Clinical Quality Framework (CQF) Update cqframework.info Kensaku Kawamoto, MD, PhD, MHS Co-Initiative Coordinator, CQF Public Health Tiger Team August.

Clinical Quality Framework (CQF)

Update

cqframework.info

Kensaku Kawamoto, MD, PhD, MHSCo-Initiative Coordinator, CQF

Public Health Tiger TeamAugust 6, 2014

4pm-5pm ET

http://wiki.siframework.org/Clinical+Quality+Framework+Initiative

CQF Objective and Scope

CQF Wiki: cqframework.info 2

• Objective:– Develop and validate harmonized standards for clinical decision

support (CDS) and electronic clinical quality measurement (eCQM)• Scope:

– Common “component” standards for metadata, data model, and logical expressions

– Updates to CDS and eCQM standards using common components• Service-based CDS guidance• Service-based eCQM evaluation• CDS knowledge specification (CDS Knowledge Artifact Specification) –

for rules, order sets, and documentation templates• eCQM knowledge specification (HQMF)

– Pilots and iterative enhancement

Status Update

• Two specifications are under HL7 ballot for comment for September– Common logical model

• QUICK – Quality Improvement and Clinical Knowledge model

– Common expression language• CQL – Clinical Quality Language

• Pilots starting this month using these specifications• Ongoing alignment efforts with other relevant initiatives, in particular

S&I Data Access Framework (DAF) and Structured Data Capture (SDC) efforts

• Key decisions made to date:– Physical model = FHIR resources and profiles, + potentially CIMI

detailed clinical models– Logical model = QUICK, with deterministic transform to/from FHIR


Quality Improvement and Clinical Knowledge (QUICK) Logical Model

Claude Nanjo

Aziz Boxwala

Jason Matthews


What is QUICK

• A computable Fact model that represents patient-centric clinical concepts in an intuitive and semantically consistent manner suitable for CDS and CQM

• Harmonizes requirements captured by the Virtual Medical Record (vMR) and Quality Data Model (QDM) models

• Aims to minimize costs associated with the use of clinical data in today’s repositories– Goal: one-to-one bidirectional mapping with FHIR


Overview of QUICK Semantic Structure


Composition


Example Leaf-Level Concepts


Why not use FHIR directly?

• QUICK has hierarchies not present in FHIR (FHIR is a ‘flat’ model)– Allows re-use of processing logic on common classes or

attributes• QUICK aims for semantic consistency across concepts. FHIR

strives to represent clinical information as it is most commonly captured in today’s systems.

• QUICK avoids use of modifying attributes such as negation indicators– Facilitates “safe” use of the model for computation


Clinical Quality Language (CQL)

Bryn Rhodes

Chris Moesel

Mark Kramer


CQL Background

• Objective is to define an author-friendly and human-readable language to define quality measures and decision support rules– Quality Data Model (QDM) heritage

• Must be computable and implementable – Health eDecisions (HeD) heritage

• Functional requirements defined in “Harmonization of Health Quality Artifact Reasoning and Expression Logic”


Probably Sexually Active

Initial Population Definition

Condition, Occurrence Patient

FHIR Logic CCDA Logic

FHIR API CCDA Generator

EHR

Medication Treatment,

Ordered

Chlamydia Test Recommended

…

EHR

Custom EHR Logic …

Defined by Rule/Measure

authors using CQL

REST API e.g. SQL

Overview of CQL Conceptual Architecture

Integration with back-end data

stores

Concepts defined in Quality Logical Model (QUICK)

Intermediate inference

Mappings from quality logical model to underlying data

models

EHRCQF Wiki: cqframework.info 12

Simple Example


Population Criteria


Chlamydia Screening, CQM


Chlamydia Screening, CDS


Public Health Alignment

• CDS related to public health– Immunization forecasting– Identification of reportable conditions– Population health management– Others?

• eCQM related to public health– Quality measurement on public health topics (e.g., chlamydia

screening)– Others?


Questions

Name E-MailMarc Hadley, Co-Coordinator [email protected] Kawamoto, Co-Coordinator [email protected] Blake, Project Manager [email protected]

cqframework.info


mailto:[email protected]



http://wiki.siframework.org/Clinical+Quality+Framework+Initiative

Clinical Quality Framework (CQF) Update cqframework.info Kensaku Kawamoto, MD, PhD, MHS Co-Initiative Coordinator, CQF Public Health Tiger Team August.

Documents

use of clinical data

fhir fhir

clinical modelslogical

composition cqf wiki

clinical information

expression logic cqf

computationcqf wiki

scopecqf wiki