1. Quality Measurement – Clinical Decision Support Harmonization Proposal

2. Goal Leverage existing relevant work to establish modularized and harmonized standards that meet Quality-related business needs –Includes quality measurement and CDS Initial target timeframe: January 2014 ballot cycle –Work with TSC to extend ballot deadlines –Continue work past ballot submission

3. Proposed Approach Foundational Components Clinical data modelExpression/logicDocument structure VocabulariesTemplates and meta-data Foundational Components Clinical data modelExpression/logicDocument structure VocabulariesTemplates and meta-data Quality Measurement-Specific Components TBD, as needed Quality Measurement-Specific Components TBD, as needed CDS-Specific Components E.g., CDS usage context, such as CDS target = Spanish-speaking patient CDS-Specific Components E.g., CDS usage context, such as CDS target = Spanish-speaking patient Quality Measurement Standards HQMF R2.X Quality Measurement Standards HQMF R2.X CDS Standards CDS Knowledge Artifact IG, DSS IG CDS Standards CDS Knowledge Artifact IG, DSS IG

4. Proposed Approach – Details ObjectiveJan. 2014 Ballot Strategy (materials due in ~2 mo.) Long-Term Approach Harmonize clinical data model, templates, and terminology for quality measurement and CDS Modify vMR and templates as required to ensure encapsulation of QDM and QRDA semantics 1.Develop DMIM, templates, and “green” versions 2.Use FHIR and request enhancements Separate out and harmonize expression logic Separate out expression logic from HQMF Develop common expression logic approach if possible Develop common expression logic approach Harmonize document specifications and implementation guides Update existing specifications (HQMF, CDS KA IG, DSS IG ) to use common components Update existing specifications to use common components

5. PSSs and Specifications (Jan. 2014) vMR Logical Model update vMR XML IG update vMR Templates IG update Expression Logic DAM and IG for Quality Measurement & CDS HQMF R2.X update CDS Knowledge Artifact IG update Decision Support Service IG update Others updates as needed if QDM updated – QRDA Cat. I/III, C-CDA

6. EXPRESSION LOGIC

7. The Foundation Clinical Quality is a data-centric problem –Quality measurement seeks to measure clinical indicators –Clinical decision support seeks to identify established patterns and offer relevant guidance –Both these activities at their core involve set-based data processing –As such, they are most naturally and easily expressed in a data- language set-focused – deals with computation of sets of information (e.g. encounters, medications, lab results, etc.) expressive – express as naturally as possible the computation of those sets (e.g. composable, reusable, flexible) complete – provide mechanisms so that the computation can be arbitrarily complex (e.g. computational, interval, set operations)

8. Operations Set Operations –Retrieve, Filter, Union, Intersect, Extend, Project, Join Computational –Comparison, Logical, String Manipulation, Arithmetic, etc. Interval –During, Between, Overlaps, Meets, etc. Aggregate –Count, Min, Max, First, Last, N

9. HQMF Operations Data Criteria –Retrieve –Filter w/ specific operations and attributes Temporally Related Information –Semi-join w/ temporal conditions Excerpt –Aggregate Computation Outbound Relationship –Semi-join w/out temporal conditions Grouper –Union and Intersection Population Criteria –Logical Operations (AND/OR/NAND/NOR/XOR) Measure Observations –Computation

10. An Approach to Harmonization Define the logical set of operations –Described above Define each of the HQMF constructs in terms of those operations –such that an existing HQMF document becomes a syntactic short-hand for an equivalent underlying expression in terms of the foundational elements Note that the foundational elements are independent of any particular data model, but the syntactic short-hands need not be...

11. Data Criteria - Retrieval

12. Data Criteria – Value Filter

13. Data Criteria – Value Filter (cont)

14. Temporally Related Information

15. Excerpt

16. Outbound Relationship Same as temporally related information, but uses relationship definition as conditions instead of temporal operators

17. Grouper

18. Population Criteria

19. Measure Observation