1. Clinical Quality Framework cqframework.info All Hands Meeting October 30, 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 Clinical Quality Language (CQL) Ballot SummaryBryn Rhodes, CQL Subject Matter Expert Quality Improvement and Clinical Knowledge (QUICK) Update Aziz Boxwala, CQF Subject Matter Expert Claude Nanjo, CQF Subject Matter Expert Pilot UpdatesSarah Ryan, CQF Co-Coordinator 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 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: 217663 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 4

5. Welcome Announcements Don’t Miss the Upcoming American Medical Informatics Association (AMIA) Panel Featuring CQFAMIA –S53: The Clinical Quality Framework Initiative: Harmonizing Clinical Decision Support and Clinical Quality Measurement Standards to Enable Interoperable Quality Improvement –Featuring Kate Goodrich (CMS), Marc Hadley (MITRE), Ken Kawamoto (University of Utah), Jacob Reider (ONC) –November 18, 2014 from 10:30 AM to 12:00 PM –Washington, DC – Washington Hilton The CQF Issue Tracker is now on the Pilots page of cqframework.info cqframework.info https://docs.google.com/spreadsheets/d/1WLMutJqLRGpbvSLr7 IT0eUq4CkE7c90kFsO0tXzo60U/edit#gid=0 CQF Wiki: cqframework.info 5

6. Welcome Standards CQF Wiki: cqframework.info 6 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

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: QUICK Data Model *DSTU: CQF-Based HQMF IG *DSTU: Quality FHIR Profile *DSTU Update TBD: CDS KAS, DSS IG 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 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. TaskPrimary OwnerDue Date QUICK and CQL Ballot ReconciliationStandards Sub- Team Leads 10/31/14 Notification of Intent to BallotStandards Sub- Team Lead 11/2/14 Initial Pilot SurveyPilot Leads11/7/14 Preliminary Pilot Evaluations (Phase 1)Pilot Leads11/21/14 Preliminary HL7 Ballot Packages SubmittedStandards Sub- Team Leads 12/7/14 Final Pilot Evaluations (Phase 1)CQF Pilot Leads12/31/14 Phase 1 of Pilots ConcludesCQF Pilot Leads12/31/14 Vote on HL7 Ballot Packages (Start 12/12/14)CQF Community1/12/14 CQF Wiki: cqframework.info 8 Welcome Detailed Near-Term CQF Timeline

9. Pilot Update Sarah Ryan, CQF Co-Coordinator Pilot Leads CQF Wiki: cqframework.info 9

10. Pilot Update CQF Wiki: cqframework.info 10 PilotPOCLiaison SMEWiki 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

11. Pilot Update CQF Issue Tracker The CQF Issue Tracker is on the Pilots page of cqframework.info cqframework.info –Please enter CQF-related questions or issues in the CQF Issue Tracker found at https://docs.google.com/spreadsheets/d/1WLMutJqLRGpbvSLr7IT0eUq 4CkE7c90kFsO0tXzo60U/edit#gid=0CQF Issue Tracker https://docs.google.com/spreadsheets/d/1WLMutJqLRGpbvSLr7IT0eUq 4CkE7c90kFsO0tXzo60U/edit#gid=0 –You will need a gmail account and access privileges –Please contact Sarah Ryan for accessSarah Ryan CQF Wiki: cqframework.info 11

12. Clinical Quality Language (CQL) Ballot Summary Bryn Rhodes, CQF Subject Matter Expert CQF Wiki: cqframework.info 12

13. CQL Ballot Summary Vote Summary VoteNumber Abstain67 (53%) Affirmative54 (42%) Negative5 (4%) Total126 91.5% Affirmative CQF Wiki: cqframework.info 113

14. CQL Ballot Summary Comment Summary Comment TypeNumber Neg-Mj39 Neg-Mi46 A-C9 A-Q34 A-S40 A-T14 Total Comments191 CQF Wiki: cqframework.info 14

15. CQL Ballot Summary 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 CQF Wiki: cqframework.info 15

16. CQL Ballot Summary Final Disposition Summary DispositionNumber Persuasive120 Persuasive with mod21 Not persuasive19 Not persuasive with mod5 Considered – No action required2 (Thank you!) Considered – Question Answered19 Considered for future use1 Not related3 Withdrawn1 CQF Wiki: cqframework.info 16

17. CQL Ballot Summary Change Summary TypeNumber Complete22 In Progress1 Not Started167 Withdrawn1 Major Change Areas: Syntax Changes – Complete ELM Changes – In Progress Specification Changes – Not Started CQF Wiki: cqframework.info 17

18. CQL Ballot Summary Syntax Changes Changed “let” to “define” Removed “during” from the retrieve expression Changed “as” to “called” in library definitions Changed “where” to “such that” in with/out clauses Quoted identifiers are now allowed for all identifiers Removed “define retrieve” Removed “u” prefix for quantity literals Changed “at least/most” to “or before/after” and “or less/more” Removed “started by” and “ended by” Added “foreach” and “define” clause to the query Now allow “ascending” and “descending” i/o just “asc”/”desc” Refined valueset definition syntax CQF Wiki: cqframework.info 18

19. CQL Ballot Summary Syntax Changes (examples) CQF Wiki: cqframework.info 19

20. CQL Ballot Summary Syntax Changes (example) CQF Wiki: cqframework.info 20

21. CQL Ballot Summary Syntax Changes (example) CQF Wiki: cqframework.info 21

22. CQL Ballot Summary Syntax Changes (example) CQF Wiki: cqframework.info 22

23. CQL Ballot Summary Next Steps Changes to the ELM structures –Mostly just changes to align with CQL, should be done in the next few days or so Changes to the specification –Update for changes to Syntax –Update for changes to ELM –Better documentation strategy for ELM –Function Reference –Advanced Topics Chapter –Clarifications –Typographical/Errata Corrections –Examples Sweep CQF Wiki: cqframework.info 23

24. Quality Improvement and Clinical Knowledge (QUICK) Update Aziz Boxwala, CQF Subject Matter Expert Claude Nanjo, CQF Subject Matter Expert CQF Wiki: cqframework.info 24

25. Next Steps 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 RhodesBryn Rhodes Join us for the next Clinical Quality Framework meeting on November 6 from 11am to 12:30pm ET CQF Wiki: cqframework.info 25

26. 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 26