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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. 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.

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.

Explore Measure Collaboration (MC) Workspace:

The MC Workspace is comprised of the eCQM Concepts, New eCQM Clinical Workflow, eCQM Test Results, and the eCQM Data Element Repository (DERep).

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.

Find Hybrid Measures:

Hybrid measures are quality measures that merge electronic health record data elements with claims data to calculate measure results. Currently hybrid measures have only been adopted for use in hospital quality reporting programs.

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 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 Framework:

CMS’s comprehensive initiative “Meaningful Measures” 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. 

 

Meaningful Measures Framework graphic

 

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. 

eCQM Lifecycle:

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.
      • ELM JavaScript Object Notation (JSON) file (.json). The JSON file is the ELM file in JavaScript Notation, as opposed to XML.
  • 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.

VSAC

The Value Set Authority Center (VSAC) is a value set authoring and central repository for the official versions of value sets that support the electronic clinical quality measures. The National Library of Medicine maintains the VSAC and provides downloadable access to the value sets and the Binding Parameter Specification. The VSAC provides measure developers with tools to search existing value sets, create new value sets, and maintain value set content consistent with current versions of the terminologies they use. A free UMLS license is required to access the value set details.

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 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.

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 TrackerFor known issues about eCQMs, see the eCQM Known Issues Jira project.

Seek Help:

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

Last Updated: Aug 17, 2020