Date: 22-09-2021

Quarter: 4

CQI hosts CDS

Chair: Paul Denning 

Scribe: Patricia Craig 

Minutes Approved as Presented 

This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."

Discussion items


FHIRcast Update



CDS is a co-sponsor of FHIRcast.

FHIRcast builds on the CCOW abstract model to specify an http-based and simple context synchronization specification that doesn't require a separate context manager. FHIRcast is intended to be both less sophisticated, and more implementer-friendly than CCOW and therefore is not a one-to-one replacement of CCOW, although it solves many of the same problems.

Starting to see implementations "in the wild".

Started with a Rest Hooks concept, but WebSockets is what is really being implemented.  RestHooks may be deprecated in the future.

Major use case for FHIRcast is Imaging.  Looking at a version 3 of FHIRCast to solicit feedback on the best way to enable a more advanced exchange.  Maybe submitting a NIB for January 2022.

Sept 2021 Connectathon report out:

The goals of this connectathon track were three-fold:
•    Simple interoperability testing: subscribe to session, receive, send event notifications.
•    Assist & enable developers new to FHIRcast.
•    Test, validate and explore more advanced content exchange scenarios.

Significant developer participants, included:
•    Mihaly Herczku, Gergely Heja - Siemens
•    Catie Ladd, Kamal - Nuance
•    Isaac Vetter, Alex Z. Liu - Epic
•    Stanislav Melnikov, Alvaro Sanchez, - Smart Reporting
•    Ryan Becker, Ryan Gabrien - 3M
•    Bas van den Heuvel - Philips

All significant developer participants have implemented at least websocket support for subscribe, send and receive event notifications and unsubscribe as described in FHIRcast STU2. This includes the following Hubs: Nuance, Epic, Siemens, Smart Reporting, and Philips. And the following FHIRcast clients: 3M, Siemens, Nuance, Philips, Smart Reporting.

Additionally, we held two educational overview sessions that were well attended.

Notable achievements: Maturity & new implementer success
•    Increasingly, available and persistent FHIRcast Hubs.
•    3M attended the FHIRcast track for the first time, having previously only developed against the Epic hub, and successfully integrated with the Siemens hub, Nuance hub, Smart Reporting hub and Philips hub over the course of the Connectathon.


Update was provided during a previous quarter.  

There were no additional questions or discussion during this quarter.

January WGM/Connectathon Planning

Note January WGM occurs Tuesday, January 18 through Friday, January 21, 2022 (shortened week due to the US Martin Luther King holiday).

January 2022 CDS-CQI WGM Agenda (draft) 

  • See above draft for updates to the meeting agenda that occurred during this meeting and up-to the time of the January meeting.
  • This meeting will be occurring on CST time.
  • The draft agenda currently is a copy of the September 2021 meeting, with the days shifted forward.
  • Will have to when to schedule re-occurring Fri Q1 meeting with OO as that will overlap with the normal Thur Q1 meeting.
  • Need to decide if CDS/CQI wants a specific call with FHIR-I or if the 15 minutes as part of a regular FHIR-I call is enough.
    • Risk Adjustment IG may need to be discussed
Connectathon  (note January 2022 specific information has not been added yet)
  • Reach out to implementers to see if all areas are covered.  Plan early and more focused scenarios.
PSS-1832 Longitudinal Maternal Health for Research project

Open question is if CDS and/or CQI would like to co-sponsor this project.

Per the PSS:  The FHIR R4 implementation guide (IG) for the US Realm will be based on Clinical Quality Framework and US Core profiles where possible. The scope of this IG will include key data elements in a longitudinal record of a mother and child for two initial research use cases:

  • Pregnancy-related and pregnancy associated deaths: The use case is focused on women who died within a year (365 days) of a pregnancy regardless of cause of death or pregnancy outcome.
  • Pregnancy-induced hypertension (PIH): The use case focuses on women with a diagnosis of pregnancy-induced hypertension.


  • Not sure if there is anyone in CQI specifically interested in the content.
  • It may tie into evidence based medicine or CPG-on-FHIR.
  • Reading the PSS, it sounds like they will be developing profiles to support the data.
    • Uncertain if they will only be defining the data or if they will be running reports and sending data to a trial.
  • Questions:
    • Is anyone concerned if this IG will impact the future ability to create eCQMs that would be using this data.
    • Are they trying to improve the data at the source level?
      • Just creating an IG will not improve the data.  There needs to be a driver so it is implemented.

Decision is to ask Public Health to come and discuss the PSS.

FHIR trackers time allowing

Discussed FHIR-33970 'Consider useContect rather than usage extensions'.

  • It has been assigned to Bryn to work on.

Reviewed and Voted on the following FHIR Trackers:

  • FHIR-31871 (Clarify relationship between maturity level assignment and draft content)

This request is no longer relevant because the Statistic data type was removed.

Motion to make Not Persuasive: Byrn Rhodes / Sherita Alaic

For - Against - Abstain: 17-0-0

  • FHIR-31872 (OrderedDistribution Summary cell may be duplicated for the same problem with different artifacts)

This request is no longer relevant because the OrderedDistribution type was removed.

Motion to make Not Persuasive: Byrn Rhodes / Sherita Alaic

For - Against - Abstain: 17-0-0

  • FHIR-32795  (Revise[x] to BackboneElement)

Latest build:

Motion to Approve:  Byrn Rhodes / Stan Rankins

For - Against - Abstain: 16-0-1

  • FHIR-33015 (Add guidance that UCUM codes specifically have first class support in Quantity and so shouldn't use terminology declarations)

Motion to Approve:  Byrn Rhodes / Stan Rankins

For - Against - Abstain: 16-0-1

  • FHIR-31742 (harmonize the way used to refer related artefacts)

This request is no longer relevant because it has already been applied.

Motion to make Not Persuasive:  Byrn Rhodes / Stan Rankins

For - Against - Abstain: 16-0-1

Action items

  • Invite Public Health to join a call to discuss the PSS-1832 Longitudinal Maternal Health for Research project.