About eCQI

Electronic Clinical Quality Improvement (eCQI)

The Centers for Medicare & Medicaid Services (CMS) is working to improve the nation’s health by transforming from a system focused on the amount of care provided to one centered around the value of care and needs of patients. To do this, CMS uses quality measurement to improve care by measuring how patients are treated and, most importantly, how well those patients do afterward. Electronic clinical quality improvement (eCQI) uses the data and capabilities of electronic health records and other health information technology, together with clinical best practices, to measure performance and drive continuous quality improvement. 

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This eCQI Ecosystem graphic, adapted from a Health Level Seven International® (HL7®) Clinical Quality Improvement workgroup graphic, highlights the ideal flow of evidence-based information used to evaluate clinical performance and outcomes in health care organizations. Although the graphic presents the process in a clear, step-by-step way, the process is often repeated and refined over time through ongoing collaboration among interested parties.

Digital quality measures (dQMs), including Electronic clinical quality measures (eCQMs), evaluate the quality of health care provided by hospitals, clinicians, and other measured entities. Measured entities are the individuals, clinicians, or health care organizations whose care processes and outcomes are evaluated using quality measures. dQMs use HL7®-standardized data elements, terminology, logic, and definitions, enabling clinical quality measures to be captured, stored, shared, and read electronically. dQMs leverage interoperable Fast Healthcare Interoperability Resources® (FHIR®)-based data modeling and expand the data source concept to devices, systems or applications outside of traditional electronic health records (EHRs).

Advancements in health data interoperability create new opportunities to modernize CMS’s quality measurement systems. HL7's FHIR® Release 5 and related data standards enable health data to be represented and shared consistently among clinicians, organizations, and patients. CMS is transitioning to dQMs beginning with FHIR-based eCQMs.

Currently, most measures review past care to determine whether the measured entity followed the evidence-based standards of care for each patient. The next stage of quality improvement in health care transformation involves using clinical decision support (CDS) and dQMs together. Integrating dQMs with CDS moves measurement beyond retrospective review by using patient data, history, and preferences to support more personalized care decisions.

CMS supports this transformation by aligning measure components, tools, and standards. Consistent standards help ensure data consistency, validity, and interoperability, which improves information sharing, software development, and system integration across health IT systems. Through this alignment, electronic measurement is expanding beyond eCQMs to include dQMs, which incorporate a variety of data sources, such as case management systems, laboratory systems, and prescription drug monitoring programs. Using data from multiple sources enables more precise and usable information for measurement, population health surveillance, care coordination, and provide clinicians a more holistic view of every patient’s health with actionable data available at critical decision points. 

CMS provides additional information about the transition to digital quality measurement through its Digital Quality Resources. If you are interested in the standards being used for this transition, consider joining the Quality Data Implementation User Group if you are interested in the standards to be used for this transition.