Name / Company / Email / Q4 / Q3 / Q4 / Q1 / Q2 / Q3 / Q4 / Q1 / Q2 /
# of attendees for each quarter: / 4 / 9 / 9 / 20 / 9 / 15 / 9 / 5 / 14
Anneke Goossen / HL7 Netherlands / / √
Austin Kreisler / Leidos / / √
Benjamin Flessner / Epic / / √
Bernd Blobel / Germany HL7 / [email protected] / √
Brett Marquard / River Rock Associates / / √
Claude Nanjo / Cognitive Medicine / / √ / √ / √
Craig Gabron / ISCBSSC / / √
David Sundaram-Stukel / Epic / / √ / √ / √ / √ / √ / √ / √ / √ / √
Donna Quirk / Academy of Nutrition and Dietetics / / √
Emory Fry / Cognitive Medicine / / √ / √ / √ / √
Estebin Aliverti / Cognitive Medicine / / √ / √ / √ / √
Floyd Eisenberg / iParsimony / / √ / √ / √ / √ / √ / √ / √
Frederic LaRoche / Gevity / / √
Gay Dolin / IMO / / √
Howard Strasberg / Wolter Kluwer / / √ / √ / √
Igor Gesdos / Roche / / √ / √ / √
Jason A. Walonoski / Mitre / / √ / √ / √
Jeff Brown / ASCO / / √
Johnathan Coleman / ONC/SRS / / √
Julia Skapik / ONC / / √ / √ / √ / √ / √ / √ / √ / √
Karsten Fehre / Medextes / / √ / √
Kenneth Salyards / SAMHSA / / √ / √ / √
Lloyd McKenzie / Gevity / / √
Mark Shafarman / Shafarman Consulting / / √
Michael vander Zel / UMCG / m.van.der.zel@umcg / √ / √ / √
Pamela Scicluna / Health Connex / / √
Richard Dixon Hughes / DH4 Pty Ltd / / √
Richard Esmond / Pen Rad / / √ / √ / √ / √ / √
Robert Jenders / UCLA / / √ / √ / √ / √
Rob Mulders / Furone / / √
Sarah Gaunt / Lantana Consulting Group / / √ / √
Tessa van Stijn / NICTIZ / / √ / √ / √
Thomson Kuhn / ACP / / √ / √ / √
Walter G. Suarez / Kaiser Permanente / / √ / √ / √ / √ / √ / √ / √ / √ / √
Time: Monday Q4
Facilitator / Floyd Eisenberg / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / No
Agenda Topics:
1) Welcome and Introductions
2) Review Agenda and Logistics for the CQI Week WGM
3) Review SWOT
Supporting Documents:
1) Previous SWOT
CQI Week Agenda:
n Confirmed overall agenda, locations
n Additions (topics):
o Discussion of next steps with HQMF
o Discussion of next steps with QRDA (normative ballot; extension of current DSTU status)
o Need for possible new PSSs (FHIR profiles, QUICK, other)
n Modifications
o Based on availability of project facilitators, CQI will meet by itself on Thursday, Q1 (room to be confirmed), and then meet jointly with CDS and FHIR Thursday Q2.
Minutes/Conclusions Reached:
The group did not reach quorum so the small group recommended edits to the Agenda and SWOT for consideration during the Tuesday sessions.
Business Session:
The group did not reach quorum so the small group recommended edits to the Agenda and SWOT for consideration during the Tuesday sessions.
Time: Tuesday Q3Facilitator / Walter Suarez / Scribe / Julia Skapik (Acting)
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes
Agenda Topics:
1) Welcome and Introductions
2) Appointment of Acting Co-Chair
3) Review/reconfirm CQI agenda for the week
4) Review SWOT, per revisions from Monday Q4
5) Review 3-year Plan
6) Overview of CQI WG
7) Quality Measurement Perspectives from the US
Supporting Documents:
n SWOT, as revised on Monday Q4
n 3-year Plan
n Presentation from Julia Skapik on Quality Measurement Perspectives from US
Business Session - Minutes/Conclusions Reached:
1. Motion was made by David Sundaram-Stukel, Epic, to nominate and appoint Julia Skapik as acting co-chair for the week; the motion was seconded by Ken Salyards, SAMHSA. No further nominations. No further discussion. Motions unanimously approved by all 9 participants. No abstentions. No negatives.
2. Quorum was established
3. SWOT: The group reviewed the revisions made to the SWOT on Monday Q4. Additional updates/corrections were made. A motion was made by David to approve the SWOT as revised. Motion was seconded by Julia. No further discussion. Motion approved unanimously by all 9 participants. No abstentions. No negatives.
4. 3-year plan: The group then reviewed the 3-year plan and made a number of updates, including identification of completed projects, adjustments to the description and timelines of current projects, and addition of new projects. A motion was then made by David to approve the 3-year plan as revised. Motion was seconded by Craig. No further discussion. Motion approved unanimously by all 9 participants. No abstentions. No negatives.
CQI Overview and Quality Measurement Perspective Session (Part 1) - Minutes/Conclusions Reached:
5. Overview of CQI WG: Walter provided a brief overview of the CQI Workgroup, history, background, work products.
6. Quality Measurement Perspectives from US: Julia presented an overview of quality measurement in the US, current policy drivers, federal/national projects and initiatives, and standards activities
Time: Tuesday Q4Facilitator / Walter Suarez / Scribe / Julia Skapik (Acting)
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes
Agenda Topics:
1) International Perspectives on Quality Measurement
a. Netherlands
b. Australia
c. Germany
Supporting Documents:
n Presentations from countries discussing quality measurement activities
Minutes/Conclusions Reached:
n Presentations were heard and discussed on current national policies, programs, initiatives and standards on quality measurement from different countries
Time: Wednesday Q1 (Joint Meeting with SDWG, Hosted by CQI)Facilitator / Floyd Eisenberg / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes
Agenda Topics:
n Joint Meeting with Structure Documents WG
n Discussion of Issues Related to C-CDA Versions 1.1 and 2.0
n Discussion on future directions for HQMF, QRDA Cat III,
n Ballot reconciliation of FHIR on Quality Profile
Supporting Documents:
n QRDA Cat III PSS
n FHIR on Quality Profile Ballot Reconciliation Spreadsheet
Minutes/Conclusions Reached:
n Discussion of Issues Related to C-CDA versions 1.1. and 2.0
o An important set of issues has been uncovered after publication in the US of the proposed rules from ONC adopting standards and certification criteria for EHRs for 2015. Because of forward compatibility issues between the two versions, the proposed rule recommends that BOTH versions of the same document be generated every time there is a request.
o Three main issues have been identified, all interrelated:
§ The requirement of being able to sending both 1.1 and 2.0 C-CDA documents
§ For CQI, our QRDA standards allow the use of negation to indicate elements "not done" for known reasons and measures have used that capability. However, specifically for Encounters and for Devices, CDA does not allow negation.
§ Lack of LOINC codes (e.g., Vital Signs) between 1.1 and 2.0, prompting people to use SNOMED. The pattern being advocated for is to switch to LOINC. Community is proposing to unwind this, use translation codes and allow both SNOMED and LOINC.
o The CQI issue above had not surfaced before apparently as measures have not used negation for these items. Some measures in development do address negation for devices, thus prompting today’s discussion.
o The group discussed a potential solution, i.e., to allow an extension in CDA for specific use cases to add negation (i.e., for QRDA in this case).
o In addition, to address the compatibility issue, HL7 is also considering to move to C-CDA 2.1 via a 6-week rapid WIKI methodology to gain consensus on a solution
o The Structured Documents Workgroup will discuss and vote on this proposal on Thursday, May 21 during their regular call.
o CQI WG members are encouraged to join this important call.
n Discussion of Future Directions of HQMF, QRDA Cat III
o HQMF: The group discussed that before considering moving HQMF to Normative, it will be important to receive and review feedback from implementers regarding how are they currently using HQMF (with examples), what they find most useful about it, what they see needs to be improved or changes. It was agreed that CQI will not be moving HQMF to normative at this time, but rather develop a plan to seek input from implementers, as noted
o QRDA Cat III: CQI is planning to move QRDA Cat III to normative. But considering that the current DSTU status expires on November, 2015, there will not be enough time to complete the normative ballot. Thus, a motion was made by Walter to request an extension of the current QRDA Cat III DSTU status. The motion was seconded by David. No further discussion. Motion approved by 17 people, with 1 abstention.
n Ballot reconciliation of FHIR on Quality Profile
o Initial reconciliation of this ballot started
o Discussion focused on first three comments (Comments 1, 2, 3) from Floyd, requesting in-person resolution.
o Agreed to do a ‘block’ vote after the resolution of the three comments
o Comment #1:
§ Need to provide further definitions of QICore, QUICK
§ Resolution: Persuasive
o Comment #2:
§ Description of models seems to be directed to the in-crowd. Need to provide more background on technologies and models and/or glossary
§ Resolution: Persuasive
o Comment #3
§ With respect to “Goal”, the presentation is not clear. Goal has a source (the role that established the goal).
§ Resolution: Persuasive with Mod. Part of this comment should be addressed by the FHIR Core team. Will add/assign a FHIR tracker item for FHIR Core related items.
o Motion made by Walter to approve the resolution of comments #1, #2, #3. Motion seconded by David. No further discussion. Motion carries with 17 approval votes, no abstentions, no negatives.
Time: Wednesday Q2Facilitator / Walter Suarez / Scribe / Floyd Eisenberg
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes
Agenda Topics:
1) FHIR Quality Profile – continued discussion
2) CDA R2 Issue Identified that Impacts QRDA
3) Update from Co-Chair Dinner
Supporting Documents:
1) FHIR Quality Profile Excel Ballot Reconciliation Spreadsheet
Minutes/Conclusions Reached:
1) Continued discussion about managing goals based on FHIR Quality Profile comment: Continued discussion addressed adding milestone needs for workflow and clinical decision support. The discussion did not result in a vote on a specific comment, but it did result in a decision to continue to collaborate with the Patient Care Workgroup regarding care plan and goal definitions in FHIR profiles.
2) New CDA R2 issue identified that impacts QRDA (See additional notes above from Wednesday Q1 on this topic): Julia Skapik raised concerns addressed in the Structured Documents Workgroup earlier in the day. The issue is that QRDA allows negation for devices or encounters “not done” (i.e., a measure can indicate a device was not used/did not occur for a given set of reasons). When CDA R2 was initially developed, only some data classes included negation; devices and encounters did not. The issue has not surfaced before apparently as measures have not used negation for these items. Some measures in development do address negation for devices, thus prompting a discussion with the Structured Documents Workgroup. The group discussed a potential solution, i.e., to allow an extension in CDA for specific use cases to add negation (i.e., for QRDA in this case).
The CQI chairs will invite the CQI WG, via the listserve, to participate in a Structured Documents Workgroup call to discuss and vote on this proposal on Thursday, May 21 (during their regular call). For discussion on May 21, from the Structured Documents minutes:
"Negation Indicator –
Motion: Create errata, which indicates that any RIM based attribute in a class referenced in CDA R2.0, which was constrained from the RIM, should be allowed as an extension to the base CDA R2.0 specification."
3) Floyd provided an update of information from the Co-Chair dinner:
a. New PSS-lite capability to get input from domain and TSC for new proposal ideas (maximum duration for a PSS-lite is 2 trimesters)
b. CQI WG received stars as a healthy workgroup
c. Workgroup health will affect TSC approval
d. PSS’ are due by Sunday 24 May for the October ballot – and all need to be complete (without comments/track changes on original PSS) before consideration.
Business Session: No additional discussion
Time: Wednesday Q3 (Joint Meeting with CDS, CQI hosting)Facilitator / Floyd Eisenberg / Scribe / Walter Suarez
Attendee / Name / Affiliation
Attendance sheet for this meeting is at the beginning of this document
Quorum Requirements Met: / Yes
Agenda Topics: