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eCQMs

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.

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
  •  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, and commercial insurance payers in programs that reimburse providers based on quality reporting.

Find eCQMs:

Eligible hospital (EH) and critical access hospital (CAH) eCQMs and supporting materials are on the eligible hospital/critical access hospital page of this website.  

Eligible professional (EP) and eligible clinician eCQMs and supporting materials are on the eligible professional/eligible clinician page of this website.

Find Pre-rulemaking eCQMs:

CMS pre-rulemaking eCQMs include measures that are developed, but specifications are not finalized for reporting in a CMS program.

Eligible hospital (EH) and critical access hospital (CAH) pre-rulemaking eCQMs.  

Eligible professional (EP) and eligible clinician pre-rulemaking eCQMs.

Report eCQMs:

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 Programwebsite 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.

eCQI Graphic for Healthcare Goals

Many different organizations may participate in the development and maintenance of 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 initiative programs. Information on the CQM and eCQM development lifecycle is available in the Blueprint for the CMS Measures Management System (Blueprint) and on the eCQM Lifecycle webpage. The 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 programs. 

eCQM Lifecycle:

The eCQM Lifecycle is a series of phases 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 users of the eCQMs 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 EHR, eCQMs are made of electronic specifications. Health Quality Measure Format (HQMF), a Health Level Seven International (HL7) standard, is used for electronically documenting eCQM content. These electronic specifications include:

  • Computable representation of the eCQM: Contains 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. The HQMF includes a Header and a Body. The header identifies and classifies the document and provides important metadata about the measure. The body contains eCQM sections (e.g., definitions, population criteria, supplemental data elements).
    • Clinical Quality Language (CQL)
    • Expression Logical Model (ELM) XML document
    • ELM JavaScript Object Notation (JSON)

  • 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).   

Naming eCQMs:

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 Information

Value

eCQM Identifier (MAT)

123

eCQM Version number

1

CMS eCQM identifier

CMS123v1

 

The eCQM tools and resources provide a foundation for the development, testing, certification, publication, implementation, reporting, and continuous evaluation of quality measures and their improvement. You can refine the tool list by selecting a category of interest and/or a role that best describes your needs, or you can also click a specific tool from the list below to view additional details.

MAT

Category:

The Measure Authoring Tool (MAT) is a web-based tool that allows measure developers to author eCQMs using Clinical Quality Language (CQL) and the Quality Data Model (QDM). The MAT provides the capability to express complex measure logic and export measures in several formats.

Get Involved:

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 CMS Measures Management System Get Involved webpage and the Engage in eCQI page for a list of current opportunities.

Provide Feedback:

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.

Seek Help:

Information on various helpdesks and tools for eCQM help is found on the eCQI Resource Center Contact Us page.

Last Updated: Jul 29, 2019