The eCQM Lifecycle

Electronic clinical quality measures (eCQMs) progress through multiple lifecycle stages.

Measure Conceptualization
Measure Specification
Measure Testing
Measure Implementation
Measure Use, Continuing Evaluation, and Maintenance

The Blueprint for the Measures Management System outlines core processes for measure developers to follow when moving through the Measure Lifecycle for the quality measures used in various quality initiatives and programs.

Opportunities are available for the public to engage in the different stages of the Measure Lifecycle including Call for Measures, Technical Expert Panels (TEPs), testing, and Public Comments.

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

eCQM Lifecycle showing the steps in a square with arrows pointing to these steps: Specification, Testing, Implementation, Use, Continuing Evaluation, and Maintentance. In the middle is a step for Conceptualization.

Conceptualization

Steps: Conceptualization initiates the Measure Lifecycle. Perform an environmental scan to identify measure concepts, measurement gaps, determine the evidence base for measure concepts for development, look for competing and related measures, and draft the business case. The end goal of measure conceptualization is a meaningful, well-researched measure concept with well-defined initial components (e.g., initial population, denominator, numerator).
Tools and Resources: CMS.gov, CMS Measures Inventory Tool (CMIT), Environmental Scan Support Tool (ESST), focus groups, literature reviews, Measure Collaboration (MC) Workspace eCQM Concepts, ONC Project Tracking System (Jira), Quality Data Model (QDM), Quality Positioning System, stakeholder interviews, TEPs
Actors: CMS, measure developers, measure stewards, measured entities (e.g., front line clinicians, hospitals, and IT staff), patients/patient advocates/caregivers, public, researchers, subject matter experts (SMEs), TEP members

Specification

Steps: Electronic specifications for a clinical quality measure are defined and developed iteratively so that measures may be collected within certified electronic health information technology (IT) (CEHRT) systems and reported consistently, reliably, and effectively. Continue drafting the business case.
Tools and Resources: Atom Text Editor, Binding Parameter Specification (BPS), Bonnie, Clinical Quality Language (CQL), CQL Evaluation Engine, CQL Execution Framework, CQL Runner, Cypress, eCQM Data Element Repository (DERep), Expression Logical Model (ELM), Health Quality Measure Format (HQMF), MC Workspace 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, measured entities, patients/patient advocates/caregivers, SMEs, public, TEP members, tool owners

Testing

Steps: Iteratively test a measure’s scientific acceptability (includes reliability and validity), feasibility, and usability and use. Test health IT’s ability to accurately calculate measures. Continue drafting the business case.
Tools and Resources: Bonnie, BPS, Cypress, Health IT Certification for eCQM Reporting, Implementation Testing, MAT, MC Workspace eCQM Test Results, ONC Project Tracking System (Jira), Synthea™, TEPs, VSAC
Actors: Health IT vendors, measure developers, measure stewards, measured entities, patients/patient advocates/caregivers, public, SMEs, TEP members, tool owners

Implementation

Steps: CMS publishes approved measures for a given quality program in program rules (e.g., Physician Fee Schedule) and/or guidelines. Health IT vendors and providers implement measures for a given quality measurement program. Finalize the initial business case. Additionally, eCQMs may be submitted to the National Quality Forum (NQF) for endorsement. Measure developers are responsible for monitoring NQF’s eCQM requirements.
Tools and Resources: Certified health IT, CMIT, eCQI Resource Center, DERep, eCQM Implementation Checklist, ONC Project Tracking System (Jira), TEPs, VSAC
Actors: Federal agency communication departments, health IT vendors, individual program technical assistance contractors, measured entities, patients/patient advocates/caregivers, public, SMEs, TEP members

Measure Use, Continuing Evaluation, and Maintenance

Steps: CMS receives stakeholder feedback on the implementation and use of measures and shares with measure stewards and measure developers to improve future versions. If the eCQM is NQF-endorsed, the measure must meet additional maintenance of endorsement requirements. Measure developers perform an annual review and a comprehensive reevaluation every 3 years. CMS publishes updates to the eCQMs annually and may publish addenda to the updates. Compare actual performance with the initial business case.
Tools and Resources: Change Review Process, CMIT, eCQI Resource Center, ESST, ONC Project Tracking System (Jira), TEPs
Actors: Health IT developers, federal agencies, individual program technical assistance contractors, measure developers, measure stewards, measured entities, Network of Quality Improvement and Innovation Contractors, patients/patient advocates/caregivers, public, SMEs, TEP members

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