dQMs - Digital Quality Measures

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) syntax into the Expression Logical Model (ELM) representation. The reference implementation is used in support of Clinical Quality Framework implementations as a tool to enable CQL output to be uniformly and automatically translated into ELM XML or JavaScript Object Notation (JSON) documents for sharing and distribution to support implementation, integration, translation, and execution of CQL-based artifacts.

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

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.

Visual Studio Code is an open-source text editor that can expand its utility by installing appropriate extensions. The ‘cqframework.cql’ extension supports highlighting, syntax checking, ad hoc evaluation, test cases, terminology for Clinical Quality Language (CQL), and Fast Healthcare Interoperability Resources® model validation. This free text editor can be used to facilitate electronic clinical quality measure evaluation and testing using the open source CQL Evaluation Engine.