The open-source model
Everything that computes the number is open
dQMGrid is open source. The proposed licensing is the Apache License 2.0 for the calculator core, conformance harness and test decks; CC0 1.0 for the rule artifacts; and CC BY 4.0 for the documentation. The exact model and licenses will be finalized after our upcoming discussions with CMS — see License. Nothing that affects how a measure is computed is held back.
Open core — in CMS’s sense, with nothing withheld
Section titled “Open core — in CMS’s sense, with nothing withheld”CMS’s Digital Quality Measurement Strategic Roadmap describes the measure calculation tool it wants as open-core software: a core that is open, that CMS, providers or third parties can run. dQMGrid is open-core in exactly that sense.
The phrase is sometimes used in the software industry for a different model — a free edition with some features withheld for a paid one. dQMGrid does not work that way. The whole point of the calculator is that you can trust the number; if an open version computed a less trustworthy result than a paid one, it would undermine the reason to use either. So nothing that affects how a result is computed is withheld from the open project.
Where the line is drawn: the signature
Section titled “Where the line is drawn: the signature”Under dQMGrid’s rules, a derivation or inference counts in a reported result only when a named, qualified reviewer has signed it. That gives a clean, defensible line:
| The dQMGrid project — open | MDinteractive — commercial | |
|---|---|---|
| Calculator core, harness, validator integration | ✓ | |
| Rule artifacts — standards and vendor tiers | ✓ | |
| Test decks, including fault-injected decks | ✓ | |
| The account, both counting modes, bias report | ✓ | |
| Signing a rule set — accepting professional responsibility for its clinical judgments | ✓ | |
| Hosting, operation, support and service levels | ✓ | |
| Integration and onboarding of a new EHR platform | ✓ |
Anyone can read a rule, fork it and run it. What cannot be copied is a qualified reviewer’s acceptance of responsibility for it. A fork can copy the content of a signed rule set; it cannot copy the signature.
Signing is not exclusive. Any qualified signer may sign rules. MDinteractive is the default signer for the rule sets it maintains. Qualification, scope and liability are set out in the governance charter — see Governance.
Models this follows
Section titled “Models this follows”dQMGrid borrows from two well-established patterns in open-source health and infrastructure software:
- A named steward. Widely used open-source health projects have a clearly identified maintainer that funds their development and offers commercial support alongside the free project. dQMGrid is stewarded by MDinteractive in the same way, and says so openly. See Stewardship.
- Open code, sold assurance. Some of the most durable open-source companies withhold no features at all. They contribute upstream first and earn their living from support, lifecycle maintenance and certification. dQMGrid’s equivalent of certification is the signature.
Upstream first
Section titled “Upstream first”When dQMGrid’s harness finds a problem in a measure package or an engine, the fix belongs upstream with the people who own that component. dQMGrid carries a documented workaround only until the upstream fix ships — as it did with the unit-conversion defect fixed in CQL 5.2.0. See Prototype results.
What is open today
Section titled “What is open today”- Readable now: this site and the EHR cookbook — not yet openly licensed; licensing will be confirmed after our upcoming discussions with CMS.
- At the first release: public release of the calculator core, conformance harness and test decks (proposed: Apache 2.0) and the rule artifacts (proposed: CC0 1.0).
- In the meantime: the repository is available to CMS on request.