Clinical Quality Framework cqframework.info All Hands Meeting March 24, am-12:30pm ET

2 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 TopicPresenter WelcomeSwapna Bhatia, Project Administrator Support ONC FHIR App ChallengeJulia Skapik, CQF ONC Lead CQF Implementation: PlexinaBasil Baluta, CEO, Plexina HL7 Ballot Review and FeedbackBryn Rhodes, CQF Subject Matter Expert Next StepsFloyd Eisenberg, CQF Co-Coordinator Questions and DiscussionFloyd Eisenberg, CQF Co-Coordinator 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 cqframework.info Clinical Quality Framework (CQF) All Hands meetings are held bi-weekly on Thursdays from 11am to 12:30pm ET Dial In: Access code: CQF Data Model meetings are held weekly on Wednesdays from 1 to 2pm ET NQM-8ENJ&rnd= NQM-8ENJ&rnd= Dial In: Participant passcode: CDS-on-FHIR/CQF Office Hours meetings are held weekly on Wednesdays from 11am to 12pm ET Dial In: Participant passcode: CQF Wiki: cqframework.info 4

5 ONC FHIR App Challenge Julia Skapik, ONC CQF Lead CQF Wiki: cqframework.info 9

ONC FHIR App Challenge cting-accelerating-fhir-app-ecosystem cting-accelerating-fhir-app-ecosystem Clinician-facing App challenge Patient-facing App challenge App Marketplace challenge

7 CQF Implementation: Plexina Basil Baluta, CEO, Plexina CQF Wiki: cqframework.info 9

Why Do I Need Plexina to Manage My Order Sets and Other Clinical Content? v2.4 March 24, 2016

Copyright Plexina Inc Who is Plexina? Clinical Knowledge Management Experts from concept, to implementation, and through effectiveness assessment. Focused on helping clinical enterprises manage transition, transformation, and optimization of clinical knowledge for EHR implementations using advanced tools make your physicians happy with responsive delivery, more well-designed content, that is usable for them help clinicians make better decisions, and perform to evidence and best-practices help reduce inappropriate care implement broad clinical improvement strategies quickly and with ease Interoperability collaborations at clients with many EHR vendors and sources of clinical knowledge Epic, Allscripts, Cerner, Orion, Meditech, BEC, Eventium, DynaMed Support Modeling and Terminology Standards including HL7 FHIR, LOINC, RxNORM, SNOMED CT, CPT and HSCPC, and others Plexina has been in production with its tools since 2005 Page 9

Copyright Plexina Inc Plexina focuses on tools for EHR Operations The majority of EHR operational costs are related to clinical knowledge standardization, transformation, content build out, deployment, and on-going maintenance performed by client. Page 10

Copyright Plexina Inc Clinical Knowledge Standardization Industry Sources Local Sources of K Legacy Workflow, & EHR Infrastructure Environment Sources Industry Sources of K Standardized, Localized K Functional in your EHR Clinical Knowledge Governance Localized Transformation & Curation Process

Copyright Plexina Inc Clinical Knowledge Governance Order Sets Rules Assessments Clinical Documentation Standard Terminologies Guidelines Order Sets Structured CDS Modeling Standards Industry Sources Standardized K Evidence Care Policies Best Practices Care Standards Service Capabilities Legacy Workflow & EHR Infrastructure Capabilities Enterprise Ontology Environment Sources Order Sets Rules Assessments Clinical Documentation Care Pathways EHR Out of the Box Capabilities NEW EHR Infrastructure and/or Capabilities Model Foundation K Localized Transformation & Curation Process Clinical Knowledge Governance

Copyright Plexina Inc Clinical Knowledge TRANSITION & CONSOLIDATION Scenario Industry Sources Environment Sources Industry Sources of K Localized Transformation & Curation Process Standardized, Localized K Functional in your NEW EHR Local Sources of K Legacy Workflow & EHR Infrastructure Capabilities EHR Out of the Box Capabilities Model Foundation K Local Sources of K Legacy Workflow & EHR Infrastructure Capabilities Local Sources of K Legacy Workflow & EHR Infrastructure Capabilities MODEL, MAP & COMPARE Clinical Knowledge Governance Largely Automated!

Copyright Plexina Inc Page 14 “Plexina enabled us to accelerate clinical content build & maintenance delivery by 50-70% AND produce 5-20 times the output.” – Dr. Joe Schneider, CMIO Baylor Scott & White Health August 2015 Plexina reduced the maintenance operation effort by 50%, and enabled over 1200 standardized order sets to be deployed across 14 hospitals in 12 months Plexina reduces the TCO of the EHR by supporting the organization and consultants with effective tools

Copyright Plexina Inc Implementation Lifecycle – Proven, Systematic, Productive Page 15 Clinical Content Builders (Clinical Analysts) All Clinicians in the Enterprise Clinical & Operational Subject Matter Experts IT & Operational Change Management Assess & Feedbac k Config & Deploy Review & QA Design & Edit Identify & Strategize Continuous Clinical Knowledge Improvement Clinical Knowledge Governance Clinical Effectiveness Openness & Feedback Managing Risk Education & Training Research & Development Clinical Audit

Copyright Plexina Inc Page 16 Clinical Content Builders (Clinical Analysts) All Clinicians in the Enterprise Clinical & Operational Subject Matter Experts IT & Operational Change Management Assess & Feedbac k Config & Deploy Review & QA Design & Edit Identify & Strategize Continuous Clinical Knowledge Improvement Clinical Knowledge Governance Clinical Effectiveness Openness & Feedback Managing Risk Education & Training Research & Development Clinical Audit Plexina unifies many silo solutions into one platform

Copyright Plexina Inc Plexina Supports Universal Clinical Content Development for the EHR Page 17 Assessments Plexina Platform Visit NotesResultsProblem ListsOrder Sets Structured DocumentationEvidenceCare PathwaysRules Resources Universal Clinical Modeling Schema Plexina Universal Clinical Model Framework Ambulatory Solutions Acute Solutions Evidence Sources Terminology & Documentation Standards (SNOMED CT, CCDA, RxNORM, LOINC, DiCOM, ICD-10, proprietary) Clinical Knowledge Modeling Standards (HL7 FHIR & CQF) Ne wW IP

Copyright Plexina Inc An Order Set in a pretty Common Format – Order Sentences Page 18

Copyright Plexina Inc Plexina will interoperate with CQF Page 19

Copyright Plexina Inc APPENDIX: The Plexina Solution (e.g. Order Set Build) A peek at managing order sets with the Plexina platform Page 20

Copyright Plexina Inc Plexina Clinical Content Design Studio: Order Set Builder Page 21

Copyright Plexina Inc Plexina Review Board: Realistic EHR Preview 132 Content emulates the target EHR environment Clinicians and Clinical Analysts can compare previous revisions, create review teams, and discuss any order item/element within the clinical content Full “config level” detail available if necessary EHR Preview used in cloud based Downtime Library to support practice in absence of EHR Downtime can be PDFs or interactive HTML with working drop downs, checkboxes, and other controls Page 22

Copyright Plexina Inc Implementing CDS Rules Complex rules and algorithms can easily be represented Page 23

Copyright Plexina Inc Continuum of Care Pathways can be Designed Collaboratively Use Plexina to co-ordinate care by combining Assessments, Order Sets, and other CDS assets into a Continuum of Care Pathway...big, or small Page 24

Copyright Plexina Inc Simplified Rules Editing Page 25 Plexina enables clinical analysts design rules with no proprietary system coding required

Copyright Plexina Inc Plexina Review Board: Interactive Review Summary 12 A concise review summary keeps clinicians informed Head reviewer sees outstanding discussions and can finalize the change instructions if any required. All reviewers see all comments of their peers All changes automatically captured and versioned Page 26

Copyright Plexina Inc Deployment Tools: Automated Compare across Environments/Versions Highlights differences in configurations of the Order Set/Clinical Documentation in the different environments. GREEN is new in the TEST environment RED is missing in the TEST environment PURPLE is something inside this section is not the same so you drill down Automates QA across environments during deployment Page 27

Copyright Plexina Inc Deployment Tools: Release/Deployment Status Reports Page 28

Copyright Plexina Inc Deployment Tools: Workflow Status Reports Page 29

Copyright Plexina Inc Deployment Tools: Workflow Status Reports by Department Page 30

Copyright Plexina Inc Contact Information Basil Baluta, CEO Page 31 Doris Bryan, Client Solutions

32 HL7 Ballot Review and Feedback Bryn Rhodes, CQF Subject Matter Expert CQF Wiki: cqframework.info 9

Ballots & Feedback Mechanism HL7 FHIR-based Clinical Quality Framework – – Includes both CDS and eCQM aspects HL7 Cross-Paradigm Specification: Neutral Mapping Notation, Release 1 – Alignment of CQL and FluentPath – Feedback – If HL7 member Join the ballot pool by 3/31 – If not HL7 member Provide comments here or by using HL7 ballot spreadsheet Swapna at

Subscribe to Clinical Quality Framework Please visit the “Join the Initiative” section of the CQF Wikipage to subscribe to our list serve and to receive more information about what’s going on with CQF: – oin+the+Initiative oin+the+Initiative 34

Next Steps Join the Initiative Engage in Workgroups ( Pilots – Co-Coordinator, Ken KawamotoKen Kawamoto – Co-Coordinator, Floyd EisenbergFloyd Eisenberg Standards Development – Subject Matter Expert, Bryn RhodesBryn Rhodes Join us for the upcoming Clinical Quality Framework All Hands meeting: 4/7/16 CQF Wiki: cqframework.info 35

Questions and Discussion Name Ken Kawamoto, Floyd Eisenberg, Swapna Bhatia, Program Initiative cqframework.info CQF Wiki: cqframework.info 36