suggest this 3rd tier should say "Consume CQL (implementation)
Directly intake, interpret, and execute CQL artifacts

(should be silent on where CQL is being interpreted/executed – could be 'native' in either EHR, or could be via services in a cloud-based architecture interfacing with the EHR)

Need to consider other implications to support BOTH native EHR and service-oriented architecture. For instance, may need to consider support for an optional layer at data interface (monitoring of patient state) and at the recommendations/suggestions/requests interface (monitoring of EHR workflow state).