Short Description

Continue the testing and use of FHIR-based Quality Measures for use in Quality Measurement programs, including CMS, Gaps in Care (GIC) and Clinical Decision Support (CDS) Use Cases. The focus of this Connectathon will be to:

  • Continue testing of Quality Measure evaluation and reporting using QI-Core 4.1.1 compliant FHIR servers
  • Test Measure Terminology Service capabilities, including version-specific expansion.
  • Test Artifact Manifest and Packaging capabilities
  • Test PlanDefinition $apply semantics
  • Test QI-Core Authoring Capabilities
  • Test Clinical Guidelines content using the WHO ANC IG
  • Test US Commons usage in Prior Authorization Questionnaires

Long Description

The Clinical Reasoning Track will continue focused testing of quality measures using data available from QI-Core 4.1.1 compliant FHIR servers:

  • Test the use of FHIR resources in alignment with FHIR R4 Implementation Guides (IG) such as QI-Core IG, Quality Measure IG and the Data Exchange for Quality Measures (DEQM) IG.

  • Test the following 2023 Reporting CMS Measures for QI-Core:
    Eligible Clinician (EC) Measures
    CMS314v1: HIV Viral Suppression (Pre-rulemaking)
    CMS1188: Sexually Transmitted Infection (STI) Testing for People with HIV
    CMS161: Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
    CMS177: Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
    CMS349: HIV Screening
    CMS951: Kidney Health Evaluation
    CMS133: Cataracts: 20/40 or Better Visual Actity within 90 Days Following Cataract Surgery
    CMS142: Diabetic Retinopahy: Communication with the Physician Managing Ongoing Diabetes Care
    CMS143: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
    CMS149: Dementia: Cognitive Assessment

    Eligible Hospital (EH) Measures
    CMS104v12: Discharged on Antithrombotic Therapy

      Eligible Hospital (EH) Measures - Hybrid
      CMS529: Hybrid Hospital-Wide Readmission
      CMS844: Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM)

      Eligible Hospital (EH) Measures - OQR
      CMS996: Appropriate Treatment for STEMI Patients in the ED

Note that the above are measure specifications exported from the MADiE development tool and extracted into the appropriate folders in the repository as a FHIR Content IG so they can be viewed and tested in a VS Code environment using the CQFramework CQL plugin. If you are interested in testing past measures, we have all the content from previous connectathons still available, see the Measure Content Index at:


  1. Gather: The Reporting System queries the Clinical Data Repository for the data required to evaluate the measure
  2. Evaluate: The Reporting System evaluates the quality measure, producing a MeasureReport resource
  3. Report: The Reporting System posts the completed MeasureReport to the Receiving System

Multiple Provider Patient Scenario

Attribution flow prepared by Michelle Currie

Grouping Value Set Expansion Scenario

ClaimsData Testing Scenario


Test an Implementation Guide

Related Tracks?

Care Planning, Public Health, CDS Hooks, Da Vinci DEQM Gaps in Care and Vulcan Schedule of Activities

Call for participants

Providers, Payers, Reporting Vendors, Decision Support Vendors, and other related HIT vendors

Track Prerequisites

By role for testing of quality measures:

Track Lead(s)

Bryn Rhodes

Track Lead Email(s) 
Any questions and/or if you would like to sign-up for the latest updates, email:

Specification Information

Implementation Guides:

Zulip stream

Track Kick off Call

Wednesday, August 23 at 10 AM ET       Track Kickoff                                  

Clinical Reasoning Track Kickoff 8-23-2023 FINAL.pptx     
Recording (passcode Sxt$m8ay)                      

Wednesday, August 30 at 10 AM ETWorking/Planning

Recording (passcode: H%3ZmOPS) 

Wednesday, September 6 at 10 AM ETWorking/PlanningPresentation
Recording (passcode: Edc3!9Gu)
Meeting Login:
Zoom meeting id: 836 4585 6405
Passcode: 552204

Connectathon Event Artifacts

Measure Calculation Tool (MCT) demo slides:

Testing Scenario:

Quality Measure Testing:

System roles:

  • Knowledge Repository
  • Terminology Server
  • Clinical Data Repository
  • Reporting System
  • Receiving System


Individual and Summary Measure Report

Action: The reporting system uses data requirements from the knowledge repository and value sets from the terminology server to construct and issue FHIR queries against the clinical data repository to retrieve the data of interest for the measure and subject(s).

Action: The reporting system posts data gathered from the clinical data repository to the receiving system.

Action: The reporting system issues an $evaluate-measure to the receiving system to calculate the measure and displays the results.

Precondition: The knowledge repository has measure and library resources loaded. The terminology server has value sets loaded. The clinical data repository has patient information loaded.

Success Criteria:  The reporting system displays expected results for the selected measure and subject.

Bonus point: The reporting system displays expected population results for all test patients

Multiple Provider Scenario:

Two groups are registered with CMS --
MIPS Group: GroupA / TIN: 00123 (this group is comprised of Practitioner/TIN pairs: John Smith/ TIN 00XXX and Jane Smith/TIN 00YYY)
MIPS Group: GroupB / TIN: 00999 (this group is comprised of Practitioner/TIN pairs: John Smith/TIN 00ZZZ and Kelly Smith/TIN 00YYZ)

Patient Jane Doe has several encounters with Practitioner John Smith - all at the same location/facility and all the encounters have codes related to Medicare Part B

All of the data for the above is coming from a single organization (EIN/TIN 00000) and a single FHIR output from their EHR

Terminology Service Testing

NOTE: The NLM's R4 FHIR Terminology Service will be available for participants to use. Use of this server requires a current UMLS license, as well as access to the UAT instance for the FHIR R4 functionality. Please provide track leads with your UMLS user id so we can coordinate access to the UAT instance. Note also that the above version-specific expand scenario is currently only partially supported by the VSAC's FHIR instance, and testing should be focused on use of the R4 ValueSet resources returned.

This UAT Base URI is no longer included on the FHIR Terminology Service for VSAC Resources as it has become a public page that points to the production servers. However, the capability statements and other important documentation are included on the FHIR Terminology Service for VSAC Resources page.

Using the UAT base URI, instead of our production server base URI  (, allows our software engineers to respond to issues and make adjustments/corrects in real time, when possible, during the connectathon.

People who have requested UAT permissions will have permissions on the UAT server:, not necessarily on the production server: (

Test cases for terminology testing are detailed in the Quality Measure IG as a set of Thunder Client tests:

Code Systems:

  • THO Condition Clinical Status Codes

  • FHIR Request Intent Codes

  • US Core Condition Category Codes

  • THO V3 Act Encounter Codes

  • QI Core RAND Appropriateness Score Codes

Value Sets:

  • FHIR Condition Clinical Status

  • FHIR Request Intent

  • US Core Condition Category

  • THO V3 Act Encounter Code

  • QI Core RAND Appropriateness Score

Clinical Decision Support Testing:

System roles:

  • Knowledge Repository
  • Terminology Server
  • Clinical Data Repository
  • Clinical Reasoning Engine
  • Healthworker Application

Scenarios (WHO Antenatal Care)

Routine Encounter Decision Support, Step 5 - Quick Check

Action: The healthworker application uses WHO Antenatal Care content from the knowledge repository and terminology server to facilitate delivery of guideline-based care as part of a routine pregnancy encounter. Specifically, the application displays the Questionnaire for Step 05 - Quick Check, pre-populating available data from the clinical data repository based on the current status of the patient.

Action: The user fills out the Quick Check questionnaire, indicating that no danger signs are present. The application issues a PlanDefinition/$apply with the results of the completed Questionnaire to the clinical reasoning engine

Action: The clinical reasoning engine processes the Quick Check PlanDefinition with the given input data and determines the contact can proceed as normal and returns the results.

Precondition: The knowledge repository has WHO ANC content loaded. The terminology server has WHO ANC value sets loaded. The clinical data repository has patient information loaded, and in the expected state of an in-progress routine pregnancy contact.

ANC content:

Test data:

Success Criteria:  The healthworker application displays guidance provided by the clinical reasoning engine, indicating no danger signs are present and the contact can proceed as normal.

Bonus point: The healthworker application has content from multiple implementation guides loaded to demonstrate inter-leaving decision support based on the common process model described in CPG.
Bonus point: The healthworker application uses the new PlanDefinition/$apply semantics (i.e. no CarePlan returned, only a RequestGroup)

Variant: User indicates a symptom that is a danger sign, decision support returns referral to emergency department

Security and Privacy Considerations:

This track will use all synthetic data and open FHIR endpoints