Clinical Quality Framework (CQF) Update cqframework.info Kensaku Kawamoto, MD, PhD, MHS Co-Initiative Coordinator, CQF Public Health Tiger Team August 6, pm-5pm ET

CQF Objective and Scope CQF Wiki: cqframework.info 2 Objective: –Develop and validate harmonized standards for clinical decision support (CDS) and electronic clinical quality measurement (eCQM) Scope: –Common “component” standards for metadata, data model, and logical expressions –Updates to CDS and eCQM standards using common components Service-based CDS guidance Service-based eCQM evaluation CDS knowledge specification (CDS Knowledge Artifact Specification) – for rules, order sets, and documentation templates eCQM knowledge specification (HQMF) –Pilots and iterative enhancement

Status Update Two specifications are under HL7 ballot for comment for September –Common logical model QUICK – Quality Improvement and Clinical Knowledge model –Common expression language CQL – Clinical Quality Language Pilots starting this month using these specifications Ongoing alignment efforts with other relevant initiatives, in particular S&I Data Access Framework (DAF) and Structured Data Capture (SDC) efforts Key decisions made to date: –Physical model = FHIR resources and profiles, + potentially CIMI detailed clinical models –Logical model = QUICK, with deterministic transform to/from FHIR CQF Wiki: cqframework.info 3

Quality Improvement and Clinical Knowledge (QUICK) Logical Model Claude Nanjo Aziz Boxwala Jason Matthews CQF Wiki: cqframework.info 4

What is QUICK A computable Fact model that represents patient-centric clinical concepts in an intuitive and semantically consistent manner suitable for CDS and CQM Harmonizes requirements captured by the Virtual Medical Record (vMR) and Quality Data Model (QDM) models Aims to minimize costs associated with the use of clinical data in today’s repositories –Goal: one-to-one bidirectional mapping with FHIR CQF Wiki: cqframework.info 5

Overview of QUICK Semantic Structure CQF Wiki: cqframework.info 6

Composition CQF Wiki: cqframework.info 7

Example Leaf-Level Concepts CQF Wiki: cqframework.info 8

Why not use FHIR directly? QUICK has hierarchies not present in FHIR (FHIR is a ‘flat’ model) –Allows re-use of processing logic on common classes or attributes QUICK aims for semantic consistency across concepts. FHIR strives to represent clinical information as it is most commonly captured in today’s systems. QUICK avoids use of modifying attributes such as negation indicators –Facilitates “safe” use of the model for computation CQF Wiki: cqframework.info 9

Clinical Quality Language (CQL) Bryn Rhodes Chris Moesel Mark Kramer CQF Wiki: cqframework.info 10

CQL Background Objective is to define an author-friendly and human-readable language to define quality measures and decision support rules –Quality Data Model (QDM) heritage Must be computable and implementable –Health eDecisions (HeD) heritage Functional requirements defined in “Harmonization of Health Quality Artifact Reasoning and Expression Logic” CQF Wiki: cqframework.info 11

Probably Sexually Active Initial Population Definition Condition, Occurrence Patient FHIR Logic CCDA Logic FHIR API CCDA Generator EHR Medication Treatment, Ordered Chlamydia Test Recommended … EHR Custom EHR Logic … Defined by Rule/Measure authors using CQL REST API e.g. SQL Overview of CQL Conceptual Architecture Integration with back- end data stores Concepts defined in Quality Logical Model (QUICK) Intermediate inference Mappings from quality logical model to underlying data models EHR CQF Wiki: cqframework.info 12

Simple Example CQF Wiki: cqframework.info 13

Population Criteria CQF Wiki: cqframework.info 14

Chlamydia Screening, CQM CQF Wiki: cqframework.info 15

Chlamydia Screening, CDS CQF Wiki: cqframework.info 16

Public Health Alignment CDS related to public health –Immunization forecasting –Identification of reportable conditions –Population health management –Others? eCQM related to public health –Quality measurement on public health topics (e.g., chlamydia screening) –Others? CQF Wiki: cqframework.info 17

Questions Name Marc Hadley, Ken Kawamoto, Bridget Blake, Project cqframework.info CQF Wiki: cqframework.info 18