Stream: cql
Topic: CQL Data Model: Which ones?
Daniel Tam (Sep 16 2021 at 21:54):
Hi, my organization is building out our CQL capabilities. We noticed that there seem to be multiple CQL data models, including QUICK, FHIR, QICORE, and QDM. Is there any guidance on which of these data models will likely be used in the future? Should we plan to just support one of these going forward? Or is the guidance to be able to work with all four of these (and any others??)?
I thought I had heard something about QUICK not being as prevalent now, but I may have misheard that. I also thought that QDM was an older data model that we were moving away from, but I noticed in the Cooking with CQL meeting that QDM was still being used. Any guidance would be very helpful, so that our engineering teams can better understand what we will need to support.
Chris Moesel (Sep 16 2021 at 22:29):
I think @Bryn Rhodes is probably in the best position to speak to that, but I think it may depend on the context in which you want to use/support CQL (e.g., eCQM, CDS, etc). Most CQL-based CDS that is being written today (that I'm aware of) uses the core FHIR data model.
Corey Sanders (Sep 16 2021 at 22:31):
If you haven't already done so, you might want to review the material in the CQF measures IG. Bryn covers a lot of this therein. https://hl7.org/fhir/us/cqfmeasures/2021May/
Paul Denning (Sep 17 2021 at 04:08):
QUICK was in the QI-Core IG for a while, but it is now essentially gone; we were going to change it to Authoring view, but when the we applied the newer IG templates, and there was a tab in the profiles to show "Snapshot Table (Must Support)", it made it clearer about what is needed to author CQL for FHIR instances conformant to QI-Core. QDM is used still used for the CMS Annual Update eCQMs; Annual Updates are published in May every year and apply to the reporting period for the following calendar year. The May 2021 Annual Update is for the CY2022 reporting period, where QRDA reports would be submitted to CMS, e.g., in 1QCY2023 (depending on the CMS program). CMS has not said when eCQMs would be based on FHIR, but there is work to convert the QDM-based eCQMS to FHIR. The capability in CQL to "using QI-Core" is new; it is an example of "profile-informed authoring", where in that case the FHIR profiles are from the QI-Core IG. In CQL "using foo" requires a "modelinfo" for "foo". Tooling now exists to create a modelinfo for any FHIR profile, which is intended to make it easier on CQL authors to write CQL in accordance with that profile (or IG with a set of profiles), compared to authoring CQL for the base FHIR specification (modelinfo). For now, most efforts to create CQL for FHIR-based applications are "using FHIR" as opposed to some profile of FHIR like QI-Core.
Bryn Rhodes (Sep 17 2021 at 13:37):
To add to this, the profile-informed authoring feature of the translator is implemented as a mapping so that the ELM that is output is still just FHIR, so that an implementation running ELM can focus on FHIR support. QDM is still used for eCQMs used by CMS, so whether your environment needs to support that depends on whether you need to run CMS program quality measures.
Brian Kaney (Sep 17 2021 at 13:52):
This might be a silly question, but if the data is FHIR and the eCQM is expressed as CQL + QDM, is there tooling to support this combination?
Bryn Rhodes (Sep 17 2021 at 13:57):
We have tried that at Connectathon with vendors and the feedback we got from that trial was "just express the measures in FHIR". It's possible, but it's a challenge, especially in the areas where there is variability in the mapping from QDM to FHIR. The QICore IG includes a detailed mapping: https://hl7.org/fhir/us/qicore/qdm-to-qicore.html
Bryn Rhodes (Sep 17 2021 at 13:57):
That could potentially be automated but it would be a significant effort.
Daniel Tam (Sep 22 2021 at 23:35):
Not sure if any of your organizations purchased the NCQA digital bundle for 2022 (which included HEDIS measures written in FHIR). We just got them here -- their CQL files are using the FHIR data model. Just wanted to share in case that helps the group.
From @Paul Denning 's message, it sounds like QUICK is no longer going to be used? Should we update the documentation to reflect that? The developers on my team thought that QUICK was still being used, due to existing references. For example, the IG that Corey sent references QUICK in this area: https://hl7.org/fhir/us/cqfmeasures/2021May/#quality-improvement-core-implementation-guide-qi-core
Paul Denning (Sep 23 2021 at 13:40):
In QI-Core we are publishing an update (not balloted) which makes some changes https://jira.hl7.org/browse/FHIR-33260 and https://jira.hl7.org/browse/FHIR-33490
We are also close to publishing QMIG, and I hope we can update that section (1.3.2.4) that talks about QUICK
Last updated: Apr 12 2022 at 19:14 UTC
