The eCQM Lifecycle

Electronic clinical quality measures (eCQMs) progress through multiple lifecycle phases

  • Measure Conceptualization
  • Measure Specification
  • Measure Testing
  • Measure Implementation
  • Measure Use, Continuing Evaluation, and Maintenance

A Blueprint for the Measures Management System, outlines core processes for CMS-funded measure developers (or contractors) to follow when moving through the eCQM lifecycle for the quality measures used in various CMS quality initiatives and programs. 

View slides from eCQM 101 - Developing eCQMs for Use in CMS Programs.

CMS provides opportunities for the public to engage in the measure development process.  View the overview including the Call for Measures page, Technical Panels page and Public Comment page.

These are the steps, tools, and actors for each eCQM lifecycle stage:


Steps: Recent literature is reviewed to determine the evidence base for measure concepts. Basic elements of a measure (Initial Patient Population (IPP), denominator, numerator, denominator exclusions, numerator exclusions and exceptions) are generated.
Tools:, JIRA, QDM, USHIK, literature reviews, stakeholder interviews and focus groups
Actors: CMS, measure developers and measure stewards, patients, providers, researchers


Steps: Electronic specifications for a clinical quality measure are defined and developed iteratively so that they may be collected within certified health IT and reported.
Tools: Bonnie, Cypress, Data Element Catalog (DEC), JIRA, Measure Authoring Tool (MAT), QDM, VSAC
Actors: Measure developers, measure stewards


Steps: A measure’s feasibility, usability and scientific acceptability is tested.
Tools: Bonnie, Cypress, MAT, JIRA, Implementation Testing, VSAC
Actors: Measure developers, measure stewards


Steps: Federally approved measures for a given measurement program are published.
Tools:, eCQI Resource Center, USHIK, VSAC
Actors: Federal agency communication departments


Steps: Health IT developers and providers implement measures for a given quality measurement program.
Tools: Certified health IT, JIRA, USHIK, VSAC
Actors: Health IT developers, providers


Steps: Health IT’s ability to accurately calculate measures is tested. Read more about Health IT Certification for eCQM Reporting.

Tools: Cypress, JIRA
Actors: Health IT developers


Steps: Measures are reported to private and public payers.
Tools: Varies based on payer.  CMS Electronic Reporting Using an Electronic Health Record (EHR), CMS Electronic Health Record (EHR) Reporting Made Simple
Actors: Health IT developers, private and public payers, providers

Continuous Evaluation

Steps: Feedback on the implementation of measures is received by CMS and shared with measure stewards and developers to improve future versions.
Tools: JIRA
Actors: Measure developers, measure stewards, health IT developers, providers, federal agencies

Detailed information for the tools referenced here are located on the eCQM Tools page.

Additionally, the National Quality Forum (NQF) endorses eCQMs.  Interested stewards and/or developers may submit candidates for consideration by NQF.  Submission guidance for eMeasures is here: