Clinical Reasoning Update Connectathon 19 HL7 WGM Baltimore, MD September 29-30, 2018

Connectathon

QDM -> QI-Core Test quality reporting submission using the FHIR MeasureReport resource for a focused set of program measures and based on the Cypress tooling Support evaluation of CMS program measures in a FHIR environment using: Translation of QDM-based CQL measures to FHIR-based CQL Evaluation of QDM-based CQL measures through runtime transformation

CQF Measures https://github.com/cqframework/cqf-measures Github repository housing an IG specifically for this track Will contain 2 versions each of the following 3 measures: Breast Cancer Screening (CMS125v7) Cervical Cancer Screening (CMS124v7) Colorectal Cancer Screening (CMS130v7) Will use the May2018 ValueSets (not the addendum) One version is a FHIR packaging of the QDM-based measure The other is a FHIR-based version of the measure Test data for these is posted here: https://drive.google.com/open?id=1lrBoPyjCOcBkKA_-jhiIDowiwDfFXftt

Participating Systems

Quality Measure Evaluation CQL Engine FHIR Server 1 2 3 FHIR DataProvider 4 CQL Engine evaluates the retrieve [Procedure: Colonoscopy] FHIR DataProvider transforms this to a FHIR url: [base]/Procedure?code=:in[valueset-url] FHIR server returns all procedures satisfying the code condition CQL Engine evaluates additional criteria to satisfy the query (status = 'active', performed ends...)

QDM Quality Measure Evaluation CQL Engine FHIR Server 1 2 3 FHIR DataProvider 5 4 CQL Engine evaluates the retrieve ["Procedure, Performed": "Colonoscopy"] FHIR DataProvider transforms this to a FHIR url: [base]/Procedure?code=:in[valueset-url] FHIR server returns all procedures satisfying the code condition FHIR DataProvider uses a StructureMap to transform results to "QDM" objects CQL Engine evaluates additional criteria to satisfy the query (relevantPeriod ends...)

Notable Achievements Calculation of QDM-based CMS Measures against FHIR source data Calculation of FHIR-based CMS Measures Used the Crucible testing engine to compare MeasureReport results from different systems Successful submission of DaVinci MedRec event using $submit-data

Vendor Feedback – QDM->QI-Core Mapping Colorectal Cancer Screening FOBT where effective during Measurement Period The QDM used authorDatetime, which QDM-to-QICore mapping says maps to Provenance That mapping is right in general, but in this case, the authorDatetime in QDM was actually being used to approximate "specimen collection", but what the measure is really looking for is "specimen collection" This means the QDM implementation will be inconsistent some systems will implement as "when recorded", some as "when collected" It also means the mapping can't be encoded in this case Translations Interventions - Difficult to know how this maps to FHIR resources Had to map some codes/code systems such as Administrative Gender Encounter Mapping "Encounter, Performed".code should map to Encounter.type, not Encounter.class

Vendor Feedback – eCQM Specifications Measure CQL would be easier to read if terminology declarations were right-aligned: In the human readable, the terminology section should just be a table with hyperlinked value set references

Vendor Feedback – QDM vs QI-Core Feedback from Athena Health: We're translating FHIR resources to QDM to support evaluating QDM-based measures. All of this would be much easier if we had FHIR-based measure and could just evaluate them directly. Feedback from DynamicHealthIT: Since we started with a working measure calculator our biggest challenge was converting the FHIR resources into native QDM data elements consumable by the measures.

FHIR Quality Reporting Breakout What versions of FHIR/USCore/QICore would you expect quality reporting to be focused on? STU2 - 0 STU3 - 7 R4 - 0 What roles Providers/Patients/Hospitals Collectors/Aggregators/Reporters Reporting Sinks Should the system support MeasureReport or BulkJSON Whether you are required to share the evidence or the conclusion is independent of the format of the response Should the approach be pull or push? could be any of the above, depends on lots of factors including timeliness of results, business relationships, quality improvement objectives, etc. Is there interest in a bridge approach? Yes, so long as there is a drive towards a single stack Use OAuth? Yes How do we specify programs? How do we specify provider attribution?

Ballot and R4 Next Steps

Ballot 14 Comments on CDS Resources 2 Comments on CQI Resources 2 Negative, 12 Affirmative 2 Comments on CQI Resources 2 Affirmative

R4 STU Next Steps Resolve and apply ballot comments Apply QA changes for maturity goals: Resource Current FMM Target FMM ActivityDefinition 2 3 DetectedIssue 1 EventDefinition GuidanceResponse Library PlanDefinition RequestGroup RiskAssessment Measure MeasureReport

Timeline http://wiki.hl7.org/index.php?title=FHIR_Ballot_Prep#R4_Publication Key Dates: 2018-10-31: Final reconciliation package posted for STU ballot 2018-11-01: Final content freeze for R4 publication 2018-11-11: IG content freeze and QA period start 2018-11-25 – 2018-12-02: QA changes applied 2018-12-07 – 2018-12-21: Recirculation ballot Before 2018-12-31: R4 publication

Questions?