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  1. Project Name and ID


Clinical Quality Expression Language

Project ID: 1108

TSC Notification Informative/DSTU to Normative           Date :  2020-03-02


  1. Sponsoring Group(s) / Project Team

Primary Sponsor/Work Group ( 1 Mandatory )

Clinical Decision Support

Co-sponsor Work Group(s)

Clinical Quality Information

Implementable Technology Specifications



Project Team:


Project facilitator ( 1 Mandatory )

Bryn Rhodes (

Other interested parties and their roles

Mark Kramer ( )

Chris Moesel ( )

Marc Hadley ( )

Stan Rankins ( )

Multi-disciplinary project team (recommended)


     Modeling facilitator


     Publishing facilitator

Bryn Rhodes (

     Vocabulary facilitator


     Domain expert rep

Aziz Boxwala ( )

Claude Nanjo ( )

     Business requirement analyst


     Conformance facilitator (for IG projects)


     Other facilitators (SOA, SAIF)




Implementers (2 Mandatory for DSTU projects):

1)  The MITRE Corporation

2)  Telligen

  1. Project De finition

3.a. Project Scope

This project will define a common canonical representation of expression logic for clinical quality drawing on the requirements of the Quality Data Model (QDM), Health Quality Measure Format (HQMF), Clinical Decision Support Knowledge Artifact Specification (CDS KAS), and the conceptual requirements established in Health Quality Reasoning and Expression Logic specification.


This project will also define a serialization mechanism for that canonical representation to enable point-to-point sharing of clinical knowledge.


In addition, the project will define a “conformance profile” consisting of a human-readable syntax targeted for measure and decision support artifact authors that can then be translated into the canonical representation.


The canonical representation will be defined as a logical model with an accompanying ITS describing how it can be serialized using a specific interchange technology such as XML.


The conformance profile syntax will be defined using the ANTLR4 grammar framework.


The project is also expected to include tooling to support language processing applications with the resulting canonical representation, as well as the high-level syntax.

3.b. Project Need

Although several standards exist for the expression of clinical quality logic, these standards are not widely adopted, and present various barriers to point-to-point sharing of clinical knowledge artifacts such as lack of tooling, complexity of implementation, or insufficient expressivity. For a more in-depth discussion of the evaluation and analysis of the various candidate standards involved, please refer to the associated Health eDecisions Research History document.


Rather than attempt to address these shortcomings in one of the available syntaxes, we propose that the solution is to enable shared understanding by defining a syntax-independent, canonical representation of the logic involved in any given artifact, and point-to-point sharing by defining a serialization for that representation.


The canonical representation would be informed conceptually by the requirements of the clinical quality domains of measurement and improvement; and technically by compiler design best practices. The resulting canonical representation would provide a basis for sharing logic in a way that is at once verifiable, computable, and serves as the input to language processing applications such as translation, tooling, or even execution engines.


In addition, a high-level domain specific language focused on clinical quality and targeted at measure and decision support artifact authors that can then be rendered in this canonical representation is needed because none of the existing syntaxes are suitable for clinical domain expert use.

3.c. Success Criteria

Success criteria for this project include:

  • Establishment of an expression language for health quality expression logic.
  • Demonstrated ability to use this grammar to describe a broad range of measures and decision support artifacts.
  • Tooling to enable language processing applications, including translators, execution, and authoring.

3.d. Project Objectives / De liverables / Target Dates

Target Date

Develop syntax and supporting tooling

2014 Jun

Submit for Comment Only Ballot

2014 Sep Ballot

Complete Comment Only Reconciliation

2014 Sep WGM

Submit for DSTU Ballot

2015 Jan Ballot

Complete DSTU Ballot Reconciliation

2015 Jan WGM

Pilot artifacts using the syntax and tooling

2014 Jun

DSTU Updates

2015 Jan – 2017 Jan

DSTU Period – 24 months

2015 Jan - 2017 Jan

STU Update and Extension to incorporate feedback from quality artifact authors

2017 Jan – 2018 Jan

STU 3 Ballot to incorporate additional feedback

2018 May Ballot

Complete STU 3 Ballot Reconciliation

2018 May WGM

Publish STU 3

2018 Jun

Continue supporting implementation and testing

2018 Jun – 2020 Apr

Submit for Normative Ballot

2020 May Ballot

Complete Normative Reconciliation

2020 May WGM

Submit Publication Request

2020 Jun

Receive ANSI Approval

2020 Jul

Project End Date

2020 Jul

3.e. Project Requirements

The requirements for this project are:

  • Provide an expression language that is usable by measure and decision support artifact authors.
  • Provide a mechanism for use of the expression language within the CDS KAS and HQMF.
  • Conform to the conceptual requirements established by the Health Quality Reasoning and Expression Logic informative standard.

3.f.    Project Risks

Risk De scription

Compressed Timeline

Impact De scription

The compressed timeline for this project and the non-trivial nature of the work involved present a risk to completion.









Mitigation Plan

To the extent possible, the specification will be developed using existing specifications, frameworks, and tooling.

3.g. Project De pendencies


3.h. Project Document Repository Location


3.i.    Backwards Compatibility

Are the items being produced by this project backward compatible?



Don’t Know


Non Product Project- (Educ. Marketing, Elec. Services, etc.)

V3 Documents – Knowledge

Arden Syntax

V3 Foundation – RIM

Clinical Context Object Workgroup (CCOW)

V3 Foundation – Vocab Domains & Value Sets

Domain Analysis Model (DAM)

V3 Messages – Administrative

Electronic Health Record (EHR)

V3 Messages – Clinical

Functional Profile

V3 Messages – De partmental

V2 Messages – Administrative

V3 Messages – Infrastructure

V2 Messages - Clinical

V3 Rules – GELLO

V2 Messages - De partmental

V3 Services – Java Services (ITS Work Group)

V2 Messages – Infrastructure

V3 Services – Web Services

V3 Documents – Administrative (e.g. SPL)

- New Product De finition – Expression Logic Representation

V3 Documents – Clinical (e.g. CDA)

- New/Modified HL7 Policy/Procedure/Process -


This project will extract the expression language definition components of the CDS Knowledge Artifact Specification into a new specification that can be referenced independently, and which will serve as a mechanism for serialization of expression logic.


The resulting specification will then be expanded to define CQL syntax, a high-level clinically-focused expression language that can be used to directly author logic for measures and decision support rules. This expression language will be a one-to-one mapping with the XML representation, and so will support translation directly to and from the XML.



  1. Project Intent (check all that apply)

Create new standard

Revise current standard (see text box below)

Reaffirmation of a standard

New/Modified HL7 Policy/Procedure/Process

Withdraw an Informative Document

N/A  (Project not directly related to an HL7 Standard)

Supplement to a current standard

Implementation Guide (IG) will be created/modified

Project is adopting/endorsing an externally developed IG

(specify external organization in Sec. 6 below)

Externally developed IG is to be Adopted

Externally developed IG is to be Endorsed


5.a. Ballot Type (check all that apply)

Comment Only


DSTU to Normative

Normative (no DSTU)

Joint Ballot (with other SDOs or HL7 Work Groups)

N/A  (project won’t go through ballot)

PBS Metrics and W o rk Group Health Reviewed ? (required for SD Approval)







Clinical and Public Health Laboratories


Clinical and Public Health Laboratories

Immunization Registries


Emergency Services

Quality Reporting Agencies


Local and State De partments of Health

Regulatory Agency

Health Care IT

Medical Imaging Service

Standards De velopment Organizations (SDOs)

Clinical De cision Support Systems

Healthcare Institutions (hospitals, long term care, home care, mental health)



Other (specify in text box below)

Other (specify in text box below)




Other (specify below)






7.b. Synchronization With Other SDOs / Profilers



  1. Strategic Initiative Reference – For PMO/TSC Use Only