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FHIR Quality Measure Implementation Guide (Jira PSS-2513)

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Basics

FHIR Quality Measure Implementation Guide (Jira PSS-2513)

1499
Ballot - STU to Normative


FHIR Implementation Guide

Implementation Guide

Details

Updated Scope:

The purpose of this change is to move the IG from US Realm to Universal Realm

The Institute of Medicine (USA) (IOM) defines quality as: 'The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.' [1] For care quality to be evaluated, it must be standardized and communicated to the appropriate organizations. To that end, this Implementation Guide will be written to provide guidance for authoring Quality Measures (QMs) utilizing the following standards:

- Fast Health Interoperability Resources (FHIR) R4 Clinical Reasoning Module

- Clinical Quality Language (CQL)

- FHIRs QI-Core Implementation Guide - provided as examples without restricting the FHIR Quality Measure IG to any data model or any specific realm.

The requirements were established by experience and implementations of eCQMs using existing HL7 V3 standards:

- Health Quality Measure Format (HQMF) R1 Normative

- CQL-based HQMF STU 3

- Quality Data Model (QDM)-based HQMF DSTU 1.4

Original Scope:

The Institute of Medicine (IOM) defines quality as: 'The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.' [1] For care quality to be evaluated, it must be standardized and communicated to the appropriate organizations. To that end, this Implementation Guide will be written to provide guidance for authoring electronic Clinical Quality Measures (eCQMs) utilizing the following standards:

- Fast Health Interoperability Resources (FHIR) R4 Clinical Reasoning Module (with reference to FHIR R3 Clinical Reasoning to support existing implementations

- Clinical Quality Language (CQL)

- FHIRs QICore Implementation Guide STU 3.2 (based on FHIR 3.0 and US Core 3.0) - provided as examples without restricting the FHIR Quality Measure IG to any data model or any specific realm.

The requirements were established by experience and implementations of eCQMs using existing HL7 V3 standards:

- Health Quality Measure Format (HQMF) R1 Normative

- CQL-based HQMF STU 3

- Quality Data Model (QDM)-based HQMF DSTU 1.4


FHIR Clinical Reasoning provides infrastructure requirements for representing health quality measures through the Measure and Library resources. A quality measure is a quantitative tool to assess the performance of an individual or an organization’s performance in relation to a specified process or outcome via the measurement of an action, process, or outcome of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.


Through standardization of a measure’s structure, metadata, definitions, and logic, FHIR Clinical Reasoning ensures measure consistency and unambiguous interpretation. A health quality measure encoded in this format is referred to as an electronic clinical quality measure (eCQM). A new term, digital Quality Measure or dQM, is currently being defined across many interested parties. For the purposes of this IG, eCQM, Quality Measure (QM), and dQM are synonymous. Standardization of document structure (e.g., sections), metadata (e.g., author, verifier), and definitions (e.g., numerator, initial population) enable a wide range of measures currently existing in a variety of formats to achieve consistency. This formal representation of the clinical, financial, and administrative concepts and logic within a QM enable unambiguous interpretation and consistent reporting.

This implementation guide (IG) provides specific guidance to QM developers and implementers to assure consistency for applying CQL expressions using any data model, enhancing ability to share QM artifacts for direct implementation and calculation.



FHIR IG - New Release - STU - Target: Ballot Cycle 2025 January FHIR Connectathon Testing (initiated in several cycles starting with May 2016) - Target: May 2016 FHIR Connectathon and every FHIR Connectathon since then Digital Quality Summit 2017 and 2018 MiHIN Connectathon 2017 1st STU Ballot - Target: 2019 May Ballot Complete 1st STU Ballot Reconciliation - Target: 2019 May WGM Request 1st STU Publication - Target: 2019 Sep WGM 1st STU Period – 12 months - Target: 2019 Sep - 2020 Sep 2nd STU Ballot - Target: 2020 Sep Ballot Complete 2nd STU Ballot Reconciliation - Target: 2020 Sep WGM Request 2nd STU Publication - Target: 2021 Jan WGM 2nd STU Period - 12 months - Target: 2021 Jan - 2022 Jan Additional STU cycles as needed - Target: as needed Normative Ballot - Target: 2022 Jan Ballot Complete Normative Ballot Reconciliation - Target: 2022 May WGM Submit Publication Request Normative Version - Target: 2022 Sep WGM Receive ANSI Approval - Target: 2023 Jan WGM Project End Date (All objectives have been met) - Target: 2023 Jan WGM


https://build.fhir.org/ig/HL7/cqf-measures/ Updated PSS: https://jira.hl7.org/browse/PSS-2513 Original PSS: PSS at: https://confluence.hl7.org/display/CQIWC/FHIR+Quality+Measure+Implementation+Guide+PSS


FHIR CQL

Quality Reporting Agencies, Regulatory Agency, Standards Development Organizations (SDOs), Payors, Other (specify in Misc. Notes below),Local and State Departments of Health; Healthcare Institutions (hospitals, long term care, home care, mental health),EHR, PHR; Health Care IT; HIS

1) National Committee for Quality Assurance (USA) (NCQA), 2) Medisolv, 3) MITRE 4) WHO

The project will support existing efforts by health plans, eCQM developers and EHR implementers to express and process eCQMs using FHIR to measure clinical performance. National Committee for Quality Assurance (NCQA) has prototyped Healthcare Effectiveness Data and Information Set (HEDIS) measures as eCQMs using FHIR starting in 2018 and this IG will support standardization. US governmental agencies (e.g., Centers for Medicare and Medicaid Services (CMS)) are considering transitioning eCQMs from existing HQMF and CQL-based HQMF standards to FHIR. While CMS has not made a decision to move the process to FHIR and there is no established date for such a transition, the FHIR-based eCQM IG will support necessary testing to provide sufficient evidence to support any such future decisions.

What common name does your group use to refer to the product(s) produced? What alternative names, aliases and keywords does your group use to refer to the product(s) that will be produced? FHIR Quality Measure IG

Quality Measure IG v5.0.0 No prior FHIR eCQM IG, however, the IG is based on experience gained from implementation of: - HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), Release 1 (PI ID: 508) - HL7 Version 3 Implementation Guide: Quality Data Model (QDM)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 756) - HL7 Version 3 Implementation Guide: Clinical Quality Language (CQL)-based Health Quality Measure Format (HQMF), Release 1 - US Realm (PI ID: 1142) - HL7 FHIR® Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 (PI ID: 1234) (project generates FHIR Clinical Reasoning)



No

2025 Sep: TSC approved an STU Publication Request for HL7 FHIR® Implementation Guide: Quality Measures, Edition 1 for 2 years 2024 November: Updated PSS to move the IG from US Realm to Universal Realm 2024 October: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Quality Measures, Edition 1 STU 5 - US Realm for 2 years Stakeholders: Healthcare IT Vendors, Other, Payer/Third Party Administrator, Regulatory Agency Other Stakeholders: Local and State Departments of Health, Healthcare institutions, quality reporting agencies, quality measure development organizations, clincial professional societies. 2023 August: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2022 April: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2022 February: TSC Approved STU Publication Request for HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2020 Sept: TSC approved Informative Publication Request for HL7 FHIR Guidance: Quality Reporting, Release 1 - US Realm 2020 June: TSC approved STU Extension Request for QI-Core Implementation Guide: STU 3.2 (v3.2.0 for FHIR 3.0.1) for 2 years 2019 Nov: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Quality Measures, Release 1 STU1 for FHIR STU3 - US Realm for 24 months For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to? R4 and STU3 and R5 Other Stakeholders: Quality Measure Development Organizations, Clinical Professional Societies
Organization & Realm

Universal

People

Bryn Rhodes



Clinical Quality Information Work Group

Clinical Decision Support Work Group

Status & Dates

Active

STU - Reconcile

12/02/2022

09/01/2028

2028 Sept WGM/Ballot

09/01/2028

2028 Sept WGM/Ballot

2026 May Ballot Info: STU Ballot Results: Met basic vote requirements. 6 negatives to reconcile. Document Name: HL7 FHIR® Implementation Guide: Quality Measures, Edition 1 2025 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 1 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Edition 1 2024 May Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 2 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Edition 1- US Realm 2024 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 9 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Edition 1- US Realm 2023 Jan Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 1 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2021 May Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 2 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2020 May Ballot Cycle Info: INFORMATIVE Ballot results: Met basic vote requirements. 14 Negatives to reconcile Document Name: HL7 FHIR Guidance: Quality Reporting, Release 1- US Realm 2020 Feb Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 15 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm 2019 May Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 16 Negatives to reconcile Document Name: HL7 FHIR Implementation Guide: Quality Measures, Release 1- US Realm
Approvals

02/11/2019


Received


Received




FHIR Management Group -- Agreed -- (PSS-2521)
System Info

247866

PSS-2513

https://jira.hl7.org/browse/PSS-2513
View Ballot Items (with NIBs)



06/25/2026

Anne Wizauer
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