Clinical Reasoning Update Connectathon 3 QDM QICore Test

Clinical Reasoning Update

Connectathon

3 QDM -> QI-Core • Test quality reporting submission using the FHIR Measure. Report resource for a focused set of program measures and based on the Cypress tooling • Support evaluation of CMS program measures in a FHIR environment using: • Translation of QDM-based CQL measures to FHIR-based CQL • Evaluation of QDM-based CQL measures through runtime transformation

4 CQF Measures • https: //github. com/cqframework/cqf-measures • Github repository housing an IG specifically for this track • Will contain 2 versions each of the following 3 measures: • Breast Cancer Screening (CMS 125 v 7) • Cervical Cancer Screening (CMS 124 v 7) • Colorectal Cancer Screening (CMS 130 v 7) • • Will use the May 2018 Value. Sets (not the addendum) One version is a FHIR packaging of the QDM-based measure The other is a FHIR-based version of the measure Test data for these is posted here: • https: //drive. google. com/open? id=1 lr. Bo. Pyj. COc. Bk. KA_-jhi. IDowiw. Df. FXftt

5 Participating Systems

Quality Measure Evaluation 1 CQL Engine 4 6 2 FHIR Data. Provide r 3 FHIR Server 1. CQL Engine evaluates the retrieve [Procedure: Colonoscopy] 2. FHIR Data. Provider transforms this to a FHIR url: [base]/Procedure? code=: in[valueset-url] 3. FHIR server returns all procedures satisfying the code condition 4. CQL Engine evaluates additional criteria to satisfy the query (status = 'active', performed ends. . . )

QDM Quality Measure Evaluation 1 CQL Engine 5 7 2 FHIR Data. Provide 4 r 3 FHIR Server 1. CQL Engine evaluates the retrieve ["Procedure, Performed": "Colonoscopy"] 2. FHIR Data. Provider transforms this to a FHIR url: [base]/Procedure? code=: in[valueset-url] 3. FHIR server returns all procedures satisfying the code condition 4. FHIR Data. Provider uses a Structure. Map to transform results to "QDM" objects 5. CQL Engine evaluates additional criteria to satisfy the query (relevant. Period ends. . . )

Notable Achievements • Calculation of QDM-based CMS Measures against FHIR source data • Calculation of FHIR-based CMS Measures • Used the Crucible testing engine to compare Measure. Report results from different systems • Successful submission of Da. Vinci Med. Rec event using $submit-data

Vendor Feedback – QDM->QI-Core Mapping • Colorectal Cancer Screening • FOBT where effective during Measurement Period • The QDM used author. Datetime, which QDM-to-QICore mapping says maps to Provenance • That mapping is right in general, but in this case, the author. Datetime in QDM was actually being used to approximate "specimen collection", but what the measure is really looking for is "specimen collection" • This means the QDM implementation will be inconsistent • some systems will implement as "when recorded", some as "when collected" • It also means the mapping can't be encoded in this case • Translations • Interventions - Difficult to know how this maps to FHIR resources • Had to map some codes/code systems such as Administrative Gender • Encounter Mapping • "Encounter, Performed". code should map to Encounter. type, not Encounter. class

Vendor Feedback – e. CQM Specifications • Measure CQL would be easier to read if terminology declarations were right-aligned: • In the human readable, the terminology section should just be a table with hyperlinked value set references

Vendor Feedback – QDM vs QI-Core • Feedback from Athena Health: • We're translating FHIR resources to QDM to support evaluating QDM-based measures. All of this would be much easier if we had FHIR-based measure and could just evaluate them directly. • Feedback from Dynamic. Health. IT: • Since we started with a working measure calculator our biggest challenge was converting the FHIR resources into native QDM data elements consumable by the measures.

1 2 FHIR Quality Reporting Breakout • What versions of FHIR/USCore/QICore would you expect quality reporting to be focused on? • • • STU 2 - 0 STU 3 - 7 R 4 - 0 • What roles • • • Providers/Patients/Hospitals Collectors/Aggregators/Reporters Reporting Sinks • Should the system support Measure. Report or Bulk. JSON • Whether you are required to share the evidence or the conclusion is independent of the format of the response • Should the approach be pull or push? • could be any of the above, depends on lots of factors including timeliness of results, business relationships, quality improvement objectives, etc. • Is there interest in a bridge approach? • Yes, so long as there is a drive towards a single stack • Use OAuth? • Yes • How do we specify programs? • How do we specify provider attribution?

Ballot • 14 Comments on CDS Resources • 2 Negative, 12 Affirmative • 2 Comments on CQI Resources • 2 Affirmative

R 4 STU Next Steps • Resolve and apply ballot comments • Apply QA changes for maturity goals: Resource Current FMM Target FMM Activity. Definition 2 3 Detected. Issue 1 2 Event. Definition 0 2 Guidance. Response 2 3 Library 2 3 Plan. Definition 2 3 Request. Group 2 3 Risk. Assessment 1 2 Measure 2 3 Measure. Report 2 3

Questions?