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Date: February 6, 2020

Quarter: 1

Discussion items


This session was hosted by Clinical Decision Support (invited CIMI and CQI). See CDS minutes for details. 2020-02-06 Q1 CDS WGM Minutes. Highlights posted here.

Bryn chair; Ken scribe

  • CIMI-based logical model

Problematic when authoring CDS or eCQMs when there are different versions of FHIR and each EHR implements differently. At the last WGM, Claude showed a logical model approach that translates to different versions of FHIR.  The next step in discussion is about whether CMS or others would support infrastructure requirements / tooling.  Motivation is because of multiple versions of FHIR and support is different depending on the implementation. Therefore, writing a knowledge artifact requires writing it in multiple versions of FHIR - either write to a specific FHIR version or use a logical model (QUICK) and the author and the implementer can use QUICK to then handle the mapping to the FHIR version(s) in use.  Challenges are gaps in definitions in different FHIR versions. FHIR also provides multiple versions of freedom and QUICK may help reduce those concerns by providing constraints.

Claude Nanjo: Wrote knowledge artifact on QUICK for validation (Claude) - also supporting OMG - were able to generate recommendations. Model development was a subset of FHIR as a proof of concept. Can leverage mappings from prior versions but the mapping is not always one-to-one.  Needs to be tested in a real production setting at University of Utah before a recommendation to HL7.  The modeling led to many recommendations for FHIR R5.  

Discussion about challenges:

  1. Mapping for each version of QI Core profiles based on needs for eCQM/CDS developers requires a data model from which to map (QDM / QUICK, etc.)
  2. Tooling required to automate export of different FHIR artifact versions from QUICK would require tooling developer and sustainability - and funding.

FHIR Shorthand (Mark Kramer) may help with this challenge - SUSHI is the tooling. FHIR Shorthand provides a mechanism to express data from different FHIR forms in usable information.

The cost needs to be paid either in the mapping or in the tooling.

Logic written against logical model is cleaner.

Perhaps another approach is to develop a mechanism to cross FHIR resources for specific metadata (e.g., start/stop times, body site, etc.).

Needed for eCQM and CDS to share content:

  1. Conceptual model for the domain
  2. A set of profile that utilize it
  3. The libraries that help implement it.

Note - to use QUICK for implementers to extract data would add significant implementer burden unless the scope or eCQMs and CDS artifacts is limited to US Core content (i.e., without the extra content covered in QI-Core that does not exist in US Core.

Next steps -

  • Add this topic to the Quality Reporting White paper project now in development to include business case for QUICK. Note - CQI has an existing sub-workgroup call every Tuesday 10-11 AM restarting February 11, 2020 to discuss this White paper content.
  • Review the Quality Reporting White paper project with CDS WG on an upcoming call. CDS initially did not want to be a co-sponsor but may want to reconsider.
  • Also consider how to gain more input from vendors.

  • FHIR profiles for CDS and CQI -  Include QI-Core outstanding questions

Remaining QI-Core trackers (all non-ballot trackers - all September ballot trackers have been resolved and the reconciliation spreadsheet uploaded to the September ballot desktop): Persuasive: Mover/Seconder/vote: Floyd Eisenberg/Rob Samples: 14-0-2 Technical correction applied - no vote needed - Current R4 version effort plans to apply resolution to this comment.

Has a vote but still says triaged Persuasive: Mover/Seconder/vote: Floyd Eisenberg/Ken Kawamoto: 14-0-2 Previously voted - formally transferred to US Core

There was insufficient time to address these issues during Q1.

  • Clinical Decision Support standards overview and coordination
BrynBryn created a new page on the CDS Confluence site: Clinical Decision Support Standards.  This site will provide information about all of the CDS knowledge artifacts supported and how they might related to each other and plans for the future. Discussed migration of the CDS Knowledge Artifact Specification to the FHIR based Clinical Reasoning specification.

  • South Korea CDS implementation - Mohammed Afzal - Personalized CDS
Mohammed Afzal

See CDS minutes which include a link to the presentation provided by Mohammed Afzal. 2020-02-06 Q3 CDS WGM Minutes

The work includes:

  • Knowledge Authoring Tool (knowledge creation dialog based, knowledge validation and verification, arden Syntax MLMs), KnowledgeButton, Vocabulary (SNOMED CT) and Applications (thyroid cancer, head and neck cancer, cardiovascular, diabetes).
  • Five layers (mining mind project 
    • Data curation
    • Information curation
    • Knowledge curation
    • Service curation
    • Supporting layer

Adaptive CDS: A system which adapts, that changes and its content and elements are based on personalized and contextual information without changing the intent of recommendation.

For the rest of the discussion, refer to the presentation available in the CDS WGM minutes - 2020-02-06 Q1 CDS WGM Minutes.

Action items

Quarter: 2

Discussion items


CQI hosted CDS




  • FHIR Quality Measure IG update and ballot reconciliation
  • FHIR Clinical Practice Guideline (CPG) ballot reconciliation and update
  • FHIR Evidence-Based Medicine (EBM) update

Marketplace Product Packaging and Metadata

Preston Lee

SOA-originated project for a Healthcare Services Marketplace Specification, but SOA indicated this particular project should be Cross Product Work Group primary-sponsored, seeking co-sponsorship from the Clinical Decision Support and/or Clinical Quality Information work groups.

Is there any potential for protected IP?

Logica Health has an MOU with HL7 that defines all of this as Creative Commons 4.0 Attribution International

Is this project about "what" or "how" the metadata would be packaged?

Not dependent on FHIR, outside of FHIR

Move to be co-sponsor of the project: Bryn, Ken seconds. Amend to include CQI as a co-sponsor, and provide periodic updates.


CDS Knowledge Artifact Specification and Composite Artifacct Specification

No forward movement on either spec, project teams have no resources to continue

The work group is moving forward with FHIR representation, but supportive of efforts to migrate from the V3-based specifications

Data Exchange for Quality Measures IG

Viet Nguyen
  • Balloted in Feb 2020, uplift to R4
  • 1st block vote is simple non-controversial typos
  • Working through comments with DEQM group, resolution and votes in CQI, typically at least 1 or 2 more block votes over the coming months
  • Will this be a separate guide from Gaps in Care?
    • Looking to ballot in September under the same project but a different IG
  • Are there plans in the workgroup for other items in DEQM beyond the reconciliation (other than Gaps in Care)?
    • Not at this point, but possible input from pilots
  • Slides:

Quality Measure IG

Rob Samples
  • Balloted in Feb 2020, uplift to R4
  • Most comments are simple editorial style
  • There are a few related to artifact packaging
  • 1st block vote is simple non-controversial
  • Work through probably 1 or 2 more block votes over the coming months

EBM-on-FHIR Project Update

Brian Alper
  • Connectathon focused on development of examples that would demonstrate potential usage within a decision support tool
  • ASTRAL Score Calculator Ischemic Stroke
    • Validated predictive model for the risk score calculator
  • Changes to the Evidence/EvidenceVariable resources to support these examples
  • Considered FHIR-25774, need clarity on the disposition

Action items

Quarter: 3

Discussion items


This session was hosted by Clinical Decision Support (invited CQI). See CDS minutes for details. Highlights posted here. 2020-02-06 Q3 CDS WGM Minutes


  • San Antonio (May) Planning - continue same pattern as this and prior WGMs except that OO inviting CQI and CDS will occur Monday (day 1) Q4 since US Realm meetings Monday Q3 which was the previous quarter for that joint meeting with OO.
  • Potential Drug-Drug Interaction (PDDI) Project Update
  • MedicationKnowledge Resource Update
  • How medications not prescribed at discharge would be documented  Tracker 24065 - Also consider how medications prescribed at discharge should be documented (i.e., which MedicationRequest.category should be used.
  • QI-Core FHIR Trackers:

Action items

Quarter: 4

Discussion items


Business Meeting

  • San Antonio (May) Planning
  • Baltimore (Sept) Planning

The meeting was cancelled due to advanced indication of lack of attendees and content.

Action items