Skip to end of metadata
Go to start of metadata

Date: Tuesday 9/22/2020

Time: 2-3:30pm

Chair: Bryn Rhodes

Scribe: Howard Strasberg

CDS Hosted CQI

Agenda brought forward by CQI

  • Clinical Reasoning Connectathon Report out and Project Update
  • Gaps in Care Connectathon Report and Project Update
  • Consider Attribution Resource (Linda Michaelsen)
  • FHIR R5 Review/Prep

Meeting Minutes

  • Combined CDS/CQI Minutes
  • ClinicalReasoning update - Bryn
    • Clinical Reasoning Update - 2020 Sep WGM.pptx 
    • Part of FHIR specification
    • Use cases include sharing and evaluation
    • Capabilities include expression logic, definitional resources and knowledge artifacts
    • Bryn reviewed the quality improvement ecosystem diagram
      • EBM on FHIR IG likely in the near future
      • CPG on FHIR IG supports the representation of guideline content
      • CDS Hooks supports integration with clinical systems
      • Quality Measure IG describes how to construct quality measures
      • DEQM - how to exchange the data of interest and report on measures
      • Blue - CDS; Purple - CQI; Red - Public Health
    • Three types of IGs
      • Model IGs - e.g. QICore, USCore
        • focused on data exchange within a particular realm
      • Content IGs - e.g. HEDIS
        • focused on publishing specific types of artifacts
        • conform to a specification IG and draw from a model IG
      • Specification IGs - e.g. DEQM
        • focused on particular use cases
        • derived from ClinicalReasoning module generally
    • Connectathon report
      • Test the ClinicalReasoning Module and related IGs
      • Broad range of participants
      • Testing focus
        • Quality measure features
        • PACIO data in a FHIR eCQM
        • End-to-end gaps in care scenario
        • Continued testing of Opioid IG via CDS Hooks
        • MAT on FHIR
          • Measure Authoring Tool
          • Can export packages that conform to the Quality Measure IG
          • Developer-assisted QDM-to-FHIR measure converstion
        • Tested supplemental data with a variety of measures
        • Continuous variable measures still have some kinks
          • Tests pass in Atom but fail in reference implementation
        • Evaluated stroke measure 104 with PACIO data
      • Discovered issues posted to github, such as $collect-data and $evaluate-measure
  • Gaps in Care - Yan Heras
    • CQF-ruler reference implementation
    • Mettles Solution's implementation
    • End-to-end test scenario
      • Gaps in care → DetectedIssue
    • Tested end-to-end gaps in care reporting
    • Tested using ATR group with care-gaps operation
    • Discussed need for future enhancement of PopulationReference and DetectedIssue
    • Identified places in spec that need clarification
    • AEGIS Touchstone tested conformance of an implementation to the IG
    • Ballot results for DEQM Release 1
      • Passed
      • 110 comments
      • At first glance, no comments of high significance
      • Discussion
        • DetectedIssue - why wasn't it used in PDDI?
          • Bryn - PDDI could potentially use it; PDDI is doing a report-out on Friday
          • Rich Boyce - DetectedIssue was included in the last version; was tricky to do with CDS Hooks card response; most recent ballot used an alternative approach involving configurations
        • DetectedIssue wasn't the focus of this DEQM ballot
    • Gaps in Care_meeting_09172020.pptx
  • Attribution resource discussion - Linda Michaelsen
    • Use of DaVinci ATR to identify groups
    • evaluateMeasure operation
      • subject has primary relationship to primary practitioner
    • Care-gaps operation
      • people wanted the attributed provider and organization
    • No true way to represent attribution in FHIR
      • Patient.generalPractitioner
      • Patient.managingOrganization
      • However, sometimes a single patient will have attribution for different features
      • May need to attribute by date, measure, topic, program or conditions
      • Patient seen one or more times by a given practitioner during the performance period
      • ATR IG doesn't specify how to get the members for a given NPI
      • CAQH is developing exchange of attribution information between payers and providers - bulk and individual
      • Provider would query the payer to see if the patient is attributed to them under any existing program
      • Payer wants to send a list of all attributed patients to their providers once a month
      • The context is value-based care rather than fee-for-service
      • Cardinality
        • One Attribution resource for each attribution?
        • Related to patient or provider?
        • Bryn - attribution to a particular provider; current Group resource may support this use case; ATR IG only uses Group in the instance case, but Group supports a definitional approach
        • Group is based on provider; you would define the characteristics and the period and list the members
        • Group.managingEntity only allows one value; PractitionerRole might work - includes both practitioner and organization
        • Use of Group would align with ATR
        • FHIR extension - Group definition profile in CPG lets you establish a group by dynamic expression
        • Might use PractitionerRole as the managing organization
    • Need for an Attribution Resource.pptx
  • FHIR R4B/R5 discussion
    • R4B in January 2021 - limited new resources with significant demand
      • Medication definition resources, EBM-on-FHIR resources
      • Can propose additional resources
    • Initial R5 ballot towards the end of 2021; may be at least another year until it's published
    • Which resources we'd like to see in R4B?
      • EBM-on-FHIR resources
      • MedicationDefinition
    • Will changes to existing resources be included in R4B?
    • R5 next steps
      • Align with subscription changes
      • Rename RequestGroup to RequestOrchestration
      • Apply QA changes for maturity goals
    • promotion candidates
      • knowledge representation level and capabilities - sharable, computable, publishable, executable
      • general purpose profiles
        • Library, PlanDefinition, ActivityDefinition, Measure
      • universally applicable guidance - e.g. using libraries, profiles, terminology
    • Floyd - we are basing our current work on R4; when will people implement R5?; what about US regulatory requirement to use R4?
    • Which other resources are going normative in R5?
    • R4B content will also be included in R5

Action Items

  • None