The Standard

Keeping Us Together While Apart

During this time of global crisis, it’s worth remembering the critical importance of what we at HL7 are doing to improve global health by making health information more available and useful. While so many are struggling with social distancing, we already have a culture that long ago learned to work together remotely on our common goals. But now with fewer opportunities to meet together in person, we need to move ahead to finish much of the work we’ve been doing over the past few years – so we’re better prepared to work together even more effectively, while knowing we must be further apart geographically.

Seqster has developed a platform that allows patients and their caregivers to collect, visualize, manage and share all of their health data in one app. We aggregate clinical data points across providers chronologically using the industry-standard coding systems that the HL7 community knows all too well. 

A significant component of the HL7 ballot process involves reconciliation of negative ballots submitted, and, in the normative process, the recirculation ballot to make the consensus group aware of any negative ballots unresolved by reconciliation. 

Since the fall of 2017, electronic Clinical Quality Measures (eCQMs) logic has been written using Clinical Quality Language (CQL). With the introduction of CQL, the eCQMs included in the CMS federal programs had to be translated from Quality Data Model (QDM)-based expression logic to CQL.

Though CQL provides more flexibility in expressing measure criteria within the logic that allows measure developers to include greater specificity and precision within the measure requirements, this did not result in a direct translation process, as new attributes and timings were made available. What this means is that clinical workflow and input are perhaps more important because CQL is able to convey these nuances, whereas the QDM-based logic expressions were limited. CQL can also be used to develop Clinical Decision Support (CDS) rules and can reuse logic from measures in those CDS rules.

When composing measures using the CQL syntax, the QDM is still used in conjunction with CQL as the means to characterize required data elements within the measure logic. This conceptual model defines what type of clinical data is needed to satisfy the measure requirements. Therefore, the QDM is still very much a part of electronically specified measures, which is incorporated into the logic definitions written using CQL.

Health Level Seven (HL7^®) drives the standards upon which electronic Clinical Quality Measures (eCQMs) sit, so participation in these venues is crucial. The HL7 community already has a lot of technical input but lacks input from the clinical side – either from clinicians or clinical informaticists. There is a gap between the clinical intent of quality measures and the technical standard, but clinical informatics experts can help bridge this gap by contributing to the conversation and development of the HL7 standards and resources.

Measure development, as we know it, is changing. Quality improvement is important to keeping healthcare costs affordable and patients safe; however, it should not come as a huge burden to clinicians. Goals of electronic Clinical Quality Measures (eCQMs) include reducing the burden of manual abstraction and reporting for provider organizations, as well as fostering the goal of access to real-time data for bedside quality improvement and clinical decision support. We want to hit the “sweet spot” as depicted in this diagram:

WHY STANDARDS?