dQMs - Digital Quality Measures

Clinical Decision Support (CDS) Connect is a freely available web-based platform, including an authoring tool and a repository, enabling the CDS community to identify evidence-based care, translate and codify information into an interoperable health information technology standard, and leverage tooling to promote a collaborative model of CDS development.

*Note: On April 28th, 2025, AHRQ’s CDS Connect went offline. An updated, likely final version of its authoring tool has been developed by the HL7® community as CDS Connect Community Edition. A newer set of tools, the open source CQL Studio, is an integrated web application suite for developing, testing, and publication of CQL- and FHIR-based artifacts that can be developed into computable guidelines, CDS, or dQMs, providing a functional superset of capabilities.

The Clinical Quality Framework (CQF) Ruler is a collection of plugins built for the HAPI Fast Healthcare Interoperability Resources® (FHIR®) Java Persistence API (JPA) server that brings the FHIR Clinical Reasoning Module to life. It enables healthcare organizations and developers to process electronic clinical quality measures (eCQMs), evaluate decision logic, and apply clinical rules in real time. Beyond quality measurement, the CQF Ruler acts as a central repository for knowledge artifacts, such as care guidelines and decision support rules, and serves as a clinical decision support service that can provide actionable recommendations at the point of care. By combining measure processing, knowledge management, and decision support, the CQF Ruler helps make quality reporting and evidence-based care more efficient, consistent, and interoperable across FHIR-enabled systems. 

The Clinical Quality Language (CQL) Evaluation Engine is an open source Java-based evaluation engine capable of evaluating the result of any CQL expression. Note: this is a component in the CQL translator repository.

Clinical Quality Language (CQL) Execution Framework is the engine that runs the rules and expressions defined in CQL to evaluate electronic clinical quality measures (eCQMs), decision support logic, or other healthcare-related computations.

The CQL-to-ELM Translator is an open-source reference implementation that translates the high-level Clinical Quality Language (CQL) source into the Expression Logical Model (ELM), a machine-readable representation of CQL logic. The translator supports syntactic and semantic validation of CQL and can generate ELM in XML or JavaScript Object Notation (JSON) format. Developed as part of the Clinical Quality Framework (CQF) effort, it supports consistent implementation of CQL-based artifacts by providing a standardized intermediate representation that can be used by authoring tools, validation tools, and CQL execution engines.

For more information or to get involved, visit the Clinical Quality Framework initiative page.

The Quality Measure Implementation Guide (QM IG) is intended to provide guidance on the representation of quality measures including digital quality measures (dQMs) using Fast Healthcare Interoperability Resources® (FHIR®) Clinical Reasoning Module. It defines the required structure, metadata, terminology, definitions, and logic needed to author, package, and evaluate dQMs in a consistent and computable way.

The Interoperability Standards Advisory (ISA) process represents the model by which the Office of the National Coordinator for Health Information Technology (ONC) coordinates interoperability standards and implementation specifications for industry use to fulfill specific clinical health information technology interoperability needs. ASTP updates the ISA throughout the year to include improvements based on recommendations received from public comments and subject matter experts. These updates are published in an annual Reference Edition. To learn more about the ISA, please visit https://isp.healthit.gov/about-isa.

Measure Authoring Development Integrated Environment (MADiE) is a software tool that makes creating and testing electronic clinical quality measures (eCQMs)/digital quality measures (dQMs) easier by combining both steps in one application.

MADiE allows eCQM developers to author eCQMs using Quality Improvement (QI)-Core, the Quality Data Model (QDM), and Fast Healthcare Interoperability Resources® (FHIR®) to test and verify eCQM behavior. MADiE helps eCQM developers execute eCQM logic against the constructed test cases to provide users with information to evaluate if the eCQM logic aligns with the intent of the eCQM.

The Office of the National Coordinator for Health Information Technology (ONC) Project Tracking System uses Jira, a project management and issue-tracking platform developed by Atlassian.

This system provides a centralized and transparent platform for users to log, track, and discuss issues with subject matter experts across a broad range of topics including: Hybrid Measures, CQL, Cypress, eCQMs, MADiE, QDM, QRDA, and USCDI+ Quality (FHIR/dQM projects coming soon). CMS uses the system throughout the development, implementation, and maintenance stages of the measure lifecycle.

A 90-day account deactivation policy is enforced for users who have not logged into the system for 90 consecutive days or longer.

Postman is a collaboration platform designed for developing and testing application programming interfaces (APIs). It serves as a hypertext transfer protocol (HTTP) client that allows users to test HTTP requests and receive various types of responses through an intuitive graphical user interface. Postman simplifies interactions with Fast Healthcare Interoperability Resources® (FHIR®) servers, enabling users to post requests and updates efficiently. It is particularly useful for testing FHIR-based digital quality measures (dQMs) during Health Level Seven International® (HL7®) Connectathons.

The Value Set Authority Center (VSAC) is a tool and repository for creating and managing value sets. It serves as the official source for value sets used in CMS electronic clinical quality measures (eCQMs) and digital quality measures (dQMs). The National Library of Medicine maintains the VSAC and offers access through web browsers and application programming interfaces (APIs).

The VSAC offers downloadable files for each measure release. These files include complete value sets for eCQMs and dQMs, the Binding Parameter Specification, and the complete lists of Direct Reference Codes, retired codes, and utilized code systems. The VSAC also provides tools that let users search existing value sets, create new ones, and keep value sets aligned with current terminology versions. Users must obtain a free Unified Medical Language System license to access the VSAC.