The document discusses using FHIR and the Clinical Reasoning Module to enable payers to more easily calculate quality measures from provider data. It describes a Payer Extract approach that would leverage standards to streamline retrieving relevant patient information from EHRs and decreasing development time. At a recent connectathon, participants focused on terminology integration and were able to successfully expose value sets and calculate cohorts using a FHIR server as the data source. The feedback was positive about moving forward with FHIR rather than other current formats.

1. Payer Extract
Connectathon Update
Using the FHIR Clinical Reasoning Module to Enable
Calculation of Payer Quality Measures

2. What is Payer Extract
 An approach to enable retrieving relevant patient
information directly from provider systems
 Leverage emerging standards to streamline the payer
quality measure calculation process
 Decrease development time for EHR Vendors, Payers,
and Quality Reporting Vendors

3. Payer Extract Approach
EHR
Data
Payer
Payer Extract
Processing
EHR FHIR
Service
Payer
Extract
FHIR
Service
Terminology
Server

4. Terminology Integration
 This connectathon we focused on terminology
integration
 When the source server doesn’t have the value sets, use
the terminology server to resolve them
 Engine “in-lines” the valueset codes into the URL
 Obvious cons here, but for reasonably small valuesets, it’s
functional
 Found and fixed several issues, we now have a
functional implementation that uses Apelon’s FHIR STU3
terminology server

5. Participant Feedback
 We were able to successfully expose HEDIS valuesets as
FHIR ValueSet resources, and along the way found and
fixed several implementation issues
 We were able to successfully calculate CQL-Based
measure cohorts using a FHIR server as the data source
 We feel that we can move forward with the approach
using FHIR rather than the myriad other formats we
currently have to consume