CDS/eCQM Harmonization

How are CDS & eCQM different?

Clinical Decision Support (CDS) and electronic Clinical Quality Measurement (eCQM) are closely related, share many common requirements, and support health care quality improvement. It’s important to also understand, though, the differences between them and the efforts to help them work together (harmonize).

The standards used for the electronic representation of CDS and eCQM were developed separately and use different data models and computable expression languages. The use of different standards

  • Makes re-using or sharing machine readable logic between eCQMs and CDS rules very difficult
  • Creates a burden for health IT developers and those who provide technical support for implementation

Why harmonize CDS & eCQM?

Harmonization of CDS and eCQM standards will improve the ease of implementation. Harmonization will also make it easier to integrate and facilitate health IT enabled clinical quality improvement. Ultimately, the same or similar standards will be made and used to

  • Measure if appropriate care was given
  • Suggest care to providers and care teams when there are opportunities to improve care quality

Instead of developing a new standard that could be used for eCQMs and CDA, the focus is on

  • Modularizing or organizing the existing standards so they’re more flexible
  • Making common components that can be shared by both eCQMs and CDS

Who is harmonizing CDS & eCQM?

The Clinical Quality Framework (CQF) initiative is a public-private partnership sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to identify, develop, and harmonize standards for CDS and eCQM.

The presentation, Quality Improvement Standards Harmonization and the Clinical Quality Framework – Using Cross-Initiative Coordination to Reach the Future State, provides details on the Clinical Quality Framework and CDS/eCQM standards harmonization efforts. 

The table below outlines the common areas and differing standards currently used in CDS and eCQMs.

 Quality InformationComputable Expression LogicMetadata
Clinical Decision Support (CDS)Virtual Medical Record (vMR-for both physical and logical models)CDS Knowledge Artifact Implementation Guide

CDS Knowledge Artifact Implementation Guide

Decision Support Service

Electronic Clinical Quality Measurement (eCQM)

Quality Reporting Document Architecture (for physical model)

Quality Data Model (for logical model)

Health Quality Measure Format (for physical model)

Quality Data Model (for logical model)

Health Quality Measure Format

The strategy employed by the CQF initiative is to identify the common components used by each domain and define common standards for each of the core components.  

Common Shared Standards

eCQM and CDS specific standards include common metadata standards common data model standard and common expression logic standards

To date, these efforts have produced the following specifications for these common elements:

Common Metadata Standard:

HL7 Specification: Clinical Quality Common Metadata Conceptual Model, Release 1

Common Expression Logic Standard:

HL7 Cross-Paradigm Specification: Clinical Quality Language, Release 1 (CQL)

Common Data Model Standard:

HL7 FHIR Profile: Quality, Release 1 - US Realm (QI-Core)

CQF and HL7® FHIR® 

HL7 FHIR® (Fast Healthcare Interoperability Resources) Specification is a standard for exchanging healthcare information electronically. The CQF initiative has developed various FHIR resources, profiles, and implementation guidance to represent quality measures and decision support artifacts. These resources are

  • Consistent with the Common Metadata Standard, and can use Clinical Quality Language (CQL) to represent expression logic, and the Quality Improvement Core Framework (QI-Core) profiles to represent clinical information.
  • Defined as part of the Clinical Reasoning Module of the Standard for Trial Use (STU) 3 version of the FHIR® standard. The Clinical Reasoning Module is published as part of FHIR STU3.
  • Being used and tested in a variety of settings including FHIR connectathons and ongoing pilots to validate that they can effectively fulfill the need for a single set of standards to support delivery of both decision support and quality measurement artifacts.

To learn more about this effort, please visit the Clinical Quality Framework github website.