Date: 5/26/2021

Quarter: Q1

CQI Hosted CDS and CIMI

Chair: Floyd Eisenberg

Scribe: Floyd Eisenberg and Paul Denning

Chairs present - Floyd Eisenberg, Patty Craig


  • Artifact Manifest Profile, Terminology Service, and Repository Service Overview
  • QI-Core - Profile authoring, Update plans for June 2021; January 2022 ballot discussion - QI-Core Trackers for Update
    • FHIR-32273 - TaskNotDone
    • FHIR-32235 - DiagnosticReportLab does not have MUST SUPPORT for performer or issued (inconsistent with US Core)
    • FHIR-32234 - DiagnosticReport.diagnosticReport.locationPerformed value should not be a slice
    • FHIR-32233 - CQL example in Observation missing caption and might be better represented than pap smear
    • FHIR-25028 - Add structure map reference to QI-Core from FHIR QMIG
    • FHIR-24280 - recommend dueTo and occurredFollowing to QI-Core Condition resource
    • FHIR-12091 - add Occupational Data for Health (ODH) - has been pending waiting for ODH publication

Meeting Minutes

Quality Measure IG

Bryn presented the Quality Measure IG Data Element Submission scenario (section 10) for input from Stan Huff (CIMI). Data requirements depend on the artifact.

  • A consuming system can then determine the value sets needed and identify applicable expansions. The program specifies which measure version and which version of the value set required.
  • Attribution - the population for the set of measures - attribution of patients to providers. Use Da Vinci Attribution Implementation Guide for attribution of patient to provider. Also determine which patients are applicable to each measure.
  • Gather data for the selected measures and submit to the receiving system - may use Bulk Data.
  • Evaluation - 2 use cases - evaluate and determine care gaps. May also address case reporting, registry reporting and surveillance activities.
    • Terminology service - introduces the notion of a quality program - version manifest (expansion profile for value sets - may change during the measure development / authoring process). Once measures are released with stable content, the value sets are pinned down for the release and can specify an expansion URI to retrieve the value set(s) using the code system version.  Uses "manifest", "expansion", and "preview" parameters.
    • Package operation on quality program allows creation of release packages of artifacts and related dependencies.
    • The specification shows examples that also use legacy codes for historical data.
    • Artifact repository operations and three levels of repository capability statements that provide increasing levels of capability: share only - (read only), publishable (support for packaging), authoring (support for write characteristics) - - - all focused on quality measurement but are applicable to other content as well.
      • Example of manifest - expansion for SNOMED version; Program Release specifies the URI specific to the release expansion (identifies versions of code systems and version(s) of value sets and the versions of measures)
  • Other processes that can use this machinery - such as clinical decision support (a clinical rule to evaluate the risk of pulmonary emboli and what tests should be done first, then management recommendations) - value set versioning at the time the rule is created and support by the terminology service in use.  Proposing to generalize for any kind of knowledge artifact. Profiles based on observations - e.g., Blood Pressure - versions of profiles starting with BP, then adding profiles with patient position and later with patient activity (exercising) - the newer profile have additional elements that were not present in previous versions; hence, the version is important.
  • Plan to incorporate directly into Clinical Reasoning capability statements and profiles in FHIR R5 for use by others. Currently the specification is in the Quality Measure IG.  The new R5 capabilities will be in the FHIR R5 ballot when it happens.  The measure-specific one is available in the Quality Measure IG when published.  Prior to R5, an R4 IG could take the same approach using extensions similar to those in the QM IG - working with MedMorph and others to use the same capabilities.

QI-Core Discussion

Progress in Profile Authoring - modifications in capabilities with CQL. Data requirements took precedence for the May HL7 FHIR Connectathon 27. Profile-informed authoring is critical to allow specific profiles within a measure (example - Logica COVID-19 profiles). Profile authoring allows flexibility and there are a lot of dependencies to enable such capability.

FHIR-32273 - Getting issue details... STATUS TaskNotDone: "rejected" is used in CPG to represent the same thing.

focus - what the task is acting on. Medication reconciliation example.

TaskNot Done vs ProcedureNotDone?

CPG approach: Only use task when no corresponding request resource.

Vendor 1 used Task, Vendor 2 used Procedure, so measure needed to handle both.

CPG (decision support) can say which to choose, so should be clearer for consuming systems to pick the right one.

Note Task.code has binding strength "example".

Procedure physical or mental change, does this apply to med rec? Med rec is intended to possibly change patient's plan of care, which could impact physical or mental capabilities.

Need a good example for this new profile. Include a note in the profile that some systems may use Procedure Not Done instead of Task Not Done.

Profile should include Trial Use (TU) note to ask for feedback.

8.20.2 QDM to QI-Core mapping discusses Procedure vs Task, so may need changes there

Motion/Second: Bryn Rhodes/Ben Hamlin

Vote (For-Against-Abstain): 13-0-0

See Jira for resolution details.

FHIR-32235 - Getting issue details... STATUS

Are we relaxing MUST SUPPORT (MS) in QI-Core if US Core has MS for issued and performer.

Why is Differential View showing these?

All 3.1.1 US Core changes were applied to US Core, but there were a lot so may have missed some.

Status, code, effective, issued

add result scoped to QI Core Lab Result

Mark performer MS.

Motion/Second: Bryn Rhodes/Ben Hamlin

Vote (For-Against-Abstain): 13-0-0

Can this be a problem with other resources?

FHIR-32234 - Getting issue details... STATUS

Not really a slice.  Constraining to QICoreLocation, not really a slice of DiagnosticReport.extension:locationPerformed

Tooling issue?

FHIR-32233 - Getting issue details... STATUS short discussion

Action Items

  • None