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 both informs and is influenced by the processes and outcomes of all the other processes in the measure development 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), focus groups, literature reviews, ONC Project Tracking System (Jira), Quality Data Model (QDM), stakeholder interviews, United States Health Information Knowledgebase (USHIK)
Actors: CMS, clinicians, hospitals, measure developers, measure stewards, patients/patient advocates, researchers

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), (Health Quality Measure Format (HQMF), Measure Authoring Tool (MAT), ONC Project Tracking System (Jira), QDM, Value Set Authority Center (VSAC), VSAC Collaboration
Actors: Measure developers, measure stewards, patients/patient advocates, 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, ONC Project Tracking System (Jira), VSAC
Actors: Clinicians, Health IT vendors, hospitals, measure developers, measure stewards, patients/patient advocates

Implementation

Steps: Federally 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), USHIK, VSAC
Actors: Clinicians, federal agency communication departments, health IT vendors, hospitals, individual program technical assistance contractors, patients/patient advocates

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, ONC Project Tracking System (Jira)
Actors: Clinicians, health IT developers, hospitals, federal agencies, individual program technical assistance contractors, measure developers, measure stewards, Quality Innovation Network-Quality Improvement Organizations, patients/patient advocates

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