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

CQI Hosted CDS


  • Roll call and Introductions (attendance on CQI and CDS WG attendance pages for the WGM)
    • FHIR R5 Roadmap


    • FHIR Management Group is considering the next (R5) Roadmap and is seeking formal feedback on the schedule by September 2019. There will be a formal request for feedback from FMG.
      • Proposed timeline:
        • January 2020 cycle to review normative content readiness (may not be a formal ballot)
        • May 2020 cycle - 1st normative ballot, main STU ballot
        • September 2020 cycle - 2nd normative ballot (if/where needed)
        • December 2020 - Publish R5
      • Discussion about the impact on QUICK - if QUICK and QI Core is intended to be FHIR version neutral then the work would be to assure QUICK output could include FHIR R5 when ready (QI-Core/QUICK also builds off of US-Core so it would need to wait for a US-Core R5. To the extent that US-Core is based on FHIR Normative content, that would not change).  It is important that QI-Core/QUICK ballots in September 2019 based on FHIR R4 and US-Core R4.
    • IG tooling is changing - to use a single template for HL7 International published FHIR IGs - will be developed over the next 2 months and will seek feedback on how to improvement FHIR IG appearance/utility
      • Use of template will be optional for the September ballot cycle - likely mandatory for cycles thereafter
      • Ballot reconciliation
        • Data Exchange for Quality Measures Discussion 
        • CQL-Based HQMF IG
        • FHIR Measure IG
    • Building IG capacity - demand for FHIR IG development is likely to increase significantly
      • Increase number of people with skills to 
        • Facilitate/develop/manage IGs
        • Review and compare IGs
        • Assist with selecting/developing terminology
      • Will also be a template to use as a base for non-HL7 work
    • Clinical Reasoning - maturity targets - see slides from Bryn shown during the session
      • need more examples to mature
      • Rename GuidanceResponse and RequestGroup
      • Maturity of DetectedIssue and RiskAssessment
      • Guidance from HQMF and other pre-existing standards - feedback will help improve Clinical Reasoning
      • Feedback/Profiles/Resources from
        • EBM-on-FHIR
        • CPG-on-FHIR
        • Quality Measure IG
        • Data Exchange for Quality Measures IG
    • FMG Considerations (questions from FMG)
      • What are FHIR Maturity Model (FMM) targets for remaining resources?
      • What do you need to do to hit targets and who will you get there and know you are on track? 
      • Is there anyone from your work group who would be good candidates to build skills in IG development and/or IG review? - Rob Samples volunteered - Bryn asked for other self-nominees
      • If you're planning to bring forward IGs for ballot, how will you ensure the implementability of those IGs prior to ballot?
    • Discussion - consider alignment with other IGs (e.g., Public Health Case Reporting). Also EHRs are not necessarily around the table to present implementation issues.
  • Ballot reconciliation
    • Data Exchange for Quality Measures Discussion - most comments were not substantive. Reconciliation will occur on CQI WG calls starting on May 17, 2019.
      • Productive weekend connectathon around the colon cancer example. Successfully used the collect data measure - working on the submit operation for VTE (works for colon cancer). Will be reprising the scenario for the Jacksonville FL DaVinci Connectathon in June. 
      • Looking for next measures to address - 3 perspectives
        • CMS priority
        • DaVinci Priority
        • Community input
        • Screening Vs Process Vs Outcome Vs Composite etc - exercise different resources - need to explore sufficient variety to support a more robust set of measures and reporting. Consider the option of using a more generic measure concept containing changes representing specific new resources that don't exist in currently profiled measures.
          • Take a comprehensive set of concepts from existing QDM-based measures and work through those examples and include them in the QI-Core ballot - best to prioritize and provide comments about availability in EHRs - i.e., if already available in all EHRs it should be reasonable to request Vs items on a wish list.
          • Validate that there is a mapping to represent these items in FHIR and include them as examples in the QI-Core implementation guide with XML and explanatory text 
          • Reminder - Ballot initial content deadline (July 14) and final content deadline (August 4) for September 2019 ballot.
    • CQL Ballot - 147 comments received - a few highlighted comments
      • Bryn reviewed a few comments and discussed potential resolutions, some of which may require some modified language as explanations (e.g., "unspecified" might be better worded as "unfiltered")
      • Reconciliation VOTE ---- Resolved Comments 140, 128, 127 all not-persuasive with mod 
        • Bryn Rhodes moved to approve
        • Anne Smith seconded
        • 19-0-0
      • Reconciliation VOTE ---- Resolved Comment 21 - persuasive - discuss converting time to UTC to enable valid comparisons between different time zones. Times do not have time zones and, when extracted they need to be reconciled to the same time zone to perform calculations - i.e., add language to the extraction documentations
        • Anne Smith moved to approve
        • Bryn Rhodes seconded
        • 18-0-0
    • CQL-Based HQMF IG - deferred due to time constraints
    • FHIR Measure IG - deferred due to time constraints
  • QUICK/QI-Core model discussion - No follow up needed after the Q1 discussion in CDS-led session


  • None

Action Items

  • Requested volunteers for building skills in IG development and IG review (1st volunteer - Rob Samples)
  • Request report-out form DaVinci Jacksonville FL Connectathon for the CQI WG

Meeting Adjourned:   12:30pm