The eCQM Lifecycle

Opportunities are available for the public to engage in the different phases of the measure development process including Call for Measures, Technical Expert Panels, testing, and Public Comment.

These are the steps, tools, and actors for each eCQM lifecycle stage:

Conceptualization

Steps: Conceptualization occurs continually and informs and is influenced by the processes and outcomes of all the other processes in the measure lifecycle. Perform an environmental scan to identify measure concepts, measurement gaps, determine the evidence base for measure concepts to be developed, and develop the business case. Basic elements of a measure (initial population, denominator, numerator, denominator exclusions, numerator exclusions, and exceptions are generated.
Tools and Resources: CMS.gov, CMS Measures Inventory Tool (CMIT), Environmental Scan Support Tool (ESST), focus groups, literature reviews, Measure Collaboration Workspace (MCW) eCQM Concepts, ONC Project Tracking System (Jira), Quality Data Model (QDM), Quality Positioning System, stakeholder interviews, Technical Expert Panels (TEPs), United States Health Information Knowledgebase (USHIK)
Actors: CMS, clinicians, hospitals, measure developers, measure stewards, patients/patient advocates/caregivers, researchers, TEP members

Specification

Steps: Electronic specifications for a clinical quality measure are defined and developed iteratively so that they may be collected within certified electronic health information technology (IT) systems and reported consistently, reliably, and effectively.
Tools and Resources: Binding Parameter Specification (BPS), Bonnie, Clinical Quality Language (CQL),  Cypress, eCQM Data Element Repository (DERep), Expression Logical Model (ELM), Health Quality Measure Format (HQMF), MCW eCQM Clinical Workflows, Measure Authoring Tool (MAT), ONC Project Tracking System (Jira), QDM, TEPs, Value Set Authority Center (VSAC), VSAC Collaboration Tool
Actors: Measure developers, measure stewards, patients/patient advocates/caregivers, TEP members, tool owners

Testing

Steps: A measure’s feasibility, usability, and scientific acceptability are tested. Health IT’s ability to accurately calculate measures is tested and certified. 
Tools and Resources: Bonnie, BPS, Cypress, Health IT Certification for eCQM Reporting, Implementation Testing, MAT, MCW eCQM Test Results, ONC Project Tracking System (Jira), TEPs, VSAC
Actors: Clinicians, Health IT vendors, hospitals, measure developers, measure stewards, patients/patient advocates/caregivers, TEP members

Implementation

Steps: CMS approved measures for a given measurement program are published within program rules and/or guidelines. CMS publishes updates to the eCQMs annually and may publish addenda to the updates. Health IT vendors and providers implement measures for a given quality measurement program. Additionally, eCQMs may be submitted to the National Quality Forum (NQF) for endorsement. Measure developers are responsible for monitoring NQF’s eCQM requirement policies.
Tools and Resources: Certified health IT, CMIT, eCQI Resource Center, eCQM Data Element Repository (DERep), eCQM Implementation Checklist, ONC Project Tracking System (Jira), TEPs, USHIK, VSAC
Actors: Clinicians, federal agency communication departments, health IT vendors, hospitals, individual program technical assistance contractors, patients/patient advocates/caregivers, TEP members

Measure Maintenance, Use, and Validation

Steps: Stakeholder feedback on the implementation and use of measures is received by CMS and shared with measure stewards and developers to improve future versions. If the eCQM is NQF endorsed, additional maintenance of endorsement requirements must be met.
Tools and Resources eCQI Resource Center, ESST, ONC Project Tracking System (Jira), TEPs
Actors: Clinicians, health IT developers, hospitals, federal agencies, individual program technical assistance contractors, measure developers, measure stewards, Network of Quality Improvement and Innovation Contractors, patients/patient advocates/caregivers, TEP members

Detailed information for the tools referenced are located on the eCQM Tools and Resources page.