Electronic clinical quality measures (eCQMs) use data electronically extracted from electronic health records (EHRs) and/or health information technology systems to measure the quality of health care provided. The Centers for Medicare & Medicaid Services (CMS) use eCQMs in a variety of quality reporting and value-based purchasing programs. Review eCQM Basics and visit the Education tab to learn more about eCQMs.
There are several benefits of using eCQMs
- eCQMs use detailed clinical data to assess the outcomes of treatment by healthcare providers and organizations.
- eCQMs reduce the burden of manual abstraction and reporting for provider organizations and clinicians.
- eCQMs foster the goal of access to real-time data for bedside quality improvement and clinical decision support.
Hospitals, professionals, and clinicians use eCQMs to provide feedback on their care systems and to help them identify opportunities for clinical quality improvement. eCQMs are also used in reporting to CMS, The Joint Commission, federal health agencies, and commercial insurance payers in programs that track and/or reimburse providers based on quality reporting.
Explore Measure Collaboration (MC) Workspace:
Find Pre-Rulemaking eCQMs:
CMS pre-rulemaking eCQMs include measures that are developed, but specifications are not finalized for reporting in a CMS program.
Find Hybrid Measures:
Hybrid measures are quality measures that use more than one data source to calculate the measure. The current hybrid measure merges electronic health record data elements with claims data to calculate measure results. To date, only the Inpatient Hospital Quality Reporting Program has adopted a hybrid measure.
For current CMS programs, eligible hospitals, critical access hospitals, eligible clinicians, and/or eligible professionals must use the most current version of eCQMs when reporting eCQMs. For hospital reporting guidance, visit QualityNet and the Quality Reporting Center for specific program reporting education. For clinician reporting guidance, visit the Quality Payment Program website and the Quality Payment Program Resource Library. For information about the Promoting Interoperability Program, refer to the CMS Promoting Interoperability Program webpage.
For HHS programs using eCQMs, refer to specific program requirements.
Read About the eCQM Strategy Project
The eCQM Strategy Project supported the CMS Patients Over Paperwork initiative to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. The project provided CMS with an understanding of eCQM implementation and reporting burden and made recommendations for improvement in the use of eCQMs in CMS quality reporting programs. Read the report here.
Learn About the Meaningful Measures Initiative:
CMS’s comprehensive Meaningful Measures Initiative identifies high priority areas for quality measurement and improvement. Its purpose is to improve outcomes for patients, their families and providers while also reducing burden on clinicians and providers. The Meaningful Measure Areas serve as the connectors between CMS strategic goals and individual measures/initiatives.
Many different organizations may participate in the development and maintenance of electronic clinical quality measures (eCQMs). The CMS Measures Management System is a standardized system and provides details on the process for developing and maintaining the quality measures used in CMS's various quality reporting and incentive programs. Information on the clinical quality measure and eCQM lifecycle is available in the Blueprint for the CMS Measures Management System (Blueprint) and on the eCQM Lifecycle webpage. The Clinical Quality Language (CQL) Style Guide is for use by measure developers. It provides examples to standardize expression of measure concepts across eCQMs and define a uniform look and feel to eCQM logic using CQL. The Guide provides a set of common best practices for implementation across CQL-based eCQMs used in CMS quality reporting and incentive programs.
The eCQM Lifecycle is a series of stages eCQMs progress through when being developed, tested, implemented, and updated. CMS provides several opportunities for stakeholders to engage throughout the Measure Lifecycle.
Updates to eCQMs:
CMS requires eCQMs approved for CMS programs to be updated annually to reflect changes in evidence-based medicine, code sets, and measure logic. CMS works with measure stewards, measure developers, and eCQMs users to ensure necessary changes are reflected in the Annual Update. Additionally, CMS may provide addenda to the eCQM Annual Update periodically within the year to ensure updated code systems are reflected in the eCQM specifications and supporting materials.
Structure of eCQMs:
To be reported from an electronic health record (EHR) and/or other health information technology, eCQMs are made of electronic specifications. Health Quality Measure Format (HQMF), CQL, Expression Logical Model (ELM), and other Health Level Seven International® (HL7) standards, are used for electronically documenting eCQM content. These electronic specifications include
- Computable representations of the eCQM, which contain important details about the measure, how the data elements are defined, and the underlying logic of the measure calculation. The files include:
- HQMF XML syntax (.xml). The HQMF includes a header and a body. The header identifies and classifies the document and provides important metadata about the measure. The HQMF body contains eCQM sections (e.g., definitions, population criteria, supplemental data elements).
- Shared CQL libraries (.cql, .xml, and .json). The shared libraries are the basic units of sharing CQL. They consist of a foundation of CQL statements used within a measure. Every measure has at least one main CQL library, which HQMF references.
- CQL file (.cql). Provides the expression logic for data criteria, population criteria, and supplemental data elements. It provides a formal description of the computable content in the measure and is organized into reusable or shareable libraries between measures and other artifacts.
- ELM XML document (.xml). Provides a machine-readable representation of the measure’s logic in XML. The intention for the ELM file is for machine processing and provides the information needed to automatically retrieve data from an EHR.
- The Human-readable representation of the eCQM displays the eCQM content in a human-readable format directly in a web browser, Hyper Text Markup Language (HTML) file (.html). This file does not include the underlying HQMF syntax, but the narrative content at the top of the HTML is extracted from the HQMF header.
- A value set and a direct reference code (DRC) convey specific coded values that are allowed for the data elements within the eCQM. Value sets are identified by an object identifier (OID) and include several metadata elements. The value set includes a list of codes (i.e., the value set “expansion code set”) acceptable or valid for a specific data element in the measure, descriptors of those codes, the code system from which the codes are derived, and the version of that code system. DRCs are specific codes that are referenced directly in the eCQM logic to describe a data element or one of its attributes. Value sets and DRCs are found in the Value Set Authority Center (VSAC).
CMS created a unique “CMS eCQM Identifier” to name eCQM files. The naming convention adds the eCQM identifier assigned to the eCQM in the Measure Authoring Tool (MAT) with the “eCQM Version Number”. “CMS” is placed in front of the number. The eCQM Version Number is used to indicate the published version of the eCQM. For example, based on this naming convention, eligible professional measure (NQF0056-Diabetes: Foot Exam) would be CMS123v1 for the first version of the measure.
|eCQM Identifier (MAT)||123|
|eCQM Version number||1|
|CMS eCQM identifier||CMS123v1|
Introduction to eCQMs
- eCQM Basics - Updated February 3, 2020
- eCQM Communications Resources - Updated February 10, 2020
- eCQM Strategy - eCQI Resource Center - MC Workspace Overview - Updated February 28, 2020
- eCQM 101 - Getting Started with Electronic Clinical Quality Measures for Quality Reporting- Updated March 20, 2019
- How to Implement eCQM Annual Updates - Updated March 20, 2019
- Introduction to Electronic Clinical Quality Measures (eCQMs) - December 7, 2016
- Measure Collaboration Workspace Series – Session 1 eCQI Resource Center, Hybrid Measure, Measure Collaboration Workspace, and the CMS Measures Inventory Tool - July 15, 2020
- Pioneers in Quality™ Proven Practices: Establish your eCQM A-team - September 5, 2017
- Developing eCQMs for use in CMS Programs - August 17, 2017
- Introduction to Electronic Clinical Quality Measures (eCQMs) Testing - February 8, 2017
- Measure Collaboration Workspace Series –Session 3 - eCQM Data Element Repository (DERep) including health system's experience with using it to implement eCQMs - August 12, 2020
- Measure Collaboration Workspace Series –Session 2 Measure Collaboration Workspace and eCQM Flows and Clinical Flow Prototype – July 29, 2020
- Use of Clinical Dashboards to Drive Performance Improvement for eCQMs - July 31, 2019
- eCQM Pre- and Post-Implementation Testing Overview - Updated March 2019
- eCQM Implementation Checklist - April 17, 2017
- 36 short educational videos (YouTube) assist providers in implementing CMS Comprehensive Primary Care (CPC), several of which are specifically relevant to electronic clinical quality improvement:
Implementing eCQMs Eligible Hospitals and Critical Access Hospitals
- Pioneers in Quality Expert to Expert Series: PC-01 & PC-05 - March 26, 2019
- Pioneers in Quality Expert to Expert Series: CAC-3 & EHDI-1a - March 5, 2019
- Pioneers in Quality Expert to Expert Series: VTE-1 & VTE-2 - February 26, 2019
- Pioneers in Quality Expert to Expert Series: ED-1 & ED-2 - February 12, 2019
- Pioneers in Quality Expert to Expert Series: STK-5 & AMI-8a - January 29, 2019
- Pioneers in Quality Expert to Expert Series: STK-2, -3, & -6 - December 11, 2018
Implementing eCQMs Eligible Professionals and Eligible Clinicians
- Three Eligible Clinician eCQMs with Substantive Changes for the 2019 Performance Year - CMS69, CMS159, and CMS160 - February 27, 2019
- Eligible Clinician eCQM Diabetes Measures - January 30, 2019
- Eligible Clinician eCQM Preventive Care and Screening Measures - January 15, 2019
- Eligible Clinician New eCQMs Finalized for 2019 - March 11, 2019
- 2018 Pioneers in Quality: Learnings from 2016 eCQM Results, Exceptions and Exclusions - May 2, 2018
- Pioneers in Quality™ Proven Practices: Ensuring eCQM Accuracy - October 10, 2017
- Quality Reporting In CMS’ Post-Acute Care Quality Reporting Programs - August 17, 2017
- Pioneers in Quality™ Proven Practices: Keys to eCQM Success - August 14, 2017
- ONC's Innovations in the Use of Electronic Health Data for eMeasurement and Quality Improvement webinar YouTube - May 4, 2017
- Health Information Technology (IT) Curriculum Resources for Educators videos were funded by The Office of the National Coordinator for Health Information Technology (ONC) as part of the Workforce Development Programs and provide instructional materials covering areas relevant to improved care delivery. NOTE: Many of these components are over 1 GB in size. Downloading may take up to 10 minutes, depending on your connection. A number of the curriculum components cover electronic clinical quality improvement.
- eCQI Toolkit - March 2017 and eCQI Resources from Mountain-Pacific Quality Health Quality Improvement Organization assist organizations with leveraging health information technology (HIT) and the Plan Do Study Act (PDSA) process improvement methodology to support and advance their health quality improvement initiatives.
eCQI Resource Center
- eCQI Resource Center Overview - July 15, 2020
- Includes tools and resources related to the eCQM annual update for the 2021 reporting and performance period and telehealth eCQM reporting implementation and reporting guidance.
- eCQI RC: eCQM Pages - November 13, 2019
- eCQI RC: Key Tools and Resources - November 13, 2019
- eCQI Resource Center Overview - May 10, 2018
CMS provides several opportunities to provide input on eCQM development and updates, public calls for measures, comments on measures under development, and participation on technical expert panels. Visit the Measure Collaboration Workspace, the CMS Measures Management System Get Involved webpage, and the Engage in electronic clinical quality improvement (eCQI) page for a list of current opportunities.
CMS, through the ONC Project Tracking System (Jira), allows stakeholders to submit issues with eCQM implementation and development and receive feedback. Submit eCQM technical questions to the eCQM Issue Tracker. For known issues about eCQMs, see the eCQM Known Issues Jira project.
Information on various helpdesks and tools for eCQM help is found on the eCQI Resource Center Contact Us page.