1. Clinical Quality Framework cqframework.info All Hands Meeting September 25, 2014 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 WelcomeBridget Blake, CQF Project Manager Prioritization of Concrete/Leaf Clinical Statement Types Aziz Boxwala, CQF Subject Matter Expert HL7 UpdateKen Kawamoto, CQF Co-Coordinator HL7 Update: Clinical Quality Language (CQL)Bryn Rhodes, CQF Subject Matter Expert HL7 Update: Quality Improvement and Clinical Knowledge (QUICK) Data Model Aziz Boxwala, CQF Subject Matter Expert Claude Nanjo, CQF Subject Matter Expert Pilot UpdateBridget Blake, CQF Project Manager Pilot Leads Next StepsBridget Blake, CQF Project Manager Questions and DiscussionBridget Blake, CQF Project Manager CQF Wiki: cqframework.info 3

4. Welcome Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Cases, Project Charter, and General Information are posted on cqframework.infocqframework.info Input requested on Quality Improvement and Clinical Knowledge (QUICK) data model concrete/leaf clinical statement types: https://docs.google.com/spreadsheets/d/1QiiNdtTeD17vbEQn9bzXL MaBY1A30c6FEyt-qsIB0cw/edit?usp=sharing https://docs.google.com/spreadsheets/d/1QiiNdtTeD17vbEQn9bzXL MaBY1A30c6FEyt-qsIB0cw/edit?usp=sharing Place feedback in spreadsheet or contact aziz.boxwala@meliorix.com by September 22, 2014 aziz.boxwala@meliorix.com QIDAM pre-publication draft is ready for review Cypress 2.5 was released on September 25, 2014 http://projectcypress.org CQF Wiki: cqframework.info 4 QIDAM=Quality Improvement Domain Analysis Model

5. Welcome Clinical Quality Framework (CQF) All Hands meetings are held weekly on Thursdays 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 QUICK Data Model meetings are held weekly on Wednesdays from 1 to 2pm ET http://fuze.me/24308131 Dial In: +1-770-657-9270 Participant passcode: 6870541 CQF Clinical Quality Language 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 5

6. Welcome Notional Project Timeline 6 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: QUICK Data Model *DSTU: CQL *Comment-Only: CQF-Based HQMF IG *Comment-Only: QUICK FHIR Profile *Comment-Only: CDS KAS 1/18/15- 1/23/15 January 2015 HL7 Working Group Meeting 4/4/15- 5/4/15 May 2015 HL7 Ballot Cycle *DSTU: CQF-Based HQMF IG *DSTU: QUICK FHIR Profile *DSTU: CDS KAS 5/10/15- 5/15/15 May 2015 HL7 Working Group Meeting 8/31/15Phase 2 of Pilots Concludes CDS=Clinical Decision Support CQL=Clinical Quality Language 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

7. Welcome Standards CQF Wiki: cqframework.info 7 CQM-Specific Standards CDS-Specific Standards Common Metadata Standard Common Data Model Standard (QUICK) Common Data Model Standard (QUICK) Common Expression Logic Standard (CQL) CDS=Clinical Decision Support CQL=Clinical Quality Language CQM=Clinical Quality Measurement QUICK=Quality Improvement and Clinical Knowledge Reconciling ballot comments

8. Prioritization of Concrete/Leaf Clinical Statement Types Aziz Boxwala, CQF Subject Matter Expert CQF Wiki: cqframework.info 8

9. HL7 Update Ken Kawamoto, CQF Co-Coordinator CQF Wiki: cqframework.info 9

10. HL7 Update: Clinical Quality Language (CQL) Bryn Rhodes, CQF Subject Matter Expert CQF Wiki: cqframework.info 11

11. HL7 Update: CQL CQL Ballot Summary CQF Wiki: cqframework.info 11 Vote Summary 91.5% Affirmative

12. HL7 Update: CQL CQL Ballot Summary CQF Wiki: cqframework.info 12 Comment Summary Neg-Mj: Negative Vote with Reason - Major Neg-Mi: Negative Vote with Reason- Minor A-C: Affirm Vote with Comment A-Q: Affirm Vote with Question A-S: Affirmative Vote with Comment -Suggestion A-T: Affirm Vote with Comment - Typo

13. HL7 Update: CQL CQL Ballot Summary CQF Wiki: cqframework.info 13 Major Comment Categories –Audience General concerns over the intended audience of the various sections –Clarity Suggestions and requests for clarification –Data Model Concerns about the relative coupling of CQL/QUICK –Syntax Comments about complexity and/or expressivity of the syntax –Timing Comments relating to temporal comparisons and support –Examples Requests for more or better examples –Questions/Comments/Errata

14. HL7 Update: CQL CQL Ballot Summary CQF Wiki: cqframework.info 14 Disposition Summary

15. HL7 Update: CQL CQL Ballot Summary CQF Wiki: cqframework.info 15 Reconciliation Summary

16. HL7 Update: Quality Improvement and Clinical Knowledge (QUICK) Aziz Boxwala, CQF Subject Matter Expert Claude Nanjo, CQF Subject Matter Expert CQF Wiki: cqframework.info 16

17. HL7 Update: QUICK QUICK Ballot Summary CQF Wiki: cqframework.info 17 Vote Distribution AffirmativeNegativeAbstainNV Affiliate06185 Consultant631112 Government/Non-Profit1225 Payor0001 Pharmaceutical1022 Provider342207 Vendor18757 Totals60205839 % of Votes33.90%11.30%32.77%22.03% Quorum77.97% Approval0

18. HL7 Update: QUICK QUICK Ballot Summary CQF Wiki: cqframework.info 18 Comment Distribution Comment TypeCount A-C10 A-Q35 A-S64 A-T12 Neg-Mi53 Neg-Mj10 Not specified (assume A-C)30 Grand Total214 A-C: Affirm Vote with Comment A-Q: Affirm Vote with Question A-S: Affirmative Vote with Comment -Suggestion A-T: Affirm Vote with Comment - Typo Neg-Mj: Negative Vote with Reason - Major Neg-Mi: Negative Vote with Reason- Minor

19. HL7 Update: QUICK QUICK Ballot Summary CQF Wiki: cqframework.info 19 Comment Summary –Relationship to other standards FHIR v3 –Model scope Statements about entities other than patients (e.g., nurse staffing ratios) –Model design and naming issues –Clarification Occurrence versus unknown occurrence versus non-occurrence Act versus observable (particularly with results) –Better documentation –Typos

20. HL7 Update: QUICK QUICK Ballot Summary CQF Wiki: cqframework.info 20 Plan –Have tentative ballot resolutions completed this week –Work with commenters over the next week –Aim for votes/block-votes in second half of October

21. Pilot Update Bridget Blake, CQF Project Manager Pilot Leads CQF Wiki: cqframework.info 21

22. Pilot Update CQF Wiki: cqframework.info 22 Pilot leads are finalizing pilot summaries Pilot leads will work with designated subject matter experts to engage the pilot teams and move the pilot forward Pilot discussions will be part of each week’s All Hands meeting; pilot teams can provide updates and get community input during All Hands meetings Pilots can share information regarding individual pilot meetings and progress via the cqframework.info pilot pagescqframework.info Initial pilot feedback will be provided to the QUICK and CQL teams by early December 2014, in preparation for the QUICK and CQL DSTU ballots

23. Pilot Update CQF Wiki: cqframework.info 23 PilotPOCLiaison SMEWiki (under development) Cardiology Appropriateness of Use Jimmy TchengAziz Boxwala http://wiki.siframework.org/Cardiology+Appropri ateness+of+Use Chlamydia Screening Johanna Goderre-JonesBryn Rhodes http://wiki.siframework.org/Chlamydia+Screenin g Immunization Decision Support Services Daryl ChertcoffClaude Nanjo http://wiki.siframework.org/Immunization+Decis ion+Support+Services Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Julie SchererClaude Nanjo http://wiki.siframework.org/Ischemic+Heart+Dis ease+and+Anti-Platelet+Use Radiology Appropriateness of Use Tom ContiBryn Rhodes http://wiki.siframework.org/Radiology+Appropri ateness+of+Use Venous Thromboembolism Prophylaxis TBDAziz Boxwala http://wiki.siframework.org/Venous+Thromboe mbolism+%28VTE%29+Prophylaxis

24. Next Steps Review QUICK data model concrete/leaf clinical statement types https://docs.google.com/spreadsheets/d/1QiiNdtTeD17vbEQn9bzXLMaBY1A30c6FEyt- qsIB0cw/edit?usp=sharing Review the QIDAM pre-publication draft Engage in workgroups (www.cqframework.info)www.cqframework.info Pilots Pilots Sub-Team Lead Peggy TsaiPeggy Tsai Individual Pilot Leads or Bridget BlakeBridget Blake QUICK Data Model Claude Nanjo, Aziz BoxwalaClaude NanjoAziz Boxwala Clinical Quality Language Bryn Rhodes Join us for the next Clinical Quality Framework meeting on October 2 from 11am to 12:30pm ET CQF Wiki: cqframework.info 24

25. Questions and Discussion NameE-Mail Marc Hadley, Co-Coordinatormhadley@mitre.org Ken Kawamoto, Co-Coordinatorkensaku.kawamoto@utah.edu Bridget Blake, Project Managerbridget@mitre.org cqframework.info CQF Wiki: cqframework.info 25