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Clinical Quality Framework
cqframework.info
All Hands MeetingSeptember 25, 2014
11am-12:30pm ET
Logistics• As a reminder, please mute your phone when you are not talking to the group. • When speaking, please say your name before making your comment.• You can ask questions by unmuting or by using the “Chat” feature on the web
meeting.To find the “Chat” feature, look for the “Chat” bubble at the top of the meeting window.
From S&I Framework to Participants:Could you please explain how the terminologies are used in this instance?
All Panelists
CQF Wiki: cqframework.info 2
• Send your “chat” to All Panelists in order to ensure the comments are addressed publicly.
• This meeting is being recorded.• Should you need to take another call, please
leave the meeting and rejoin (i.e., please do not put the meeting line on hold).
Agenda
Topic PresenterWelcome Bridget Blake, CQF Project Manager
Prioritization of Concrete/Leaf Clinical Statement Types
Aziz Boxwala, CQF Subject Matter Expert
HL7 Update Ken Kawamoto, CQF Co-Coordinator
HL7 Update: Clinical Quality Language (CQL) Bryn Rhodes, CQF Subject Matter Expert
HL7 Update: Quality Improvement and Clinical Knowledge (QUICK) Data Model
Aziz Boxwala, CQF Subject Matter ExpertClaude Nanjo, CQF Subject Matter Expert
Pilot Update Bridget Blake, CQF Project ManagerPilot Leads
Next Steps Bridget Blake, CQF Project Manager
Questions and Discussion Bridget Blake, CQF Project Manager
CQF Wiki: cqframework.info 3
Welcome
• Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Cases, Project Charter, and General Information are posted on cqframework.info
• Input requested on Quality Improvement and Clinical Knowledge (QUICK) data model concrete/leaf clinical statement types: https://docs.google.com/spreadsheets/d/1QiiNdtTeD17vbEQn9bzXLMaBY1A30c6FEyt-qsIB0cw/edit?usp=sharing
Place feedback in spreadsheet or contact [email protected] by September 22, 2014
• QIDAM pre-publication draft is ready for review• Cypress 2.5 was released on September 25, 2014
http://projectcypress.org
CQF Wiki: cqframework.info 4QIDAM=Quality Improvement Domain Analysis Model
Welcome
• Clinical Quality Framework (CQF) All Hands meetings are held weekly on Thursdays from 11am to 12:30pm ET
• https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=666535029
• Dial In: +1-650-479-3208 • Access code: 666 535 029
• CQF QUICK Data Model meetings are held weekly on Wednesdays from 1 to 2pm ET
• http://fuze.me/24308131
• Dial In: +1-770-657-9270• Participant passcode: 6870541
• CQF Clinical Quality Language meetings are held weekly on Wednesdays from 11am to 12pm ET
• https://global.gotomeeting.com/meeting/join/554237525
• Dial In: +1-770-657-9270• Participant passcode: 6870541
CQF Wiki: cqframework.info 5
Welcome
Notional Project Timeline
6
Kick-off (3/21)
Pre-Discovery, Call for
Participation
May 2014 Sep 2015
Discovery
Initiative End
Mar 2014 Nov 2015Jul 2014
Implementation
Pilot
Charter, Use Cases, Functional Requirements
Standards Development and Review
Use Case Pilots Technology Evaluations
Use Case Kick-off Use Case Consensus
Pilot Kick-off
Evaluation
…
Mar 2014: Pre-Discovery - Call for participationApr-Jun 2014: Discovery - Charter, use case, and functional requirements developmentMay 2014-Nov 2015: Implementation – Standards development and review Jun 2014-Nov 2015: PilotsDec 2015: Evaluation
Date Milestones Through August 2014
4/11/14 Charter Finalization
4/18-4/30/14 Initial Logical Model Development
4/25/14 Use Case Selection
5/1/14 Proposed Harmonized Logical Model Approach
6/30/14 Pilot Planning Begins
7/3/14 Use Case Finalized
7/30/14 Narrow Slices of Draft Specifications Ready for Pilots
8/3/14 Standards (Incorporating Initial Pilot Feedback) Submitted for HL7 Ballot
8/18/14 Pilot Implementation Begins
8/8-9/8/14 September 2014 HL7 Ballot Cycle*Comment-Only: QUICK Data Model*Comment-Only: CQL
Date Milestones
9/14/14-9/19/14
September 2014 HL7 Working Group Meeting*PSS: CQF-Based HQMF IG
12/31/14 Phase 1 of Pilots Concludes
12/12/14-1/12/15
January 2015 HL7 Ballot Cycle*DSTU: QUICK Data Model*DSTU: CQL*Comment-Only: CQF-Based HQMF IG*Comment-Only: QUICK FHIR Profile*Comment-Only: CDS KAS
1/18/15-1/23/15
January 2015 HL7 Working Group Meeting
4/4/15-5/4/15
May 2015 HL7 Ballot Cycle*DSTU: CQF-Based HQMF IG*DSTU: QUICK FHIR Profile*DSTU: CDS KAS
5/10/15-5/15/15
May 2015 HL7 Working Group Meeting
8/31/15 Phase 2 of Pilots Concludes
CDS=Clinical Decision SupportCQL=Clinical Quality LanguageDSTU=Draft Standard for Trial UseFHIR=Fast Healthcare Interoperability Resources HQMF=Health Quality Measures FormatIG=Implementation GuideKAS=Knowledge Artifact SpecificationQUICK=Quality Improvement and Clinical Knowledge
Welcome
Standards
CQF Wiki: cqframework.info 7
CQM-Specific Standards
CDS-Specific Standards
Common Metadata Standard
Common Data Model
Standard(QUICK)
Common Expression
Logic Standard
(CQL)
CDS=Clinical Decision SupportCQL=Clinical Quality LanguageCQM=Clinical Quality MeasurementQUICK=Quality Improvement and Clinical Knowledge
Reconciling ballot comments
Reconciling ballot comments
Prioritization of Concrete/Leaf Clinical Statement Types
Aziz Boxwala, CQF Subject Matter Expert
CQF Wiki: cqframework.info 8
HL7 Update
Ken Kawamoto, CQF Co-Coordinator
CQF Wiki: cqframework.info 9
HL7 Update: Clinical Quality Language (CQL)
Bryn Rhodes, CQF Subject Matter Expert
CQF Wiki: cqframework.info 11
HL7 Update: CQL
CQL Ballot Summary
CQF Wiki: cqframework.info 11
Vote Summary
91.5% Affirmative
HL7 Update: CQL
CQL Ballot Summary
CQF Wiki: cqframework.info 12
Comment Summary
Neg-Mj: Negative Vote with Reason - MajorNeg-Mi: Negative Vote with Reason- MinorA-C: Affirm Vote with CommentA-Q: Affirm Vote with QuestionA-S: Affirmative Vote with Comment -Suggestion A-T: Affirm Vote with Comment - Typo
HL7 Update: CQL
CQL Ballot Summary
CQF Wiki: cqframework.info 13
Major Comment Categories– Audience
• General concerns over the intended audience of the various sections
– Clarity• Suggestions and requests for clarification
– Data Model• Concerns about the relative coupling of CQL/QUICK
– Syntax • Comments about complexity and/or expressivity of the syntax
– Timing• Comments relating to temporal comparisons and support
– Examples• Requests for more or better examples
– Questions/Comments/Errata
HL7 Update: CQL
CQL Ballot Summary
CQF Wiki: cqframework.info 14
Disposition Summary
HL7 Update: CQL
CQL Ballot Summary
CQF Wiki: cqframework.info 15
Reconciliation Summary
HL7 Update: Quality Improvement and Clinical Knowledge (QUICK)
Aziz Boxwala, CQF Subject Matter Expert
Claude Nanjo, CQF Subject Matter Expert
CQF Wiki: cqframework.info 16
HL7 Update: QUICK
QUICK Ballot Summary
CQF Wiki: cqframework.info 17
Vote Distribution
Affirmative Negative Abstain NV
Affiliate 0 6 18 5
Consultant 6 3 11 12
Government/Non-Profit 1 2 2 5
Payor 0 0 0 1
Pharmaceutical 1 0 2 2
Provider 34 2 20 7
Vendor 18 7 5 7
Totals 60 20 58 39
% of Votes 33.90% 11.30% 32.77% 22.03%
Quorum 77.97%
Approval 0
HL7 Update: QUICK
QUICK Ballot Summary
CQF Wiki: cqframework.info 18
Comment Distribution
Comment Type Count
A-C 10A-Q 35A-S 64A-T 12Neg-Mi 53Neg-Mj 10Not specified (assume A-C) 30Grand Total 214
A-C: Affirm Vote with CommentA-Q: Affirm Vote with QuestionA-S: Affirmative Vote with Comment -Suggestion A-T: Affirm Vote with Comment - TypoNeg-Mj: Negative Vote with Reason - MajorNeg-Mi: Negative Vote with Reason- Minor
HL7 Update: QUICK
QUICK Ballot Summary
CQF Wiki: cqframework.info 19
Comment Summary– Relationship to other standards
• FHIR• v3
– Model scope• Statements about entities other than patients (e.g., nurse staffing
ratios)
– Model design and naming issues– Clarification
• Occurrence versus unknown occurrence versus non-occurrence• Act versus observable (particularly with results)
– Better documentation– Typos
HL7 Update: QUICK
QUICK Ballot Summary
CQF Wiki: cqframework.info 20
Plan– Have tentative ballot resolutions completed this week– Work with commenters over the next week– Aim for votes/block-votes in second half of October
Pilot Update
Bridget Blake, CQF Project Manager
Pilot Leads
CQF Wiki: cqframework.info 21
Pilot Update
CQF Wiki: cqframework.info 22
• Pilot leads are finalizing pilot summaries• Pilot leads will work with designated subject matter experts to
engage the pilot teams and move the pilot forward• Pilot discussions will be part of each week’s All Hands meeting;
pilot teams can provide updates and get community input during All Hands meetings
• Pilots can share information regarding individual pilot meetings and progress via the cqframework.info pilot pages
• Initial pilot feedback will be provided to the QUICK and CQL teams by early December 2014, in preparation for the QUICK and CQL DSTU ballots
Pilot Update
CQF Wiki: cqframework.info 23
Pilot POC Liaison SME Wiki (under development)Cardiology Appropriateness of Use
Jimmy Tcheng Aziz Boxwala http://wiki.siframework.org/Cardiology+Appropriateness+of+Use
Chlamydia Screening Johanna Goderre-Jones Bryn Rhodes http://wiki.siframework.org/Chlamydia+ScreeningImmunization Decision
Support ServicesDaryl Chertcoff Claude Nanjo http://wiki.siframework.org/Immunization+Decis
ion+Support+Services
Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic
Julie Scherer Claude Nanjo http://wiki.siframework.org/Ischemic+Heart+Disease+and+Anti-Platelet+Use
Radiology Appropriateness of Use
Tom Conti Bryn Rhodes http://wiki.siframework.org/Radiology+Appropriateness+of+Use
Venous Thromboembolism Prophylaxis
TBD Aziz Boxwala http://wiki.siframework.org/Venous+Thromboembolism+%28VTE%29+Prophylaxis
Next Steps• Review QUICK data model concrete/leaf clinical statement types
https://docs.google.com/spreadsheets/d/1QiiNdtTeD17vbEQn9bzXLMaBY1A30c6FEyt-qsIB0cw/edit?usp=sharing
• Review the QIDAM pre-publication draft• Engage in workgroups (www.cqframework.info)
• Pilots• Pilots Sub-Team Lead Peggy Tsai• Individual Pilot Leads or Bridget Blake
• QUICK Data Model• Claude Nanjo, Aziz Boxwala
• Clinical Quality Language • Bryn Rhodes
• Join us for the next Clinical Quality Framework meeting on October 2 from 11am to 12:30pm ET
CQF Wiki: cqframework.info 24
Questions and Discussion
Name E-MailMarc Hadley, Co-Coordinator [email protected] Kawamoto, Co-Coordinator [email protected] Blake, Project Manager [email protected]
cqframework.info
CQF Wiki: cqframework.info 25
