The eCQM Lifecycle

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

  • Measure Conceptualization
  • Measure Specification
  • Measure Testing
  • Measure Implementation
  • Measure Maintenance, Use, and Validation

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

CMS provides several opportunities for stakeholders to engage throughout the measure lifecycle.  Visit the Engage page to select activities of interest to you.  

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


Steps: Opportunities are available for the public to engage in the measure development process including Call for Measures, Technical Expert Panels, and Public Comment. Recent literature is reviewed to determine the evidence base for measure concepts to be developed. Basic elements of a measure (Initial Population (IP), denominator, numerator, denominator exclusions, umerator exclusions and exceptions) are generated.
Tools and Resources:, JIRA, QDM, USHIK, literature reviews, stakeholder interviews and focus groups
Actors: CMS, measure developers and measure stewards, patients, providers, researchers


Steps: Opportunities are available for the public to engage in the measure development process including Public Comment. 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 and Resources: Bonnie, Cypress, Data Element Catalog (DEC), JIRA, Measure Authoring Tool (MAT), QDM, VSACVSAC Collaboration
Actors: Measure developers, measure stewards


Steps: A measure’s feasibility, usability and scientific acceptability is tested. Health IT’s ability to accurately calculate measures is tested and certified. 
Tools and Resources: Bonnie, Cypress, MAT, JIRA, Implementation Testing, VSAC, Health IT Certification for eCQM Reporting
Actors: Health IT vendors, Measure developers, measure stewards


Steps: Federally approved measures for a given measurement program are published within program rules and/or guidelines. CMS publishes updates to the eCQMs annually and may publish addenda to the updates. Health IT vendors and providers implement measures for a given quality measurement program.
Tools and Resources: eCQM Implementation Checklist, Certified health IT, eCQI Resource Center, JIRA, USHIK, VSAC
Actors: Federal agency communication departments, health IT vendors, providers

Measure Maintenance, Use, and Validation

Steps: Stakeholder feedback on the implementation and use of measures is received by CMS and shared with measure stewards and developers to improve future versions.
Tools and Resources: 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 eCQM is here: