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HL7 Clinical Quality Information Workgroup
CQI Co-chairs: Patty Craig, Paul Denning, Floyd Eisenberg, Juliet Rubini, Yan Heras
Meeting Chair:  Paul Denning
Meeting Scribe: Patty Craig

Hosting: CDS and FHIR Infrastructure


  • Roll call and Introductions
  • Reviewed Agenda for the week and updated as needed
  • New PSS for Referral Management (RM) from  Interoperability Standards Priorities Task Force (Seth Blumenthal, AMA) for CDS sponsorship, possible co-sponsorship by CQI
    • AMA is working on the ONC USCDI common data elements for patient referral.   See slide deck for more information.
    • They are creating high-value Use Cases in order to identify the patient data that is relevant to the specific scenario.  They are not only looking at 'general' data elements, but also what the referring physician would need from the perspective of 'testing', etc.
    • This has been discussed with O&O.  It is also being discussed with Patient Care, Vocabulary, and Public Health.
    • Goal of the project would be an IG and possible updates to (FHIR) profiles
    • Both CDS and CQI are "interested parties"; however, neither want to sponsor or co-sponsor the PSS as they are more consumers than originators of the artifacts.  It was determined that the project was outside their core missions.
    • FHIR-I needs to know if any of the Resources that they are responsible for will be involved.  Seth will follow-up with them.
  • FHIRcast  (
    • Issac Vetter provided an update.  The project is on progress - CDS is a co-sponsor.  See the slide deck for information.
    • Balloted in May 2019 cycle and reconciliation is completed.
    • Connecthathon update:
      • Focused in on websockets and gained some solid implementation experience. From Philips, Bas’s implementation not only supported FHIRcast’s recommended security layer of SMART on FHIR (including the SMART EHR launch flow, subscription creation and notifications), but also used websockets to synchronize two applications. George from Nuance, supported our track remotely. Further, both Elsevier and Epic implemented and tested our draft websockets spec.
      • Websocket support is important for FHIRcast implementers! This fall, they will refine and incorporate our draft websocket write-up in the FHIRcast specification at: They will also pursue a small, targeted STU2 ballot within HL7 to ballot this content into the base specification. 
    • 2019:  Release STU specification and support / test Websockets.
    • 2020: Ballot in Feb. focusing on Websockets.
  • DaVinci (Documentation, Templates and Rules) DTR Project Update?
    • Bryn Rhodes provided an update on behalf of the DaVinci project.  [Da Vinci Ballot Update Sep 2019rev1.pptx]
    • Balloted in May 2019 cycle.  Received 61 affirmative and 21 negative major.  12 comments remained unresolved and will be reconciled on CDS WT calls.
    • Balloted in Sept 2019 cycle as an STU.  85 new comments.  Which will be worked through.
    • A Connectathon occurred as part of the Prior Authorization track.
      • IG is still going to the reconciliation.
      • They did find some issues that they will evaluate.
      • Will be piloting with Rush Medical / Epic.
      • Also, provide Prior Authorization demos during the Connectathon.
  • DaVinci Alerts IG Project Update
    • Linda Michaelsen provided an update related to the Connectathon concerning ADT-related alerts, driven by a NPRM issued by the U.S. CMS.
    • Two people tested during the Connectathon.
    • Trying to decide between a message or a communication.  The testers decided that a message header was the better option.
    • This may be going to ballot in January.
  • FHIR update, R5 planning -
    • Bryn Rhodes provides an update [FHIR Update and R5 - 2019 Sep.pptx] concerning CDS/CQI related resources. 
    • Proposed balloting
      • May 2020 for comment
      • Sept 2020 for normative
      • Fall 2020 for a second normative, with the idea for publishing soon after
    • Bryn asked if anyone is attempting to create an IG based on R5.  He is aware of one IG.  No one in the room bought up any other IG. 
    • What resources should go normative?  None were raised.
    • Any issues with quality criteria?  None were raised.
    • Considering turning warnings to errors in the build, any concerns?  None were raised
    • Do we need an interim ballot?  None was request.
    • Major trackers to consider
      • Last cycle, we were asked to consider name changes for RequestGroup (#24619) and GuidanceResponse (#24620).  Proposals are captured within the tracker items.  These are both CDS Resources.
      • No major changes requested for CQI Resources.
    • To ballot a future STU, Resources must comply with the FHIR Maturity Model level 2 (FMM2).
    • New IGs, and at some point old IGs, will have to use the HL7 IG template.
  • Clinical Reasoning Connectathon update
    • Measure testing:
      • Successfully testing 4 eCQAMs in STU3 and identified issues with 2 other eCQMs in STU3
      • Tried all 6 eCQMs in STU4 and found issues for all of them.
    • Decision support
      • Successfully tested Opioid Recs #10 and #11 STU3 and R4 with the patient view hook
      • Identified issues with usage in the order-select hook
    • Bulk Data Import, identified a path forward
      • Will be using a file of Bundles, one bundle per Measure
      • Successfully testing with "proxy" servers
      • Need to incorporate into DEQM
    • Discussions with Public Health occurred.  Current using PlanDefinition and are looking to try to run those definitions on the Clinical Reasoning reference implementations.
    • Feedback will be incorporated into the Quality Measure IG and the Data Exchange for Quality Measures (DEQM) project.
  • Clinical Steering Division update was provided by Bryn
    • An implementation guides will now use the HL7 IG template.  Addresses inconsistencies as well as many of the quality criteria as part of the template.  At some point, existing IGs will need to retrofit to the template.
    • FMM2 will be required for STU ballots going forward
      • 3 independent implementers in at least one Connectathon will also be required
      • Question about whether their are existing STU IGs that have been published do not meet this requirement.  FHIR-I individuals do not know and if there is, it is unknown how they will be addressed.
      • A ballot review checklist
        • FHIR and CDA will both be providing their own checklist 
      • FHIR community process
        • Set of procedures and processes that communities can use to move content through.  It must be open source and use the FHIR community process.  Then the code can have a FHIR community logo displayed with it.
  • DEQM update
    • Comments for the May 2019 ballot have been reconciled and are in the process of applying the solution.  And will go for publishing.
    • Work on STU 4 will begin afterwards and the team will be working on a ballot in January 2020.
  • Ballot reconciliation - QI Core
    • Item #24286
      • Currently statusReason is not part of the base in R4, so it will need an extension.
      • It is being requested that statusReason is added to the base in R5.
      • Moved by Rob Samples to accepted was written, Seconded by Claude Nanjo
      • No further discussion
      • Abstain: 3, Opposed: 0, Affirmative: 40
    • Item #24284
      • This is not persuasive for R4.  Claude will add as an update for R5.
      • Moved by Rob Samples to accepted was written, Seconded by Anne Smith
      • No further discussion
      • Abstain: 4, Opposed: 0, Affirmative: 38
    • Item #24276
      • The resources referenced are not CQI resources.
      • A discussion has occurred between CIMI and O&O that these resources need to be changed.
      • More discussion is needed on this tracker item.


  • None

Action Items

  • None

Meeting Adjourned:  12:30pm