FHIR Quality Measure Implementation Guide PSS

The Institute of Medicine (IOM) defines quality as: “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” [1] For care quality to be evaluated, it must be standardized and communicated to the appropriate organizations. To that end, this Implementation Guide will be written to provide guidance for authoring electronic Clinical Quality Measures (eCQMs) utilizing the following standards: 

• Fast Health Interoperability Resources (FHIR) R4 Clinical Reasoning Module (with reference to FHIR R3 Clinical Reasoning to support existing implementations
• Clinical Quality Language (CQL)
• FHIRs QICore Implementation Guide STU 3.2 (based on FHIR 3.0 and US Core 3.0) - provided as examples without restricting the FHIR Quality Measure IG to any data model or any specific realm.

The requirements were established by experience and implementations of eCQMs using existing HL7 V3 standards:

• Health Quality Measure Format (HQMF) R1 Normative
• CQL-based HQMF STU 3
• Quality Data Model (QDM)-based HQMF DSTU 1.4

FHIR Clinical Reasoning provides infrastructure requirements for representing a health quality measure as an electronic format. A quality measure is a quantitative tool to assess the performance of an individual or organization’s performance in relation to a specified process or outcome via the measurement of an action, process, or outcome of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base. 

FHIR Clinical Reasoning defines the components for classification and management of the quality measure as well as important metadata and sections that also define the specific elements that carry the content of the quality measure. 

Through standardization of a measure’s structure, metadata, definitions, and logic, FHIR Clinical Reasoning ensures measure consistency and unambiguous interpretation. A health quality measure encoded in this format is referred to as an electronic clinical quality measure (eCQM). Standardization of document structure (e.g., sections), metadata (e.g., author, verifier), and definitions (e.g., numerator, initial population) enable a wide range of measures currently existing in a variety of formats to achieve consistency. This formal representation of the clinical, financial, and administrative concepts and logic within an eCQM produce unambiguous interpretation and consistent reporting. 

This implementation guide (IG) provides specific guidance to eCQM developers and implementers to assure consistency for applying CQL expressions using any data model, enhancing ability to share eCQM artifacts for direct implementation and calculation. The IG will provide examples using the US Realm FHIR QICore data model but it will not restrict usage of any data model and, therefore, it is relevant for Universal Realm.

The project will support existing efforts by health plans, eCQM developers and EHR implementers to express and process eCQMs using FHIR to measure clinical performance. National Committee for Quality Assurance (NCQA) has prototyped Healthcare Effectiveness Data and Information Set (HEDIS) measures as eCQMs using FHIR starting in 2018 and this IG will support standardization. US governmental agencies (e.g., Centers for Medicare and Medicaid Services (CMS)) are considering transitioning eCQMs from existing HQMF and CQL-based HQMF standards to FHIR. While CMS has not made a decision to move the process to FHIR and there is no established date for such a transition, the FHIR-based eCQM IG will support necessary testing to provide sufficient evidence to support any such future decisions.

What common name does your group use to refer to the product(s) produced?  What alternative names, aliases and keywords does your group use to refer to the product(s) that will be produced? 
FHIR Quality Measure IG

If your project creates a Post-Release 1 version; indicate the name of the prior product and if it is supplanting, replacing or coexisting with a previous release:

No prior FHIR eCQM IG, however, the IG is based on experience gained from implementation of:

• HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), Release 1 (PI ID: 508)
• HL7 Version 3 Implementation Guide: Quality Data Model (QDM)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 756)
• HL7 Version 3 Implementation Guide: Clinical Quality Language (CQL)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 1142)
• HL7 FHIR® Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 (PI ID: 1234) (project generates FHIR Clinical Reasoning)

Enter any dependencies or the name & Project Insight ID of project(s) that this project is dependent upon to achieve its objectives:

FHIR

CQL
 

Projects and their Project Insight IDs can be found via http://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?ref=common

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If you checked New Product Definition or New Product Family, please define below:

For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4 and STU3 and R5

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Enter “U.S.” or name of HL7 affiliate(s) here.  Provide explanation/justification of realm selection. For projects producing deliverables applicable to multiple realms, document those details here. 

For Investigative projects, indicate if the project is planned to be Realm Specific or Universal, if known. Work Groups are encouraged designating project a Universal project initially, and discover which Realms can contribute to the work effort during the discovery phase of the project. Note: This status is subject to change during the investigative process.

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Other:  Indicate other stakeholders, vendors or providers not listed above.

Quality Measure Development Organizations, Clinical Professional Societies