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2018SEP_PSS_CQI_DieterleMichaelsonNguyenDolin_DataExchgQualityMeasure_FHIR_IG_revised7.docx

 

  1. Project Name and ID

 

Click here to go to Appendix A for more info regarding this section including guidance on naming conventions .

An ID will be assigned by Project Insight

FHIR Implementation Guide for Data Exchange for Quality Measures

Project ID: 1429

 

 

TSC Notification:  Informative/STU to Normative 

Date: 

 

 

- or -                     Direct to Normative (no STU) (includes reaffirmations)       

 

Identify ISO, IEC or ISO/IEC standard to be adopted in text box below

Enter info here if an ISO, IEC or ISO/IEC Standard is to be adopted as an American National Standard; enter the designation of the standard(s)to be adopted.

Includes text from ISO, IEC or ISO/IEC standard: Check here if this standard includes excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption.

 

 

Yes

 

x

No

 

 

 

 

 

Select the unit of measure used in the standard; if no measurements are in the standard, select N/A

 

 

N/A

 

 

U.S.

 

 

Metric

 

x

Both

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Investigative Project (aka PSS-Lite)

Date : 

  1. Sponsoring Group(s) / Project Team

Click here to go to Appendix A for more information regarding this section.

2.a. Primary Sponsor/Work Group

Primary Sponsor/Work Group
(1 (And Only 1) Allowed)

Clinical Quality Information

2.b. Co-sponsor Work Group(s)

Co-sponsor Work Group(s)

(Enter co-sponsor approval dates in Section 6.d Project Approval Dates)

 

Clinical Decision Support

Patient Care

Indicate the level of involvement that the co-sponsor will have for this project:

 

Request formal content review prior to ballot

x

Request periodic project updates. Specify period: 

Monthly and at WG meetings

 

Other Involvement. Specify details here: 

 

2.c. Project Team

All names should have confirmed their role in the project prior to submission to the TSC.

Project facilitator ( 1 Mandatory )

Bryn Rhodes, Gay Dolin, Robert Dieterle, Linda Michaelsen, Viet Nguyen

Other interested parties and their roles

Da Vinci - Accelerator Project

Multi-disciplinary project team (recommended)

 

Modeling facilitator

Eric Haas

Publishing facilitator

Eric Haas

Vocabulary facilitator

Eric Haas

Domain expert rep

Multiple (see Da Vinci use case SME list)

Business requirement analyst

Multiple (see Da Vinci use case SME list)

Conformance facilitator (for IG projects)

Eric Haas

Other facilitators (SOA, etc)

 

 

 


Implementers (2 Mandatory for STU projects)

FHIR Project Note: The implementer requirement will be handled by the “balloting” project.  Therefore work groups do not fill out the above section.  However, feel free to list implementers specific to your work group’s resources if you know of any.

1) Cerner

2) Epic

3) United

4) Humana

5) Rush Presbyterian (Chicago)

6) Cambia

7) Providence Health

8) BCBS of Alabama

  1. Project Definition

3.a. Project Scope

Click here to go to Appendix A for more information regarding this section and FHIR project instructions.

SUMMARY

  • Payers and providers need common exchange process to share the data required to complete quality measures   as well as gaps in care
  • The initial focus of this PSS was This PSS focuses on both the standard for exchange and the specific use case of medication reconciliation attestation and the underlying process from which the attestation is created that support information for transitions of care, and care management plans involving medication changes.
  • Proof of 30 day medication reconciliations is increasingly required for value based care incentives.   Providers and care coordinators face the challenge of collecting accurate and complete patient medication records across care settings.
  • Additional work has been completed to support additional example measures: Colorectal Cancer Screening and Venous Thromboembolism Prophylaxis.
  • Today’s manual and ad hoc processes are costly and will not scale.

------------------

Description of the proposed initial FHIR IG

-Scope: to address the general case of requesting/exchanging specific (patient level) detailed information for quality measures

- general concept:

 

-Develop general use case for one or more measures where an Aggregator (potentially CQL driven) is the requestor and/or recipient of individual measures on one or more patients

-Note: Aggregator may be part of EHR, Payer system or a standalone service

-Aggregator will exchange information with the Provider’s EHR or other provider service as a pull, push, or subscribe operation (recommendation/options/requirements as part of IG development)

-Exchange with provider system may have more than one FHIR content set depending on the requirements of the specific use case and HIT technology (scope determined as part of IG development)

- The attestation to 30-day Medication Reconciliation Post discharge (MRP) will be used as the example use case to test the general framework

- US-Core profiles will be utilized to provide compatibility with STU 4 3

- Since US-Core updates will not be until after FHIR R4 is balloted and finalized, Da Vinci profiles will be created for any STU 4 3 US-Core profiles that will be in R4. When US-Core profiles updates, the IG will be updated and aligned with R4 US-Core profiles.

Other aspects of medication reconciliation to be addressed in subsequent phases are (may be one or more IGs):  

-knowing when a patient is discharged

-ensuring a discharge medication list is created in

-communicating the discharge medication list to the responsible ambulatory provider

-consuming the discharge medication list within the ambulatory provider's EHR

-comparing the discharge medication list with the preadmission medication list and reconciling the differences

-producing a reconciled medication list

-documenting/attesting to the completion of medication reconciliation

-communicating changes in the reconciled medication list to the patient

-communicating completion of medication reconciliation to the payer and other responsible organizations

- Addition of FH IR Bulk Data Access as a format for exchanging quality measure and gaps in care information

Description of the proposed additional Gaps in Care IG

Scope: to address the general case of requesting/exchanging specific (patient and population level) detailed information for gaps in care.

General Concepts:

- Define the following:

o scope of a “gap in care”

o key stakeholders

o the clinical and administrative process for defining the open and closed gaps in care for a single patient or population of patients

o the FHIR payload to represent this list of patients/population and their gaps in care, including the status of the gap in care

o the FHIR interactions to support the query and response of this list

o the process of reporting the resolution of a gap in care back to a reporting stakeholder (e.g. payers), aligned with the framework established in the DEQM IG. This addresses both the closure of gap as well as exceptions.

- Out of scope

o How the provider organization utilize the Gaps in Care information once it’s received via FHIR

o Hierarchical Condition Category documentation for risk adjustment, also referred to as “gaps in coding.”

 

 

3.b. Project Need

Click here to go to Appendix A for more information regarding this section and FHIR project instructions.

Uniform standard for Data Exchange for Quality Measurement and Gaps in Care to meet quality utilization, care management, and quality measurement reporting. Manage patient safety and appropriate medication management.  

3.c. Security Risks

Click here to go to Appendix A for more information regarding this section.

Will this project produce executable(s), for example, schemas, transforms, style sheets, executable program, etc.  If so the project must review and document security risks. Refer to the Cookbook for Security Considerations for additional guidance, including sample spreadsheets that may be used to conduct the security risk assessment .

 

 

Yes

 

x

No

 

 

Unknown

 

 

3.d. External Drivers

Click here to go to Appendix A for more information regarding this section.

Creation of Implementation Guide regarding quality measure reporting with focus on the use case for medication reconciliation attestation to be completed by balloting in the September 2018 cycle                                                                                                   

3.e. Project Objectives / Deliverables / Target Dates for D EQM IG

Within each row, enter the explicit work product(s) / objective(s).  Indicate their target date at the right in WGM/Ballot Cycle format.  Include the project end date as the last objective (for standards projects, the end date will be the projected ANSI approval date).

Click here for further information, FHIR project instructions, and an EXAMPLE

Target Date (in WGM or ballot cycle format, e.g.

‘2017 Sept WGM’ or

‘2017 Jan Ballot’)

Submit for STU Ballot(First Ballot Cycle)

2018 Sept Ballot

 

 

Complete STU Reconciliation

2018 Nov

Request STU Publication

2018 Dec

Update Implementation Guide for R4 based on US-Core updates for R4 and implementation feedback

2019 Jan at the earliest

STU Period – 12 months

2019 Jan - 2020 Jan

Submit for additional STU rounds as appropriate based on feedback

2019 Sept – 2020 Jan

Submit for Normative Ballot

Based on FHIR normative schedule for incorporated artifacts

Complete Normative Reconciliation

TBD

Submit Publication Request

TBD

Project End Date (all objectives have been met)

Jan 2021 (expected)

3.e. Project Objectives / Deliverables / Target Dates for Gaps in Care IG

Within each row, enter the explicit work product(s) / objective(s).  Indicate their target date at the right in WGM/Ballot Cycle format.   Include the project end date as the last objective (f or standards project s , th e   end date will be the projected ANSI approval date ) .

Click here for further information, FHIR project instructions, and an EXAMPLE

Target Date   (in WGM or ballot cycle format, e.g.

‘201 7 Sept WGM’ or

‘201 7 Jan Ballot’)

Connectathons to test IG Content

Dec 2019, Jan 2020, February 2020, May 2020  

Submit for STU Ballot ( First Ballot Cycle)

Target : 2020 May Sept Ballot Cycle

Complete STU Reconciliation

20 2 1 0   Nov Mar  

Request STU Publication

20 2 1 0   Dec Apr

STU Period – 12 months

20 2 1   Jan May - 202 3 2   Jan May

Submit for additional STU rounds as appropriate based on feedback

20 21   Jan May – 202 3 2 Jan

Submit for Normative Ballot

Based on FHIR normative schedule for incorporated artifacts

Complete Normative Reconciliation

TBD

Submit Publication Request

TBD

Project End Date (all objectives have been met)

Jan 202 3 2 (expected)

 

1.a. Common Names / Keywords / Aliases

Click here to go to Appendix A for more information regarding this sec H tion sec t ion .

HEDIS Measure Reporting, MRP, FHIR IG, Medication Reconciliation, HEDIS, NCQA, Quality Measures , Gaps in Care

1.b. Lineage

Click here to go to Appendix A for more information regarding this section.

N/A

1.c. Project Dependencies

Click here to go to Appendix A for more information regarding this section.

FHIR STU 4.0 Final Ballot, Reconciliation and Publication

US-Core updates for FHIR R4

1.d. HL7-Managed Project Document Repository Location

Click here to go to Appendix A for more information regarding this section.

HL7-Managed Project Document Repository – HL7 organizational GitHub site

URL – https://github.com/HL7/davinci-deqm    https://github.com/HL7/data-exchange-for-quality-measures

1.e. Backwards Compatibility

Are the items being produced by this project backward compatible?

 

X

Yes

 

 

No

 

 

Unknown

 

x

N/A

 

 

 

 

 

 

 

 

If you check 'Yes' please indicate the earliest prior release and/or version to which the compatibility applies:

 

For V3, are you using the current data types? 

(Refer to TSC position statement on new projects using R2B for more information on the current V3 data types)

 

 

Yes

 

 

No

 

 

Unknown

 

x

N/A

 

 

 

 

 

 

 

 

If you check 'No' please explain the reason:

If desired, enter additional information regarding Backwards Compatibility.

1.f.    External Vocabularies

Will this project include/reference external vocabularies?

 

x

Yes

 

 

No

 

 

Unknown

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

If yes, please list the vocabularies: SNOMED, CPT, HCPCS/CPT II, RxNorm, LOINC

 

  1. Products (check all that apply)

Click here to go to Appendix A for more information regarding this section

 

Arden Syntax

 

 

V2 Messages – Administrative

 

Clinical Information Modeling Initiative (CIMI)

 

 

V2 Messages - Clinical

 

Clinical Context Object Workgroup (CCOW)

 

 

V2 Messages - Departmental

 

Domain Analysis Model (DAM)

 

 

V2 Messages – Infrastructure

 

Electronic Health Record (EHR) Functional Profile

 

 

V3 Domain Information Model (DIM / DMIM)

X

FHIR Extensions

 

 

V3 Documents – Administrative (e.g. SPL)

x

FHIR Implementation Guide (enter FHIR product version below)

 

 

V3 Documents – Clinical (e.g. CDA)

X

FHIR Profiles (enter FHIR product version below)

 

 

V3 Documents - Knowledge

 

FHIR Resources

 

 

V3 Foundation – RIM

 

Guidance (e.g. Companion Guide, Cookbook, etc)

 

 

V3 Foundation – Vocab Domains & Value Sets

 

Logical Model

 

 

V3 Messages - Administrative

 

New/Modified/HL7 Policy/Procedure/Process

 

 

V3 Messages - Clinical

 

New Product Definition (please define below)

 

 

V3 Messages - Departmental

 

New Product Family (please define below)

 

 

V3 Messages - Infrastructure

 

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

 

 

V3 Rules - GELLO

 

White Paper

 

 

V3 Services – Java Services (ITS Work Group)

 

Creating/Using a tool not listed in the HL7 Tool Inventory

 

 

V3 Services – Web Services (SOA)

 

FHIR STU4 and FHIR STU2, may include FHIR STU3

  1. Project Intent (check all that apply)

Click here to go to Appendix A for more information regarding this section and FHIR project instructions.

 

Create new standard

 

 

Supplement to a current standard

 

Revise current standard (see text box below)

 

x

Implementation Guide (IG) will be created/modified

 

Reaffirmation of a standard

 

 

Project is adopting/endorsing an externally developed IG:

 

New/Modified HL7 Policy/Procedure/Process

 

 

Specify external organization in Sec. 6 below;

 

 

 

 

Externally developed IG is to be (select one):

 

White Paper (select one):

 

 

Adopted  - OR -

 

Endorsed

 

 

Balloted Informative OR

 

Non-balloted WG White Paper

 

 

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

-          

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

Click here to go to Appendix A for more information regarding this section and FHIR project instructions.

 

Comment (aka Comment-Only)

 

 

Joint Ballot (with other SDOs)

 

Informative

 

 

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

x

STU to Normative     - OR -

 

Normative (no STU)

 

 

 

 

3.b. Joint Copyright

Click here to go to Appendix A for more information regarding this section

Check this box if you will be pursuing a joint copyright.  Note that when this box is checked, a Joint Copyright Letter of Agreement must be submitted to the TSC in order for the PSS to receive TSC approval.

Joint Copyrighted Material will be produced?

 

 

Yes

 

x

No

 

 

  1. Project Logistics

4.a. External Project Collaboration

Click here to go to Appendix A for more information regarding this section and FHIR project instructions.

This is an externally funded Da Vinic Vinci project

For projects that have some of their content already developed:

How much content for this project is already developed?

30%

Was the content externally developed (Y/N)? 

Da Vinci members

Is this a hosted (externally funded) project? 
(not asking for amount just if funded)

 

 

 

 

 

 

 

x

Yes

 

 

No

4.b. Realm

Click here to go to Appendix A for guidelines regarding choosing Universal or Realm Specific.

 

Universal     - OR -

 

x

Realm Specific

 

 

 

Check here if this standard balloted or was previously approved as realm specific standard

 

U.S. Data exchanged is specific to meet US quality measures 

4.c. Stakeholders / Vendors / Providers

Click here to go to Appendix A for more information regarding this section

This section must be completed for projects containing items expected to be ANSI approved, as it is an ANSI requirement for all ballots

 

Stakeholders

 

Vendors

 

Providers

 

Clinical and Public Health Laboratories

 

Pharmaceutical

 

Clinical and Public Health Laboratories

 

Immunization Registries

x

EHR, PHR

 

Emergency Services

x

Quality Reporting Agencies

 

Equipment

 

Local and State Departments of Health

x

Regulatory Agency

x

Health Care IT

 

Medical Imaging Service

 

Standards Development Organizations (SDOs)

x

Clinical Decision Support Systems

x

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

x

Payors

x

Lab

 

Other (specify in text box below)

 

Other (specify in text box below)

 

HIS

 

N/A

 

N/A

 

Other (specify below)

 

 

 

 

 

N/A

 

 

 

4.d. Project Approval Dates – For DEQM IG

Click here to go to Appendix A for more information regarding this section.
Approvals are by simple majority vote of the approving body

Sponsoring Work Group Approval Date:

2018-05-16

Administrative review – in parallel with Work Group Approval

Co-Sponsor Group Approval Date

 

2018-05-16
 

Family Management Group Approval Date(s)

CIMI Projects: CIMI Management Group

N/A

CDA Projects: CDA Management Group

N/A

FHIR Projects: FHIR Management Group

2018-05-23

V2/Publishing Projects: V2 Management Group

N/A

US Realm Projects: US Realm Steering Committee Approval
(Email WG approved PSS to: tscpm@HL7.org )

2018-06-05

Affiliate Specific Projects: Affiliate Approval Date

N/A

Submit PSS to Steering Division after all of the above approvals are received

Steering Division (of Primary Sponsor WG) Approval Date:

SD Approval Date 2018-07- 09 19

Last PBS Metrics Score :

x

Green

 

Yellow

 

Red

PBS Metrics Reviewed ? (required for SD Approval if not green)

 

Yes

 

No

ARB and Steering Division approval may be in parallel

Architectural Review Board Approval Date:

(required for externally developed content)

N/A

TSC Approval

If applicable, TSC has received a Joint Copyright/Distribution Agreement (containing the verbiage outlined within the SOU),
signed by both parties.

 

 

Yes

 

No

x

N/A

Technical Steering Committee Approval Date:
(Email SD WG approved PSS to: tscpm@HL7.org )

TSC Approval Date CCYY-MM-DD 2018-07-24

 

4 .d. Project Approval Dates – Gaps in Care IG

Click here to go to Appendix A for more information regarding this section.
Approvals are by simple majority vote of the approving body

Sponsoring Work Group Approval Date:

2019 -11 - 22

Administrative review – in parallel with Work Group Approval

Co-Sponsor Group Approval Date                           Patient Care:

                                                           Clinical Decision Support :

 

2020 -02-0 6

2020-02-0 6

Family Management Group Approval Date(s)

CIMI Projects: CIMI Management Group

N/A

CDA Projects: CDA Management Group

N/A

FHIR Projects: FHIR Management Group

2020 -02-20

V2/Publishing Projects: V2 Management Group

N/A

US Realm Projects: US Realm Steering Committee Approval
(Email WG approved PSS to:
tscpm@HL7.org )

2020-02 -18

Affiliate Specific Projects: Affiliate Approval Date

N/A

Submit PSS to Steering Division after all of the above approvals are received

Steering Division (of Primary Sponsor WG) Approval Date :

SD Approval Date   201 9-10-18 2020-03-02

Last PBS Metrics Score :

x

  Green

 

Yellow

 

Red

PBS Metrics Reviewed ? (req uired for SD Approval if not green )  

 

  Yes

 

  No

ARB and S teering Division approval may be in parallel

Architectural Review Board Approval Date:

(required for externally developed content)

N/A

TSC Approval

If applicable, TSC has received a Joint Copyright/Distribution Agreement (containing the verbiage outlined within the SOU),
signed by both parties.

 

 

Yes

 

No

x

N/A

Technical Steering Committee Approval Date :
(Email SD WG approved PSS to:
tscpm@HL7.org )

TSC Approval Date CCYY-MM-DD