Stan Rankins / Telligen / / x / x / x / x / x / x / x
Richard Esmond / Pen Rad / / x / x / x / x
Robert Jenders / UCLA / / x / x / x
ShirinZaidi / Gevity Consulting Inc / / x / x / x / x
Steve Fine / Cerner / / x
Tessa van Stijn / NICTIZ / / x / x / x / x
Thomson Kuhn / ACP / / x / x / x
VinayakKulkarni / Cerner / / x
Walter G. Suarez / Kaiser Permanente / / x / x / x / x / x / x
Yunwei Wang / IMO / / x / x
Steven Posnack / ONC / / x
AvinashShanbley / ONC / / x
Chris Melo / Philips / / x
Matt Schuller / BCBSA / / x
Lorraine Constable / Constable Consulting / / x
Tone Southerland / Ready Computing / / x
Margaret Ditloff / Academy Nurtition's Dietetics / / x
Sheryl Taylor / NIST / / x
Terry McDonnell / Syapse / / x
Isacc Vetter / Epic / / x / x
Emory Fry / Cognitive / / x / x
Dave Carlson / VA / / x
Greg Rehwoldt / Deloitte / / x
Susan Matney / Intermountain Health / / x
Russ Buchanan / Gevity Consulting / / x / x
Joey Coyle / Intermountain Health / / x
John Donnelly / Intepro Solutions / / x
Sun-JuAhn / Korean Agency for Tech and STDs / / x
Rik Smithies / HL7 UK / / x
Richard Kavanagh / NHS England / / x
Stan Huff / Intermountain Health / / x
Claude Nanjo / Cognitive / / x / x
CaremelaCouderc / IMO / / x
ReinhardEgelkraut / CGM Clinical / / x
Emmanuel Helm / HL7 Austria / / x
Time: Monday Q2
Facilitator / n/a / Scribe / n/a
Attendee / Name / Affiliation
This quarter is a joint session with all other Domain Experts Steering Division workgroups, not sponsored by CQI. CQI attendance was not taken and no decisions were made.
Quorum Requirements Met: / N/A

Agenda Topics:

Large Multi-workgroup Joint Meeting: EHR, AP, BRIDG, CH, CIC, EC, PC, Pharm, CQI

  • CQI co-chair(s) attending: Walter Suarez, Floyd Eisenberg, Chris Millet

Supporting Documents:

Minutes/Conclusions Reached:

General overview of activities of all workgroups in the Domain Experts Steering Division. No actions were taken and no decisions were made. The session was a mechanism to learn about all DESD workgroup activities for sharing and collaboration.

Business Session

N/A

Time: Monday Q3
Facilitator / Walter Suarez / Scribe / Floyd Eisenberg
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y

Agenda Topics:

BUSINESS MEETING TOPICS

  • WG Agenda Review and Update
  • Review WG Mission, Charter edits initiated.

Supporting Documents:

None

Minutes/Conclusions Reached:

The Workgroup began updating the week’s agenda and reviewed the Mission and Charter, to be completed in the next quarter (Q4).

Business Session

Work on updating the Mission and Charter.

Time: Monday Q4
Facilitator / Chris Millet / Scribe / Floyd Eisenberg
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y

Agenda Topics:

  • Mission and Charter
  • SWOT
  • New PSS Proposals

Supporting Documents:

  • CQI WG Document page – draft SWOT and Mission and Charter uploaded to the document page for review by those attending and others who could not attend.

Minutes/Conclusions Reached:

  • Mission and Charter: The draft mission and charter updates was completed and posted for comment until at least Tuesday afternoon, May 10 Q4. The version is uploaded to the CQI WG site.
  • SWOT: The WG updated the SWOT and the draft was posted for comment until at least Tuesday afternoon, May 10 Q4. The version is uploaded to the CQI WG Site.
  • New PSS Proposals
  • QRDA Category I and QRDA Category III have been in use only recently and have a series of updates. Category I especially updates frequently with the US domain Quality Data Model (QDM) and therefore, are not ready for normative.
  • HQMF R2.1 may be considered for normative and will review the PSS to see if it needs updating.
  • Further PSS requirements will be determined through the week.

Business Session

  • Draft updates to Mission and Charter and SWOT

Time: Tuesday Q1 (Joint with SDWG, CQI Hosting)
Facilitator / Chris Millet / Scribe / Floyd Eisenberg
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y

Agenda Topics:

  • Update from Structured Documents on CDA R2.1
  • CDA R2.1 and QRDA Coordination
  • Provenance
  • Negation

Supporting Documents:

  • None

Minutes/Conclusions Reached:

CDA 2.1 Update – Calvin Beebe discussed a summary of the CDA R2.1 progress.

1)Additional attributes added to the clinical statement

2)Moved forward those in the clinical statement pattern

3)Additional time elements for observations (e.g., effective, activity and availability times) where needed – using the RIM classes for definitions

4)Plan to have RMIM available on wiki site

5)Action negation indicators were added to Supply and Encounter

6)No classes were added to assure backward compatibility

7)Opens up better fidelity with other groups

8)Next steps are to move from narrative – may occur in September 2016 but more likely January 2017

9)Question – Is it possible to make some sample libraries? The answer depends on volunteer capabilities. It may be better to go to ballot first as 2.1 normative release, and perhaps move toward a second normative release with such examples.

10)There are also plans to update C-CDA 2.1 but not necessarily in concert with CDA R2.1 at this point in time.

QRDA and C-CDA R2.1

If QRDA is based on the 2.0 release, the LOINC codes would be out of sync. SDWG will review if there are any comments on the C-CDA R2.1 DSTU site relevant to QRDA. The SDWG updated C-CDA R2.1 with errata in March 2016. Since that release there have not been many errata. The CQI WG confirmed that the latest update to QRDA Category I addressed the C-CDA R2.1 updates so the LOINC codes should be in synch.

C-CDA R2.1

SDWG is working on a companion guide to clear up issues for implementers. Thus, if the data are cleaner, re-use is improved. Example – race and ethnicity primary population standardization will help the re-use as well. The companion guide is an artifact that previously existed. It is being updated to go with the 2015 Edition Certification Rule – to be discussed in SDWG tomorrow. It will be balloted in HL7 in September 2016. There is a section to discuss value sets. The Project Insight number is 1236 Link to the activity:

Extension allows differences in value sets. CDA templates articulate conformance constraints for binding value sets. Once populated, the source of the code is not clear (i.e., did it come from a specific value set or not). The extension binds the value set to the value reported. Such extension may have applicability to other use cases than measures, but the pattern has not been seen in clinical documentation. It adds complexity to generic document processing so a clear use case requiring such binding is important before considering adding complexity. It would also help to survey vendors to determine the impact.

Provenance

Measure developers increasingly need to address the source of data elements (e.g., device, role of individual, etc.), i.e., how the information was generated. The provenance is increasingly important for measures of patient engagement and shared decision making. It is also very important to manage clinical workflow for clinical decision support. Examples also include device data such as information from wearable devices to be able to compare the results for the same patient.

  • We need list of the metadata needed to address provenance – the originator of the data is important to understand its meaning (e.g., a care goal determined by the patient)
  • CDA starts in the header – assumed to be the author of all information in the document
  • The HITSC Provenance Task Force recommended items for managing provenance without excess overload. It will help to start with those recommendations.
  • CBCC published a data provenance guide used by the S&I framework activity. The area is not a green field.
  • CDA R2 includes the capabilities need but it is not implemented. The specification has capabilities but guidance for behavior and regulatory requirements is lacking somewhat.

Next steps – potentially encourage groups to pilot use of the CDA capabilities in managing provenance and coordinate standards discussion in HL7 as well.

Negation

The negation concept to discuss expression of avoiding a clinical action for a reason so that the next clinician is aware of the avoidance rationale. This issue is different than indicating content has been evaluated and is not true (i.e., “no known drug allergies”). Negation of action (avoidance of an action for a reason) requires examples with different use cases. CQI is seeking advice on the most effective way to model negation of action. The topic will be discussed as well in other sessions during this WG meeting.

Business Session

N/A

Time: Tuesday Q2
Facilitator / Floyd Eisenberg / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y/N

SESSION WAS CANCELLED

Several CQI WG members joined the Orders and Observations WG session for Q2 on Tuesday. The topic for discussion was requirement for DeviceUseRequest and DeviceOrder. DeviceUseRequest is a FHIR resource developed as part of FHIR Quality (QI Core) and is currently “owned” by CQI and CDS. The discussion led to agreement that the request and order are distinct and both are necessary. Further decision on potentially transferring ownership to Orders and Observations will require additional discussion and vote by the CQI and CDS workgroups.

Supporting Documents:

[Reference Minutes from Orders and Observations]

Minutes/Conclusions Reached:

Business Session

Time: Tuesday Q3 (Joint with PC and CDS – PC Hosting)
Facilitator / n/a / Scribe / n/a
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y/N

Agenda Topics:

Proposed Topics

  • Allergy Intolerance/Adverse Events
  • Review Negation issues
  • Review QI Core constraints with respect to primary resources managed by PC

[REFERENCE NOTES FROM PATIENT CARE WORKGROUP]

Supporting Documents:

Minutes/Conclusions Reached:

Business Session

Time: Tuesday Q4
Facilitator / Chris Millet / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Y/N

Agenda Topics:

Topics

  • QRDA User Guide
  • Postponed until Q1 Thursday
  • September PSS proposals
  • CQF on FHIR
  • Comment ballot reconciliation postponed until Q1 Wednesday
  • Other Topics
  • S&I Framework transition

Supporting Documents:

None

Minutes/Conclusions Reached:

  • QRDA User Guide
  • Postponed until Q1 Thursday
  • September PSS proposals
  • Workgroup discussed the information received at the Steering Division
  • The current HL7 policy is that DSTUs that are expiring can only be extended once, for one year. At the end of this period, a new ballot to update that DSTU will be needed.
  • Workgroup reviewed current status of ballots:
  • QRDA Cat 1 – Expiration: April, 2017
  • QRD Cat 3 – Expiration: June, 2017
  • HQMF R2.1 – Expiration: March, 2017
  • Group discussed the need to parse-out these work items, and do ballots on them sequentially, starting with HQMF
  • More regarding this will be discussed at Thursday’s Q1 session (Next Steps and Sept PSS items)
  • Deadline for September PSS is May 22, 2016. WG will have one call prior to this deadline (Friday, May 20) to finalize/approve any PSSs
  • CQF on FHIR
  • Comment ballot reconciliation postponed until Q1 Wednesday
  • Other Topics
  • S&I Framework transition
  • S&I Framework is being ended and transitioned to work being done in other settings
  • ONC plans include looking at a new initiative to support pilot implementation and established the Tech Lab with four goals
  • Standards Coordination (User Group that would replace CQF)
  • Testing and Utilities
  • Pilots – Funding is being made available by ONC via Tech Lab Standards Exploration Awards Cooperative Agreement
  • Innovation
  • The Workgroup discussed ways in which CQF initiative from the S&I would be transitioned into the Tech Lab.

Business Session

Time: Wednesday Q1 (Joint with CIMI, CDS – CQI Hosting)
Facilitator / Floyd Eisenberg / Scribe / Chris Millet
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes

Agenda Topics:

Proposed Topics

  • Part 1: Discussion of the Data Model - FHIR Quality Logical View / QUICK (CIMI, CDS, CQI)
  • Part 2: CQF on FHIR

Supporting Documents:

Minutes/Conclusions Reached:

  • Introductions
  • Changes to the agenda:
  • PSS’s needed for the FHIR STU 3 ballot
  • Need to decide what FHIR maturity level we want to be for the resources for that ballot
  • OO asked for a discussion
  • Timelines for modeling
  • Need to figure out QI-Core what will move forward and what will be replaced with CIMI
  • Claude currently looking at ProcedureProposal for modeling in CIMI
  • Procedure Request Resource owned by patient care
  • Question to CIMI, is it feasible to use CIMI tooling to replace QI-Core for Sept. timeline? Can we create the CIMI content for creating the QI-Core? If it’s not ready then we may not make the Sept ballot cycle
  • Claude – may have something in 2-3 weeks, but only one resource in progress
  • Bryn – even if we have the tooling, there’s no way to get the content to replace all of the content of QI-Core, recommends focus on the tooling chain
  • Claude- has been working on tooling to create FHIR profiles to contribute to the FHIR HAPI infrastructure
  • Take elements from quick, build archetypes in CIMI and then use to build FHIR profiles and to develop process and ballot the process and the CIMI archetypes. Possible new PSS

Possibly update existing FHIR Quality PSS to work on this tool chain

  • Will work on updating the PSS for later session during Q4 to review
  • Are we balloting a QUICK model as well? So that it can be a HL7 artifact that people can find it
  • Bryn - it is currently available on the current FHIR build under the quick page, but it is based on FHIR DSTU 2 resources.
  • Ken worried about not being able to change resources once they are finalized in DSTU 3
  • There is a PSS with TSC and ArB for taking CIMI constructs and analyzing it and doing tooling. Sounds really related to this QI-Core CIMI tooling discussion
  • Stan – doesn’t recognize the project from the description
  • Jay – possibly talking about the PC project to map SKIN model into CIMI
  • Does anyone know what are big changes coming to QI-Core based on existing work in CIMI?
  • Bryn – what CQL would need are
  • Treat primitives as primitives, (i.e. patient.name instead of patient.name.value)
  • Treat extensions as first class (i.e. not present them differently than resources)
  • Resolve references transparently (i.e. should be able to say observation.subject.name)
  • Support for implicit conversions within CQL to make the above easier to deal with
  • Where can we find the details of this? On github; tooling is on CQL wiki
  • Claude presenting on tooling to transform simple archetype to FHIR profile
  • Then handle archetype hierarchies
  • Bryn walk through slides on FHIR maturity level
  • FHIR feedback from CQI-CDS
  • need to decide on if we want to do any connectathon tracks? Do we want to continue doing the CQF on FHIR track. Proposal due to FMG by June 1
  • Feedback on FHIR survey priority of resources?
  • Bryn will send list of FHIR survey priority of resources and link to all FHIR resources to solicit feedback by the end of the day on any changes we would want to make

Business Session

Time: Wednesday Q2
Facilitator / Chris Millet / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes

Agenda Topics

  • Topics
  • Industry Direction and Feedback
  • CIHI (Canadian Institute for Health Information) - Jessica Ramirez-Mendoza
  • CMS Updates
  • TBD
  • NOTE: 12:30 - Birds of a Feather: Value Based Care and Secondary Data Use for FHIR, C-CDA, Value Sets
  • Salon Drummond East
  • Pick up lunch tray on 4th floor and bring it to 3rd floor, Salon Drummond East

Supporting Documents:

Minutes/Conclusions Reached:

  • Jessica presented on CIHI
  • Walter kicked off discussion on US initiatives and NPRMs
  • RFI comments are due June 7
  • IPPS comments June 17
  • MIPS comments June 27
  • PAC is not preparing comments on this
  • Julia highlighted sections that HL7 should consider commenting on
  • Approving measures
  • References to standards
  • Data quality

Business Session

Time: Wednesday Q3 (Joint Meeting with PC, PC Hosting)
Facilitator / n/a / Scribe / n/a
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes

Agenda Topics:

  • Care Plan
  • Order Sets

Supporting Documents:

  • None

Minutes/Conclusions Reached:

  • [Refer to Patient Care Minutes for Wednesday Q3]
  • Much of the discussion addressed order sets and protocols and their similarities.

Business Session:

Time: Wednesday Q4(Joint Meeting with CIMI, CDS, FHIM, PC – CDS Hosting)
Facilitator / n/a / Scribe / n/a
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes

Agenda Topics:

Supporting Documents:

Minutes/Conclusions Reached:

  • [Refer to CDS Minutes for details of content for Wednesday Q4]
  • The CDS and CQI Workgroups voted together in this session on the update to the FHIR Quality (QI Core/QUICK) PSS to enable balloting in September 2016 and again in January 2017. Details of the vote are included in the CDS Minutes.

Business Session