Health Level Seven®, International
2012 Project Scope Statement
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1. Project Name and ID
Harmonization of Health Quality Artifact Reasoning and Expression
Logic
Project ID:
2. Sponsoring Group(s) / Project Team
Primary Sponsor/Work Group (1 Mandatory)
Co-sponsor Work Group(s)
Project Team:
Project facilitator (1 Mandatory)
Other interested parties and their roles
Multi-disciplinary project team (recommended)
Modeling facilitator
Publishing facilitator
Vocabulary facilitator
Domain expert rep
Business requirement analyst
Other facilitators (SOA, SAIF)
Clinical Decision Support
Clinical Quality Information, Structured
Documents
Bryn Rhodes
Keith Boone
Patty Craig, Aziz Boxwala, Keith Boone, Marc
Hadley
Implementers (2 Mandatory for DSTU projects):
1) NCQA
2) CMS/ONC
3) The Joint Commission
4) AMA Convened PCPI
5) S&I Pilots
3. Project Definition
3.a. Project Scope
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Health Level Seven®, International
2012 Project Scope Statement
Introduction
The expression of clinically relevant logic for the use of health quality
measurement and clinical decision support has historically been viewed from
different perspectives, based on the different specific needs of each domain.
However, the resulting mechanisms have produced significantly different approaches
to representation of what are essentially the same underlying concepts.
This project seeks to identify the set of concepts and functionality that are
common to both domains with respect to the expression of logic for reasoning about
clinical information. By identifying this common core set of concepts, and
formalizing them in conceptual and logical models that are independent of both the
clinical data model involved, and the ultimate container and focus of that logic,
the project can establish a basis for describing and sharing health quality
knowledge between the historically disparate domains of quality measurement and
clinical decision support.
Currently, health quality artifacts from the two domains are defined by:
1) Health Quality Measure Format (HQMF) Specification, (release 2 of the DSTU)
for quality measures.
2) CDS Knowledge Sharing Implementation Guide (HeD) for decision support
artifacts.
Contextual Overview
Broadly, the information represented within health quality artifacts for
measurement and decision support can be broken down into three basic categories:
1) Clinical Data Representation
2) Expression Logic for Criteria and Data Specification
3) Metadata and Domain-Specific Information
Clinical data representation is the definition of the structure of the clinical
data on which the artifact will operate. For the purposes of health quality
artifacts this is represented using a realization of QDM within HQMF for quality
measurement and QRDA for quality reporting. For decision support, clinical data is
represented using the CDS-vMR Logical Model as referenced from an HeD artifact.
Expression logic within HQMF is represented as criteria templates defined in terms
of the clinical data model, as well as logical operators within the structure of
the artifact, and additional dialect-specific expression language extensions.
Within HeD, expression logic is represented using an expression component schema
that is independent of the data model and the CDS domain.
Metadata and domain-specific information within the measurement domain is captured
by the HQMF format, and within HeD by the various artifact components described in
the HeD Schema and realized concretely for specific artifact types.
The scope of this project is restricted specifically to the representation of
expression logic. The clinical data representation aspect is covered by a separate
project focusing on harmonization of QDM and vMR. The representation of metadata is
also covered by a separate project.
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© 2017 Health Level Seven® International. All rights reserved.
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Health Level Seven®, International
2012 Project Scope Statement
Phases
This project will focus on three phases:
1. Defining a harmonized conceptual description of Expression Logic for Health
Quality Artifacts, both Quality Measures and Clinical Decision Support.
2. Building a logical model, informed by the conceptual description (created in
#1), for representing expression logic for Health Quality Artifacts.
3. Realizing a platform-specific implementation of the logical model (created in
#2).
4. Proposed Coordination with existing specifications:
a. HQMF R2 – Modularization of the HQMF format to reference the data model
components of the specification. This could be the same data model that
is currently used by HQMF, but would be specified by reference, rather
than directly as part of the HQMF schema.
b. HQMF R2 – Modification of the expression logic components of HQMF to
reference the common expression logic components (created in #3).
c. HeD – Changes to the Knowledge Artifact Implementation Guide to
reference the expression logic components (created in #3).
d. QRDA – Modularization of the QRDA formats to allow reference to a data
model, in this case the HQMF-specific data model (created in #4a).
Health Quality Artifact Reasoning and Expression Logic Conceptual Model
This phase of the project will focus on description of the functional requirements
for behavior in clinical artifacts, providing a conceptual description of the types
of reasoning that must be available to describe quality measures as well as
clinical decision support artifacts.
The requirements will be determined based on the existing requirements specified as
part of the HeD and HQMF specifications. These requirements will be captured as an
informative document.
Health Quality Artifact Expression Logic Logical Model
The next phase of this project will be to produce a platform independent logical
model that allows for the representation of the reasoning functionality described
by the previous phase.
This phase will produce an industry standard UML model derived from the specific
types of expressions that can be represented within HQMF and HeD. The set of
operations required will be determined as the superset of the operations available
in both specifications, as described briefly in the following sections.
HeD Functionality
Specifically, from HeD the logical model will capture the ability to represent:
 Values, including Simple Values, Objects, Intervals, and List
 Comparison Operators
 Logical Operators
 Nullological Operators
 Conditional Operators
 Arithmetic Operators
875098166
2012 Apr Release
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Health Level Seven®, International
2012 Project Scope Statement





String Operators
Date and Time Operators
List Operators
Aggregate Operators
Interval Operators
HQMF Functionality
From HQMF the logical model will capture the ability to represent:
 Data Criteria, including retrieval and attribute filtering and associated
semantics
 Temporally Related Information, including pause quantities and uncertain
ranges
 Excerpt, including aggregate and sequential selection
 Outbound relationship, including related information association
 Grouper
 Population Criteria specification (logical operators)
 Measure Observation computation (NOTE: Only the computational aspects will be
captured at this level, specification of the measure computation type is
quality measure specific information and is part of the HQMF specification
directly).
Health Quality Artifact Expression Logic Platform-Specific Implementation
Using the Health Quality Artifact Expression Logic Logical Model, this phase will
produce a platform-specific model appropriate for reference by HQMF and HeD.
3.b. Project Need
There is a desire from the Health Quality community to have a single family of
standards that support both Quality Measures and Clinical Decision support. As the
two domains evolve, the existing specifications have enough discrepancies between
them that mapping and/or translation of an artifact intended for measurement to an
artifact intended for clinical decision support, or vice versa, is for all
practical purposes infeasible. This results in unnecessary duplication of
significant effort, both in the creation of artifacts, as well as the environments
that must consume and execute those artifacts. By providing a common basis of
functionality that is a superset of the requirements of both domains, this
redundancy can be largely eliminated, allowing artifact creation and environment
implementation efforts to focus on the aspects that truly are different between the
domains (e.g. population versus patient focus, post-event measurement versus inprogress detection, and measurement of effect versus process guidance). Therefore,
by harmonizing and modularizing, the standards can better support the Health
Quality community.
3.c. Success Criteria
Success will be demonstrated by
1) Producing an informative document describing the conceptual requirements for
expression logic in Health Quality artifacts.
2) Producing a platform-independent logical model that allows for the
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Health Level Seven®, International
2012 Project Scope Statement
representation of expression logic within Health Quality artifacts.
3) Producing a platform-specific technology specification that realizes the
platform-independent logical model in an XML ITS.
4) Updating existing specifications for HeD and HQMF to reference the platformspecific expression logic component.
3.d. Project Objectives / Deliverables / Target Dates
Target Date
Health Quality Artifact Reasoning and Expression Logic
Functional Requirements
Health Quality Artifact Reasoning and Expression Logic
Representation Model
Health Quality Artifact Reasoning and Expression Logic XML ITS
Coordination and Proposed Changes to HeD KA IG
Coordination and Proposed Changes to HQMF R2
Coordination and Proposed Changes to QRDA Category I & III
Project End Date (all objectives have been met)
Enter Target Date
Enter Pjt End Date
3.e. Project Dependencies
1. CDS Knowledge Sharing Implementation Guide, #931
2. Health Quality Measure Format (HQMF) Specification, (release 2 of the DSTU),
#508
3.f. Project Document Repository Location
Enter the SPECIFIC URL where supporting project documents, deliverables, ballot
reconciliation work and other project information will be kept. A template to
create a Project Page on the HL7 Wiki is available at:
http://wiki.hl7.org/index.php?title=Template:Project_Page.
3.g. Backwards Compatibility
Yes
No
Don’t Know
N/A
Are the items being produced by this project backward compatible?
To the extent possible, the changes proposed will be implemented to minimize the
impact on the existing specifications as much as possible. However, some nonbackwards-compatible impact is anticipated to be unavoidable due to the requirement
to modularize the existing HQMF specification.
4. Products
Non Product Project- (Educ. Marketing, Elec. Services, etc.)
Arden Syntax
Clinical Context Object Workgroup (CCOW)
Domain Analysis Model (DAM)
Electronic Health Record (EHR)
Functional Profile
V2 Messages – Administrative
V2 Messages - Clinical
V2 Messages - Departmental
V2 Messages – Infrastructure
V3 Documents – Administrative (e.g. SPL)
V3 Documents – Clinical (e.g. CDA)
V3 Documents - Knowledge
V3 Foundation – RIM
V3 Foundation – Vocab Domains & Value Sets
V3 Messages - Administrative
V3 Messages - Clinical
V3 Messages - Departmental
V3 Messages - Infrastructure
V3 Rules - GELLO
V3 Services – Java Services (ITS Work Group)
V3 Services – Web Services
- New Product Definition - New/Modified HL7 Policy/Procedure/Process -
5. Project Intent (check all that apply)
Create new standard
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Supplement to a current standard
2012 Apr Release
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Health Level Seven®, International
2012 Project Scope Statement
Revise current standard (see text box below)
Reaffirmation of a standard
New/Modified HL7 Policy/Procedure/Process
Withdraw an Informative Document
N/A (Project not directly related to an HL7 Standard)
Implementation Guide (IG) will be created/modified
Project is adopting/endorsing an externally developed IG
(specify external organization in Sec. 6 below)
Externally developed IG is to be Adopted
Externally developed IG is to be Endorsed
The project potentially will lead to the creation of a new expression language
specification and/or modifications to the Knowledge Artifact IG (#931) and HQMF
(#508).
5.a. Ballot Type (check all that apply)
Comment Only
Informative
DSTU to Normative
Normative (no DSTU)
Joint Ballot (with other SDOs or HL7 Work Groups)
N/A (project won’t go through ballot)
If necessary, add any additional ballot information here. If artifacts will be
jointly balloted with other HL7 Work Groups or other SDOs, list the other groups.
6. Project Approval Dates
Sponsoring Group Approval Date
Steering Division Approval Date
PBS Metrics Reviewed? (required for SD Approval)
Technical Steering Committee Approval Date
WG Approval Date CCYY-MM-DD
SD Approval Date CCYY-MM-DD
Yes
No
TSC Approval Date CCYY-MM-DD
7. External Project Collaboration
None
7.a. Stakeholders / Vendors / Providers
Stakeholders
Clinical and Public Health Laboratories
Immunization Registries
Quality Reporting Agencies
Regulatory Agency
Standards Development Organizations
(SDOs)
Payors
Other (specify in text box below)
N/A
Other:
Vendors
Pharmaceutical
EHR, PHR
Equipment
Health Care IT
Clinical Decision Support
Systems
Lab
HIS
Other (specify below)
N/A
Providers
Clinical and Public Health Laboratories
Emergency Services
Local and State Departments of Health
Medical Imaging Service
Healthcare Institutions (hospitals, long term
care, home care, mental health)
Other (specify in text box below)
N/A
Indicate other stakeholders, vendors or providers not listed above.
7.b. Synchronization With Other SDOs / Profilers
Check all SDO / Profilers which your project deliverable(s) are associated with.
ASC X12
AHIP
ASTM
BioPharma Association (SAFE)
CEN/TC 251
CHCF
CLSI
CHA
DICOM
GS1
IEEE
IHE
IHTSDO
ISO
LOINC
NCPDP
NAACCR
Object Management Group (OMG)
The Health Story Project
WEDI
Other (specify below)
For standards and implementation guides (IG) being developed by this project,
please indicate:
- Similarities to standards or IGs from the checked SDO/Profilers
- How they will be different
- How overlaps will be coordinated with the checked SDO/Profilers
875098166
2012 Apr Release
© 2017 Health Level Seven® International. All rights reserved.
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Health Level Seven®, International
2012 Project Scope Statement
- Why coordination is not needed with other SDOs/Profilers
8. Realm
Universal
Realm Specific
Check here if this standard balloted or was previously approved as realm specific standard
(Enter “U.S.” or name of HL7 affiliate here)
9. Strategic Initiative Reference – For PMO/TSC Use Only
This section used only for Strategic Initiative Projects.
1.
2.
3.
HL7 Recognition
HL7 Internal Processes
HL7 Implementation
875098166
2012 Apr Release
© 2017 Health Level Seven® International. All rights reserved.
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