About eCQI

Electronic Clinical Quality Improvement (eCQI)

The Centers for Medicare & Medicaid Services (CMS) is working to improve the health of our nation by transforming care from a volume-based, provider-centered system to a value-based, patient-centered, learning health system. This transformation includes using quality measurement to improve care given to patients by measuring how patients are treated and, most importantly, how well those patients do afterward. eCQI activities provide common standards and shared technologies to monitor and analyze the quality of healthcare provided to patients and patient outcomes.

eCQI Ecosystem

This eCQI Ecosystem graphic was adapted from a graphic developed by the Health Level Seven International® (HL7) Clinical Quality Improvement workgroup. The image highlights the ideal iterative flow of evidence-based information from research to clinical practice and measurement to evaluate clinical performance and outcomes for healthcare organizations. Please note that while it is depicted in a linear fashion, the process is often interactive between stakeholders and phases, and is iterative.

Electronic clinical quality measures (eCQMs) measure the performance of hospitals, clinicians, and others (measured entities) who provide healthcare services. The “e” in eCQMs means performance is measured using data extracted from an electronic health record (EHR) and/or health information technology (IT) system. eCQMs include data elements, terminology, logic, and definitions using HL7 standards, which represent a clinical quality measure in an electronic document that can be captured, stored, shared, and read electronically.

Advancements in the interoperability of health care data and requirements from CMS and the Office of the National Coordinator for Health Information Technology (ONC) have created new opportunities to modernize CMS’s quality measurement systems. The ONC 21st Century Cures Act final rule requires health IT application programming interface developers to update their certified health IT to support HL7's Fast Healthcare Interoperability Resources® (FHIR) Release 4 and specific data standards allowing for the consistent representation and sharing of information among clinicians, organizations, and patients. The health care community and CMS are exploring a potential transition to FHIR®-based quality measurement beginning with FHIR-based eCQMs.

Currently, most eCQMs primarily look back at recent activities to determine whether the measured entity adhered to the evidence-based standard of care was adhered to for each patient. The next stage of quality improvement for healthcare transformation for quality improvement consists of using clinical decision support (CDS), eCQMs, and digital quality measures (dQMs) together to improve quality. Rather than limiting quality improvement to retrospective measurement, we are moving to provide standards to express CDS that use evidence-based medicine and the patient’s own history, preferences, and data to customize care recommendations and actions for each individual patient.

CMS and many private payors are committed to value-based payment models by rewarding this transformation with incentives for better outcomes and lower costs. A goal is quality improvements that better address patient needs and preferences and reduce measure entity burden.

CMS supports this transformation by working to align measure components, tools, and standards through stakeholder engagement. Standards are essential to ensure data consistency, validity, and interoperability to be better able to share information, develop software, integrate data, and implement systems. This alignment and use of standards is expanding the capability of electronic measurement beyond eCQMs to include dQMs, which incorporate a variety of data sources, such as case management systems, laboratory systems, and prescription drug monitoring programs. The use of data from multiple sources will enable more precise and usable information for measurement, population health surveillance, and care coordination and provide clinicians a more holistic view of every patient’s health with actionable data available at critical decision points. CMS invites you to view the CMS dQM Strategic Roadmap for an outline of activities required to transition to digital quality measurement and to join the Quality Data Implementation User Group if you are interested in the standards to be used for this transition.

The eCQI Resource Center brings together stakeholders from across the eCQI community and provides a centralized location for news, information, tools, and standards related to eCQI, eCQMs, and dQMs. The majority of tools and resources referenced within the eCQI Resource Center are openly available for stakeholder use. These tools and resources provide a foundation for the development, testing, certification, implementation, reporting, and continuous evaluation of eCQMs, dQMs, and CDS tools.