1. Clinical Quality Framework cqframework.info All Hands Meeting March 26, 2015 11am-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).

3. Agenda TopicPresenter WelcomeSarah Ryan, Co-Coordinator Ballot UpdateMarc Hadley, CQF Subject Matter Expert Mark Kramer, CQF Subject Matter Expert Pilot UpdateSarah Ryan, CQF Co-Coordinator American College of CardiologyRachel Davis, American College of Cardiology Next StepsKen Kawamoto, CQF Co-Coordinator Questions and DiscussionKen Kawamoto, CQF Co-Coordinator CQF Wiki: cqframework.info 3 CQF=Clinical Quality Framework

4. Welcome Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Cases, Project Charter, and General Information are posted on cqframework.infocqframework.info Clinical Quality Framework (CQF) All Hands meetings are held bi- weekly on Thursdays (starting on 2/12/15) from 11am to 12:30pm ET https://siframework1.webex.com/siframework1/onstage/g.php?t=a&d=666535029 Dial In: +1-650-479-3208 Access code: 666 535 029 CQF Quality Improvement and Clinical Knowledge (QUICK) Data Model meetings are held weekly on Wednesdays from 1 to 2pm ET https://meet.mitre.org/mkramer/DY1F9VCD Dial In: +1-770-657-9270 Participant passcode: 217663 CQF Clinical Quality Language (CQL) meetings are held weekly on Wednesdays from 11am to 12pm ET https://global.gotomeeting.com/meeting/join/554237525 Dial In: +1-770-657-9270 Participant passcode: 6870541 CQF Wiki: cqframework.info 4

5. Announcements The Quality Data Model-Based Health Quality Measure Format Implementation Guide (QDM-Based HQMF IG) R1.1 was published on February 12, 2015. The R1.1 publication updated the DSTU to align with the updates made in HQMF R2.1 and align it with the removals and additions of datatypes and operators made in QDM 4.1.1.

6. Welcome Standards CQF Wiki: cqframework.info 6 CQM-Specific Standards CDS-Specific Standards Common Metadata Standard Common Data Model Standard (Quality FHIR Profile, QUICK) Common Data Model Standard (Quality FHIR Profile, QUICK) Common Expression Logic Standard (CQL) CDS=Clinical Decision Support CIMI=Clinical Information Modeling Initiative CQL=Clinical Quality Language CQM=Clinical Quality Measurement DAF=Data Access Framework FHIR=Fast Healthcare Interoperability Resources QUICK=Quality Improvement and Clinical Knowledge SDC=Structured Data Capture

7. Welcome Notional Project Timeline 7 Kick-off (3/21) Pre-Discovery, Call for Participation May 2014Sep 2015 Discovery Initiative End Mar 2014Nov 2015Jul 2014 Implementation Pilot Charter, Use Cases, Functional Requirements Standards Development and Review Use Case Pilots Technology Evaluations Use Case Kick-off Use Case Consensus Pilot Kick-off Evaluation … Mar 2014: Pre-Discovery - Call for participation Apr-Jun 2014: Discovery - Charter, use case, and functional requirements development May 2014-Nov 2015: Implementation – Standards development and review Jun 2014-Nov 2015: Pilots Dec 2015: Evaluation DateMilestones Through August 2014 4/11/14Charter Finalization 4/18-4/30/14Initial Logical Model Development 4/25/14Use Case Selection 5/1/14Proposed Harmonized Logical Model Approach 6/30/14Pilot Planning Begins 7/3/14Use Case Finalized 7/30/14Narrow Slices of Draft Specifications Ready for Pilots 8/3/14Standards (Incorporating Initial Pilot Feedback) Submitted for HL7 Ballot 8/18/14Pilot Implementation Begins 8/8-9/8/14September 2014 HL7 Ballot Cycle *Comment-Only: QUICK Data Model *Comment-Only: CQL DateMilestones 9/14/14- 9/19/14 September 2014 HL7 Working Group Meeting *PSS: CQF-Based HQMF IG 12/31/14Phase 1 of Pilots Concludes 12/12/14- 1/12/15 January 2015 HL7 Ballot Cycle *DSTU: CQL *Comment-Only: CQF-Based HQMF IG *Comment-Only: Quality FHIR Profile 1/18/15- 1/23/15 January 2015 HL7 Working Group Meeting 4/4/15- 5/4/15 May 2015 HL7 Ballot Cycle *DSTU: CQL-Based HQMF IG *DSTU: Quality FHIR Profile *DSTU Update TBD: CDS KAS, DSS IG 5/4/15Phase 2 of Pilots Concludes 5/10/15- 5/15/15 May 2015 HL7 Working Group Meeting 8/31/15Phase 3 of Pilots Concludes CDS=Clinical Decision Support CQL=Clinical Quality Language DSS=Decision Support Service DSTU=Draft Standard for Trial Use FHIR=Fast Healthcare Interoperability Resources HQMF=Health Quality Measures Format IG=Implementation Guide KAS=Knowledge Artifact Specification QUICK=Quality Improvement and Clinical Knowledge

8. CQF Wiki: cqframework.info 8 Ballot Update StandardSubject Matter Expert CQF-Based HQMF Implementation Guide Marc Hadley Quality FHIR Profile Mark Kramer CQF=Clinical Quality Framework CQL=Clinical Quality Language FHIR=Fast Healthcare Interoperability Resources HQMF=Health Quality Measures Format IG=Implementation Guide

9. CQF Wiki: cqframework.info 9 Pilot Update Each pilot is meeting to review Phase I lessons learned and Phase II objectives Next featured Pilot: Breast Cancer Decision Support, April 9 th. Feedback received from pilots by the end of the May ballot period (5/4/15) can be addressed in the draft standards; after May, feedback would be included in a DSTU update PilotPOCWiki (under development) Cardiology Appropriateness of Use Rachel Davis http://wiki.siframework.org/Cardiology+Appropri ateness+of+Use Chlamydia Screening Johanna Goderre-Jones http://wiki.siframework.org/Chlamydia+Screenin g Immunization Decision Support Services Daryl Chertcoff http://wiki.siframework.org/Immunization+Decis ion+Support+Services Ischemic Heart Disease and Anti-Platelet Use Julie Scherer http://wiki.siframework.org/Ischemic+Heart+Dis ease+and+Anti-Platelet+Use Radiology Appropriateness of Use Tom Conti http://wiki.siframework.org/Radiology+Appropri ateness+of+Use Breast Cancer Decision Support Chad Armstrong http://wiki.siframework.org/Breast+Cancer+Deci sion+Support

10. Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease Dr. James Tcheng, American College of Cardiology– Pilot Lead, SME Dino Damalas, American College of Cardiology – IT Leadership Joe Allen, American College of Cardiology –SME Rachel Davis, American College of Cardiology – Informatics Support Ganesan Srinivasan –Technical Support Chris Moesel – Pilot SME Advisor

11. Agenda Completed Phase 1 Objectives CQL Translation Process Phase II Objectives

12. Completed Phase I Objectives Selected “No prior evaluation of CAD” to translate into HeD & CQL Understand AUC translation into HeD & CQL Created a strategic timeline to complete the translation

13. CQL Translation Process The AUC guidelines will be translated into –Health e Decisions (HeD): metadata / container –CQL: expression logical language The translated documents will allow our use case actors to utilize “No prior evaluation of CAD” in EMR systems

14. Phase II Objectives Identify / define value sets Represent AUC as a comprehensive Health eDecisions document w/ CQL logic Initiate discussion with EMR vendor to utilize CQL at point of care

15. Questions

16. Next Steps Engage in workgroups (www.cqframework.info)www.cqframework.info Pilots –Individual Pilot Leads, Sarah Ryan, or Bridget BlakeSarah RyanBridget Blake QUICK Data Model and Claude Nanjo –Claude Nanjo, Aziz BoxwalaClaude NanjoAziz Boxwala Clinical Quality Language –Bryn RhodesBryn Rhodes Join us for the next Clinical Quality Framework meeting on April 9th from 11am to 12:30pm ET, and bi-weekly thereafter CQF Wiki: cqframework.info 16

17. Questions and Discussion NameE-Mail Sarah Ryan, Co-Coordinatorsarahryan@mitre.org Ken Kawamoto, Co-Coordinatorkensaku.kawamoto@utah.edu Bridget Blake, Project Managerbridget@mitre.org cqframework.info CQF Wiki: cqframework.info 17