Digital Quality Implementers' Community (DQIC) Overview

The Digital Quality Implementers Community (the Community or DQIC) is a collaborative consensus-based effort to develop, advance, and standardize tools and platforms that make digital quality measurement possible. Initially, the Community will focus on evolving currently available Clinical Quality Language (CQL) engines that enable Digital Quality Measurements and plans to expand its scope to include additional tools, developers, and programming languages in the digital quality sector over time.

The DQIC brings together technical expertise, real world experience, regulatory knowledge, and public policy understanding to assess current regulatory frameworks and issues and, as appropriate, develop consensus proposals to enable the innovation and adoption of quality measurement application.  As appropriate, the DQIC will educate policy makers on these issues and proposals.  

DQIC Vision

The Vision of the DQIC is to attract the leading experts and organizations in the sector to enable rapid advancement of a consensus agreed upon approach to a quality enablement layer for the country to ensure consistency across disparate solutions. CQL engines can be variable and incomplete, which is why DQIC envisions developing clear requirements and test cases for consistent behavior. Confidence in and trust of the infrastructure is critical, and the Community must make the investment to convert once a consensus approach has been developed. In addition, the ability for the Community to continue to have the choice to select from among several vendors and not be locked in or dependent on a single vendor or approach will be key.

DQIC Objectives

• The Community will establish consensus approaches for open infrastructure, tooling, and best practices, ensuring that digital quality measures are consistent, interoperable, and universally applicable across diverse health care settings.

• The Community will foster innovation, providing a collaborative space for the creation of cutting-edge tools that enhance the efficiency of quality measurement applications by bringing together developers, vendors, and experts,.

• The Community will address challenges in the complex realm of clinical reasoning modules, serving as a forum to identify and solve implementation problems, crucial for advancing the field.

• The community will provide validation tools to ensure accuracy and consistency in the results produced by different proprietary solutions, instilling confidence among stakeholders.

• The Community will promote the value of digital quality standards and provide visibility to federal partners such as CMS and ONC throughout the process.

See Figure 1 (below) for the focus of DQIC:

Open

Antitrust

In all DQIC discussions, members must remember that meetings include representatives of companies that compete with one another in the marketplace.  Discussions, plans, consensus arrangement, agreements, strategies, etc., may be unlawful if they relate to any of the following topics:

• Current or future prices or bidding information

• Limits on production or product lines

• Allocating customers or territories

• Individual company marketing strategies, projections, or assessments

• Establishing a practice of dealing with customers or suppliers

DQIC Structure

The DQIC’s will operate on a consensus basis where all members have an equal voice and the opportunity to advise and provide input, although no single member has a veto. Participation in the community will require active engagement including assistance in developing tooling for the community. Initial membership in the Community will be limited to vendors who have or are actively planning to build CQL engines to support the implementation of digital quality measures. Other interested parties can participate through joining regular public calls to hear about the progress the Community is making and to provide feedback.

Ultimately, the agreed upon list of priorities and projects the Community works on will be recommended by group consensus. Final decisions and decisions about which the group cannot come to consensus will be made by the Executive Committee.

The DQIC will operate by means of an Executive Committee. The Executive Committee approves the group’s specific agenda and policy positions, establishes goals and objectives, and oversees the overall direction of the Community.  Subgroups can be created as desired by members to research and address specific issues or questions.  The Steering Committee is currently comprised of Leavitt Partners and NCQA. Future members of the Executive Committee could include other measure developers such as the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health Information Technology (ONC), the Agency for Healthcare Research and Quality (AHRQ), and the United States Preventive Services Task Force (USPSTF).

All members of the Executive Committee hold equal voices and decision-making authority within the committee. This ensures a balanced representation of perspectives and expertise in guiding the direction of the DQIC. In the event of a tie, LP, as a measure agnostic party, will hold the tie-breaking vote.

Who Should Join DQIC?

The DQIC Guidelines for Inclusion gives details on who should join DQIC.

Github Governance

There are four levels of participation within GitHub: Stakeholder, Contributor, Committer, and Digital Quality Implementers Community Steering Committee (DSC). Anyone with interest can participate as a Stakeholder and a Contributor. Participation as a Committer or a DQIC Steering Committee (DSC) member requires official membership in DQIC. Initial membership in the Community will be limited to vendors who have or are actively planning to build CQL engines to support the implementation of digital quality measures; however, this will be expanded as the specification stabilizes. Membership in DQIC requires active participation and contributions as Committers and DSC members, compliance with the DQIC charter, and a monthly membership fee. Refer to DQIC’s GitHub Governance document for more detailed information on work product governance.

DQIC Meetings

The Community meets in-person and via conference call regularly and as needed to discuss objectives, action items, outreach, and next steps.

Executive Committee Meetings

Executive Committee meetings formalize decision-making for the objectives and prepare for the upcoming DQIC meeting.  The Executive Committee includes NCQA and Leavitt Partners, and may include the Office of the National Coordinator (ONC), the Centers for Medicare and Medicaid Services (CMS), U.S. Preventative Services Task Force (USPSTF). DQIC’s Executive Committee will convene by videoconference biweekly for strategic discussions and planning. Executive Committee meetings will alternate weeks with DQIC meetings. The first Executive Committee meeting will be held on January 29, 2024, at 1:30 pm ET.

The following will be emailed to steering community members:

• Meeting agendas will be emailed 48 hours in advance of each meeting.

• Meeting recaps will be emailed 1-week following each meeting.

• Meeting announcements will be emailed, as needed.

In the event an unscheduled steering committee meeting is needed, notice shall be given at least 2 weeks in advance for in-person meetings and at least 1 week in advance for conference calls. 

General Community Meetings

The Community will convene by videoconference on a biweekly basis as well as on an ad hoc basis as required by current events and requirements to complete the work of DQIC. DQIC’s first meeting will be held on January 22, 2024, at 1:30 pm ET. All meetings shall be open for attendance to all members.  The purpose of general community meetings is to review the work done to address the previous meeting’s action items, strategize ways to put Community prioritizes into action, review and discuss written and communication materials, and share experiences and views that will benefit the policy decision making process. The general Community meetings will abide by the following meeting schedule:

The following will be posted on the secure client only internal site:

• Meeting agendas will be posted 48 hours in advance of each meeting whenever possible.

• Meeting recaps will be posted no later than 1-week following each meeting whenever possible.

• Meeting announcements.

DQIC Decision Making Process

Each member of the Coalition has a vote equal to the other members.  The members have the right and the responsibility to:

• Set the Community:

• Structure,

• Membership,

• Governance process,

• Advance and discuss policy priorities,

• Advance and discuss policy positions,

• Discuss advocacy strategy as appropriate; 

• Attend, or determine who will attend on its behalf, internal meeting;

• Attend, or determine who will attend, meetings with external stakeholders; and

• Govern any external communications.

All policy positions of the DQIC will be determined by consensus. The DQIC’s guiding principles are determined on a consensus basis by the members, and all members have an equal voice and the opportunity to advise and provide input, although no single member has a veto.

The Community is action-oriented and will capitalize on members’ expertise and experience, including delegating agreed-upon action items to members who volunteer to be the issue/project “champions.” Core working principles include:

• An equal opportunity for each member to express their positions and objectives.

• A desire to collectively engage in a consensus process to build new content together.

• Respectful and professional dialogue.

Honest consideration of proposals, suggestions, and positions put forward by members.

Work products on GitHub will be managed by the Digital Quality Implementers Community Steering Committee (DSC). The DSC consists of those individuals identified as ‘owners’ on the development site. The DSC is responsible for ensuring the smooth running of the project, including strategic planning, release cycles, change management, and changes to project governance. Membership of the DSC is by nomination from the existing DSC members. A nomination will result in discussion and then a vote by the existing DSC members. DSC membership votes are subject to consensus approval of the current DSC members. DSC members must also be approved by the DSC Executive Committee.

Decisions on the project such as whether to accept a change, add a feature, or what to include in a particular release, are made through discussion with all members of the community. Anyone is welcome to comment on proposed changes, but ultimately, the committers make the determination on accepting or rejecting a proposed change. Where committer consensus cannot be reached, the decision is escalated to the DSC. In order to ensure that the project is not bogged down by endless discussion and continual voting, the project operates a policy of active consensus – that is, those who have not stated their opinion explicitly have implicitly agreed to the implementation of the proposal. This allows the majority of decisions to be made without resorting to a formal vote..

DQIC Membership Responsibilities

Each member of the Coalition has a vote equal to the other members.  The members have the right and the responsibility to:

• Define the structure of the DQIC

• Manage the governance of deliverables produced by the DQIC as well as the open source CQL-Tests Gitlab repository

• Advance and discuss policy priorities

• Advance and discuss policy positions,

• Discuss advocacy strategy as appropriate; 

• Attend, or determine who will attend on its behalf, internal meeting;

• Attend, or determine who will attend, meetings with external stakeholders; and

• Govern any external communications.

Like all other alliances administered by Leavitt Partners, government observers are also made aware of all progress and can provide input when appropriate. They are also invited to all key meetings as observers of the community.

DQIC Members

Membership can be found in the https://dqic.atlassian.net/wiki/spaces/DQIC/pages/25886722 page

Confidentiality

The discussions and interactions of the members while working on this project are confidential.  Internal discussions and materials will not be shared outside of the Community without the approval or consent of each member

DQIC Communications

The DQIC strives for transparency, openness, and inclusivity for decisions made by consensus. In addition, the DQIC welcomes feedback from any member. The following directions have been agreed on by the DQIC:

Public Vs. Private Communication

. Definitions: Private communication means communication within DQIC. Public communication means communication made publicly available for anyone to comment.

• The Community will strive very hard to gain consensus among the DQIC participants. Feedback received from the public will be reviewed by DQIC but may or may not be incorporated based on prior consensus decisions.

• All ‘in flight’ materials that are currently in draft form will first be reviewed by the group on the private Confluence site or via email.

• Once the group establishes near consensus on the deliverable, we will post to the public forums to be available for comment

Communication Channels

Administrative Matters

The Community is strategically and administratively managed by Leavitt Partners, a health intelligence and policy consulting firm.  Leavitt Partners supports the Community with organization, research, strategy assessments and option development, the development of appropriate messages and documents (e.g., briefing papers, talking points, and research), coordination of any advocacy efforts, and management of internal and external logistics.

DQIC Membership Obligations

Each voting member of the community has the following obligations:

1. Provide adequate representation at bi-weekly meetings.

2. Active participation in Zulip community as well as monitoring project progress in GitHub

3. Ensure risks and issues are brought forward for discussion.

4. Provide nominal membership fee based upon the organization’s combined annual revenue. Please contact a member of the administration team to learn more.

Travel: Members are responsible for their individual travel expenses