Date: 5/26/2021

Quarter: Q2

CQI Hosted CDS

Chair: Paul Denning

Scribe: Floyd Eisenberg


  • CQL Coverage Overview -
    • Last WGM:  MITRE efforts to highlight in the narrative the measure logic covered in the expressions - consider if and how to incorporate into standards (perhaps include in Implementation Guide - QM IG, DEQM, CPG?) - provide clarity on requirements and what artifacts might look like. Related to Gaps in Care  FHIR-28486 - Extension on DetectedIssue evidence to indicate status of evidence RESOLVED - CHANGE REQUIRED (Mike O'Keefe, MITRE)
  • Composite Measure Discussion (Bryn Rhodes )

Meeting Minutes

  • QM IG Ballot comment review (34 comments - proposed dispositions for most). Bryn is constructing a block vote for some.  Some "in-person" require outreach to the submitter.
  • CQL Project Update (now normative)
    • Some improvements to navigation, syntax diagrams, navigable diagram for elements (railroad diagrams) and plan to do the same for FHIR Path.  The specification is normative and trial use - trial use elements are marked through the specification. Still accepting changes in the trial use content. Comments on the normative content would require a new project.  The comments on the trial use comments are not sufficient thus far to warrant an update or new ballot or publication (for the STU content).  Individuals can comment using the FHIR Jira tool.
    • Tests cover the scope of functionality
    • CQL Versioning Discussion - discussed but not resolved as looking for more input from a larger audience via Zulip chat, mostly all dependent on FHIR-32666:
      • FHIR-32666 - add version parameter for media types. Indicate the versions supported by the translator and the java engine. For best practice reasons, the CQL library doesn't state the version of CQL - can't parse the library without knowing the version so including the version only in the library wouldn't work. This is similar to how the FHIR Resources manage versions.  
        • When specifying the media type, one can specify the version parameter (rather than in the library). The change is backward compatible. However, some of the elements are normative. Thus, use of the version parameter is trial use and the version parameter can be used with any of the CQL ELM media types. This change applies specifically always and only the major/minor components (1.0 through 1.5). Version can reference any published version of the specification, currently, 1.0 - > 1.5
        • Not voted during this session: Seek implementer feedback beyond the group of attendees to this Q2 session - posted to Zulip chat for feedback before resolution of this tracker. 
      • FHIR-31392 and FHIR-31675 - support contains a terminology comparator - happens with direct reference code - add terminology contains 
        • Discussed but not resolved in this session
      • FHIR-31397 - multi-filter support in retrieve - expanding with a query optimization step - multiple code, date and "other" filters
      • FHIR-32667 - add conformance expectations for version specifiers in CQL/ELM libraries - has fixed invariant "textCQL" - based on FHIR-32666 can add other media types
        • Waiting for resolution of FHIR-32666 to be able to resolve this tracker due to the dependency
      • FHIR-32668 - (tracker on QMIG) add guidance and conformance expectations for specifying CQL/ELM version (also references FHIR-32669 tracker on CPG-onFHIR)
        • Waiting for resolution of FHIR-32666 to be able to resolve this tracker due to the dependency
    • Bryn provided example of performing static analysis with the translator changes. However, the existing MAT tooling would need to take another step to enable such static analysis. Take advantage of the new feature in 1.5 to pass a value set and understand it is a value set. It is a common pattern already in use.
  • QM IG Trackers
    • FHIR-32651 - Add example Library for manifest - add links for libraries from examples page (the examples exist but not necessarily easy to navigate to them)
      • Motion to approve: Persuasive - Bryn Rhodes/Floyd Eisenberg: 19-0-0
    • FHIR-32334 - CQFM parameter extension should include default value
      • Motion to approve: Persuasive - Bryn Rhodes/Floyd Eisenberg: 18-0-0
    • FHIR-31680 - Support ability to specify that a stratifier should only be applied to a specific population (e.g., to numerator and not the whole measure population). "AppliesTo" extension that will help ratio measures especially. Define the extension and allow it. In absence of any "appliesTo" it would behave as it does today.
      • Motion to approve: Persuasive - Bryn Rhodes/Floyd Eisenberg: 18-0-0
    • FHIR-32046 - change the binding of Measure.type to use ObservationMeasureType in profile of Measure - the reference to MeasureType in the profile is indicating it is MUST SUPPORT but not changed from the base.
      • Bryn to follow up with commenter (Rob McClure) before resolution - See discussion description in the tracker comments.
    • FHIR-32599 - consider alternative composite measure - CQL retrieve measureReports. Need to be careful the results of the measureReports are comparable - I.e., account for the fact there may be different denominators if they are not the same.  A short discussion ensued.
      • No resolution suggested during this session. Feedback from measure developers will help to understand the use case for writing a measure on measureReport.

Action Items

  • None