Clinical+Quality+Framework+Charter+and+Members

include component="page" wikiName="siframework" page="cqf header" =Challenge Statement= Clinical decision support (CDS) and electronic clinical quality measurement (eCQM) are closely related, share many common requirements, and are both in support of improving health care quality. However, the standards used for the electronic representation of CDS and eCQM have not been developed in consideration of each other, and use different approaches to patient data and computable expression logic.

|| · Quality Reporting Data Architecture (for physical model)   · Quality Data Model (for logical model)  ||  · Health Quality Measure Format (for physical model)   · Quality Data Model (for logical model)  ||  · Health Quality Measure Format  ||
 * || ** Quality Information ** || ** Computable Expression Logic ** || ** Metadata ** ||
 * ** Clinical Decision Support ** || · Virtual Medical Record (for both physical and logical models)  ||  · CDS Knowledge Artifact Implementation Guide  ||  · CDS Knowledge Artifact Implementation Guide   · Decision Support Service  ||
 * ** Electronic Clinical Quality Measurement (eCQM) **

It is currently difficult to share logic between eCQMs and CDS interventions. Adhering to different standards places an additional implementation burden on vendors and providers with homegrown systems. Burdens on vendors and providers include the following:
 * A CDS intervention author cannot easily re-use the work of an eCQM developer or vice versa.
 * An electronic health record (EHR) system that supports both CDS and eCQM will need to map its native data format to two different data standards and to implement computation capabilities for two different logic expression standards.

Harmonization of the CDS and eCQM standards is required to reduce implementation burdens, promote integration between these two domains, and facilitate care quality improvement. =Scope Statement= The scope of this initiative includes the following: 1) To identify, define, and harmonize electronic standards that promote integration between CDS and eCQM in the areas of: 2) To refactor existing CDS and eCQM standards to utilize the harmonized standards and, where possible, resolve current known limitations in these standards. 3) To the extent possible, to pilot the standards and refine them accordingly. 4) To engage the clinical quality community to optimize the rigor and usability of harmonized CDS and eCQM specifications, with the ultimate goal of improved patient outcomes. 5) To support the balloting and publication of the harmonized standards with the Health Level Seven International (HL7) standards development organization. 6) To discuss implications for current implementers. 7) To support emerging/leading edge approaches to eCQM and CDS, to the extent possible given available resources and priorities. 8) To support adoption of eCQMs across regulatory agencies.
 * Metadata: Identify common metadata across the two domains and harmonize the representation of that metadata.
 * Quality Information Data Model: Develop a common quality information data model that supports the requirements of both eCQM and CDS.
 * Logical Expression Language: Develop a common expression language that can be used to define both CDS and eCQM logical expressions.

All artifacts in the original scope of the base standards are in scope. For quality measures, this includes intermediate and clinical outcome measures as well as trending. Patient reported outcomes are also potentially included within scope.

Out-of-scope items will be identified by the Clinical Quality Framework initiative team during the discovery phase. =Value Statement=

Much of the standards harmonization work is already underway in HL7 work groups. The Clinical Quality Framework Standards and Interoperability (S&I) initiative will promote wider visibility into the standards under development and provide additional implementation-based feedback, leading to more robust specifications.

CDS and eCQM are complementary and essential components of clinical quality improvement (CQI). Harmonizing the electronic standards used for these two domains and developing a common Clinical Quality Framework will have a number of important benefits, including the following:
 * Reduced implementer burden with regard to time and cost.
 * Increased re-use of eCQM artifacts in CDS and vice versa.
 * Improved standards quality through the unification of community effort.

Community involvement in the harmonization of the eCQM and CDS standards gives participants the following:
 * The ability to accelerate the standards development process.
 * Early access to standards under development for internal prototyping, etc.

Furthermore, implementation-based feedback will enhance the quality of the standards that are developed. Ultimately, the work of the CQF initiative will facilitate the achievement of improved clinical quality and outcomes. =Target Outcomes= =Expected Deliverables= =Relevant Standards and Stakeholders=
 * Harmonized standards for representation of quality improvement (CDS and eMeasures) artifacts and for exchange of data related to quality improvement.
 * Alignment with Meaningful Use and other related regulations.
 * Unification of the existing CDS and eCQM standards communities.
 * Broader visibility into the harmonized standards being developed in HL7.
 * Incorporation of implementation-based feedback into CDS and eCQM standards development activities.
 * Project Charter
 * Use cases and functional requirements
 * List of relevant standards and stakeholders
 * Harmonized standards for the domain
 * CDS and eCQM standards refactored to use new harmonized standards
 * Implementation feedback report
 * Completion of pilots that demonstrate one or more use cases
 * Report on lessons learned and experience gained during pilots

Relevant Standards, Schemas, Formats, Terminologies, and Value Sets
– C-CDA (Consolidated Clinical Documentation Architecture) – CIMI (Clinical Information Modeling Initiative) – FHIM (Federal Health Information Model) – ebRIM/ebRS – HL7 Care Record – HL7 FHIR – HL7 HQMF – HL7 RIM – HL7 v2.5.1 – QDM (Quality Data Model) – QRDA (Quality Reporting Documentation Architecture) I, II, III – vMR (Virtual Medical Record) – TLS+SAML – TLS+OAuth2 – S/MIME – MU2 ModSpec RTM <span style="font-family: Arial,Helvetica,sans-serif;">– SOAP (IHE SOAP) <span style="font-family: Arial,Helvetica,sans-serif;">– RESTful (IHE mHealth) <span style="font-family: Arial,Helvetica,sans-serif;">– Direct <span style="font-family: Arial,Helvetica,sans-serif;">– HTTP <span style="font-family: Arial,Helvetica,sans-serif;">– SMTP <span style="font-family: Arial,Helvetica,sans-serif;">– ArdenML <span style="font-family: Arial,Helvetica,sans-serif;">– Arden Syntax <span style="font-family: Arial,Helvetica,sans-serif;">– AHRQ eRecommendations Format <span style="font-family: Arial,Helvetica,sans-serif;">– CDSC L3 <span style="font-family: Arial,Helvetica,sans-serif;">– CREF <span style="font-family: Arial,Helvetica,sans-serif;">– HQMF (Health Quality Measure Format) <span style="font-family: Arial,Helvetica,sans-serif;">– HL7 CDS Knowledge Artifact Specification <span style="font-family: Arial,Helvetica,sans-serif;">– GELLO <span style="font-family: Arial,Helvetica,sans-serif;">– GEM (Guideline Elements Model) <span style="font-family: Arial,Helvetica,sans-serif;">– IHE Sharing Value Sets <span style="font-family: Arial,Helvetica,sans-serif;">– SNOMED CT, LOINC, ICD, CPT, RxNorm, NDC, etc. <span style="font-family: Arial,Helvetica,sans-serif;">– Value Sets Used in eCQMs <span style="font-family: Arial,Helvetica,sans-serif;">– [|HL7][|Decision Support Service (DSS)] Specifications <span style="font-family: Arial,Helvetica,sans-serif;">– HL7 Context Aware Information Retrieval (InfoButton) <span style="font-family: Arial,Helvetica,sans-serif;">– HL7 Model Interchange Format <span style="font-family: Arial,Helvetica,sans-serif;">– IHE [|Care Management Profile] <span style="font-family: Arial,Helvetica,sans-serif;">– IHE Retrieve Clinical Knowledge Profile (Profile for InfoButton) <span style="font-family: Arial,Helvetica,sans-serif;">– IHE RFD (Retrieve Clinical Format for Data Capture) <span style="font-family: Arial,Helvetica,sans-serif;">– IHE RPE (Request for Procedure Execution) <span style="font-family: Arial,Helvetica,sans-serif;">– IHE [|Request for Clinical Guidance Profile] (an implementation of HL7 DSS)
 * <span style="font-family: Arial,Helvetica,sans-serif;">Data Model
 * <span style="font-family: Arial,Helvetica,sans-serif;">Security Layer
 * <span style="font-family: Arial,Helvetica,sans-serif;">Transport Layer
 * <span style="font-family: Arial,Helvetica,sans-serif;">Knowledge Representation
 * <span style="font-family: Arial,Helvetica,sans-serif;">Terminologies and Value Sets
 * <span style="font-family: Arial,Helvetica,sans-serif;">Other Relevant Standards

Relevant Stakeholders
<span style="font-family: Arial,Helvetica,sans-serif;">– Academic and Community Provider Organizations <span style="font-family: Arial,Helvetica,sans-serif;"> – Content Publishers <span style="font-family: Arial,Helvetica,sans-serif;"> – HIT Vendors <span style="font-family: Arial,Helvetica,sans-serif;"> – Medical Research Organizations <span style="font-family: Arial,Helvetica,sans-serif;"> – Medical Societies <span style="font-family: Arial,Helvetica,sans-serif;"> – Patients (PGHD – Patient Generated Health Data) <span style="font-family: Arial,Helvetica,sans-serif;"> – Pharmaceutical and Medical Device Companies <span style="font-family: Arial,Helvetica,sans-serif;"> – Public Health Agencies and other Government Agencies (CDC, NIH, NLM, FDA, etc.) <span style="font-family: Arial,Helvetica,sans-serif;"> – Standard Terminology Suppliers <span style="font-family: Arial,Helvetica,sans-serif;">– Clinical Decision Support Consortium <span style="font-family: Arial,Helvetica,sans-serif;"> – Content Publishers who offer CDS services <span style="font-family: Arial,Helvetica,sans-serif;"> – Content Implementers (i.e. consulting firms) <span style="font-family: Arial,Helvetica,sans-serif;"> – HIT Vendors <span style="font-family: Arial,Helvetica,sans-serif;"> – HIEs <span style="font-family: Arial,Helvetica,sans-serif;"> – HISPs (Health Information Service Providers) <span style="font-family: Arial,Helvetica,sans-serif;"> – OpenCDS <span style="font-family: Arial,Helvetica,sans-serif;"> – Providers implementing clinical content in an HIT system <span style="font-family: Arial,Helvetica,sans-serif;"> – Registries (e.g., professional association registries) <span style="font-family: Arial,Helvetica,sans-serif;">– Case Managers <span style="font-family: Arial,Helvetica,sans-serif;"> – Compliance, regulatory, and legal entities <span style="font-family: Arial,Helvetica,sans-serif;"> – Home Health Agencies <span style="font-family: Arial,Helvetica,sans-serif;"> – Patients <span style="font-family: Arial,Helvetica,sans-serif;"> – Payers and their agents involved in revenue cycle <span style="font-family: Arial,Helvetica,sans-serif;"> – Practitioners <span style="font-family: Arial,Helvetica,sans-serif;"> – Provider Organizations (including VA and DoD) <span style="font-family: Arial,Helvetica,sans-serif;"> – Public Health Agencies <span style="font-family: Arial,Helvetica,sans-serif;"> – Pharmacies and MTM Services <span style="font-family: Arial,Helvetica,sans-serif;"> – Social Security Administration (SSA) <span style="font-family: Arial,Helvetica,sans-serif;">– ASTM (American Society for Testing and Materials) <span style="font-family: Arial,Helvetica,sans-serif;"> – CDSC (Clinical Decision Support Consortium) <span style="font-family: Arial,Helvetica,sans-serif;"> – GLIDES (GuideLines Into DEcision Support) <span style="font-family: Arial,Helvetica,sans-serif;"> – HITSP (Health Information Technology Standards Panel) <span style="font-family: Arial,Helvetica,sans-serif;"> – HL7 (Health Level Seven International) <span style="font-family: Arial,Helvetica,sans-serif;"> – IHE (Integrating the Healthcare Enterprise) <span style="font-family: Arial,Helvetica,sans-serif;"> – NQF (National Quality Forum) <span style="font-family: Arial,Helvetica,sans-serif;"> – OMG (Object Management Group) <span style="font-family: Arial,Helvetica,sans-serif;">– AHRQ USHIK (Agency for Healthcare Research and Quality United States Health Information Knowledgebase) <span style="font-family: Arial,Helvetica,sans-serif;"> – AMA-convened Physician Consortium for Performance Improvement® (PCPI®) <span style="font-family: Arial,Helvetica,sans-serif;"> – ANA (American Nursing Association) NDNQI (Nursing Database Nursing Quality Indicators) <span style="font-family: Arial,Helvetica,sans-serif;"> – BTE (Bridges to Excellence) <span style="font-family: Arial,Helvetica,sans-serif;"> – CDC (Centers for Disease Control and Prevention) <span style="font-family: Arial,Helvetica,sans-serif;"> – CMS Hospital Inpatient Quality Reporting System <span style="font-family: Arial,Helvetica,sans-serif;"> – CMS Hospital Outpatient Quality Reporting System <span style="font-family: Arial,Helvetica,sans-serif;"> – CMS/PQRS (Center for Medicare and Medicaid Services, Physician Quality Reporting System) <span style="font-family: Arial,Helvetica,sans-serif;"> – NCQA (National Committee for Quality Assurance) <span style="font-family: Arial,Helvetica,sans-serif;"> – NQF (National Quality Forum) – OFMQ (Oklahoma Foundation for Medical Quality) <span style="font-family: Arial,Helvetica,sans-serif;">– QOPI (Quality Oncology Practice Initiative) <span style="font-family: Arial,Helvetica,sans-serif;"> – The Joint Commission =Potential Risks= 1.Given the aggressive timeline, a schedule delay in one item may have significant downstream scope and schedule impact.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Content and Guideline Creators (such as but not limited to):
 * <span style="font-family: Arial,Helvetica,sans-serif;">Content Integrators (such as but not limited to):
 * <span style="font-family: Arial,Helvetica,sans-serif;">Content Users (such as but not limited to):
 * <span style="font-family: Arial,Helvetica,sans-serif;">Standards and Schema Development Agencies (such as but not limited to):
 * <span style="font-family: Arial,Helvetica,sans-serif;">Quality Measurement Entities (such as but not limited to):
 * Mitigation/Response: Prioritize activities and leverage community expertise.

2.Additional review and implementation-based feedback may introduce delays into the development of harmonized standards.
 * Mitigation/Response: Review and implementation feedback are critical to the quality of standards; the benefits outweigh the risk.

3.Implementation and piloting of non-final standards may result in “throwaway” work.
 * Mitigation/Response: Implementation feedback is critical to the quality of standards; the benefits outweigh the risk.

4.Vendors’ focus on Meaningful Use activities may impact their ability to participate in pilots.
 * Mitigation/Response: Focus on items already in EHR certification criteria (at least proposed), actively engage with vendors, and make tools and resources (e.g., an open-source environment) available to them to make participation easier and beneficial.

Additional risks and mitigations may be identified during discovery phase. =Members= media type="custom" key="25524570" =Timeline= Mar 2014: **Pre-Discovery** - Call for participation Apr 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**

=Review=  media type="custom" key="25493790"

 =Consensus= media type="custom" key="25599814"

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