eCQM Annual Update Implementation Checklist

The Centers for Medicare & Medicaid Services (CMS) require eligible clinicians (EC) and hospitals to use the appropriate eCQM versions for the designated reporting/performance period for applicable quality reporting programs. Please check the eCQM Standards and Tools Versions table for which version of the eCQM you should use for a specific reporting/performance period.

CMS makes annual updates to the eCQMs and hybrid measures adopted in CMS programs.

Annual eCQM updates may include:

Codes system changes – SNOMED CT, RxNorm, etc
Logic, data model, value set, and direct reference code (DRC) updates
Clinical updates based on new research, literature, and clinical guidelines
Clarifications based on implementation issues reported in the Jira Project Tracking System
Changes based on advances in technical standards and data exchange protocols.

CMS also updates eCQM materials annually. Materials updates may include:

Guide for Reading eCQMs
Specifications (human-readable documents and machine-readable XMLs)
Technical Release Notes (TRNs)
Value Sets, Binding Parameter Specification (BPS), Direct Reference Codes (DRCs)
eCQM Logic and Guidance Document
Telehealth Guidance
eCQM Flows
Quality Reporting Document Architecture (QRDA) Implementation Guides.

The Preparation and Implementation checklists below provide technical steps health information technology (IT) developers, implementers, and measured entities must follow to update their systems and processes with the eCQM Annual Update (AU). Note the steps below assume it has been determined which eCQMs to report.

Preparation Checklist

1. Sign up for a Unified Medical Language System (UMLS) account

A UMLS account grants access to the value sets in the Value Set Authority Center (VSAC) to view all concepts and codes included in eCQM value sets.

2. Sign up for an ONC Project Tracking Jira account

Create an Account on the ONC Project Tracking System (Jira).

*If you receive a warning message during sign up, email onc-jira-questions@healthit.gov for help.

After you have an account, you can submit questions about eCQM implementation and receive feedback by creating an issue ticket in the ONC Project Tracking System. Available topic areas include:

3. Create an eCQI Resource Center account

4. Create a Cypress Account

Cypress provides implementers with the ability to validate the conformance of QRDA Category I and Category III documents to CMS QRDA Implementation Guides and verify the results of eCQM calculation.

5. Review the code system versions used in the eCQM specification for the upcoming reporting/performance year

Review the eCQM Pre-Publication document and the VSAC download page.

Work with your coding department and health IT vendor to ensure your systems have been updated to the latest code versions.
Some value sets contain “legacy codes.” These codes will be inactive in the current code system version but will be considered active in one of the prior code system versions noted in the file.

6. Review the standards, tools, and documents used to support the eCQM specification for the upcoming reporting/performance year

Work with your health IT vendor to ensure your systems are using updated technical standards and testing tools found in the eCQM Pre-Publication document and eCQM Standards and Tools versions table.

7. Review EHR certification requirements with your vendor/health IT developer

Work with your EHR vendor/Health IT developer to ensure the technology you are using is certified for eCQM reporting and has been tested with the Cypress tool. Visit the Health IT Certification for eCQM Reporting page for more information.

Implementation Checklist

1. Access and review the appropriate eCQM Annual Update

Review the updated eCQMs used in CMS quality programs for the upcoming reporting/performance period in the sortable tables on the Eligible Clinician, Hospital - Outpatient, and/or Hospital - Inpatient eCQMs webpages.
- Read and verify if the Telehealth guidance for Eligible Clinicians for the quality reporting period affects your reporting.
Download the eCQM annual update zip files and corresponding implementation resources on the Eligible Clinician, Hospital - Outpatient, and/or Hospital - Inpatient eCQM Resources tabbed webpages.

2. Access and view measure specification files

Navigate to an individual measure page by selecting an eCQM title on one of the tabular pages above. You can also search for measures on the homepage directly below the homepage banner.

On the individual measure page, select the Specifications and Data Elements tab. Download and open the specification zip file for the individual eCQMs or hybrid measures your organization uses. Review Health Quality Measure Format (HQMF) including specific reading instructions.

*You can also download individual measure specifications directly from the tabular pages mentioned above.

HTML file - Provides high level understanding of the header information from the Health Quality Measure Format (HQMF) and the population criteria, definitions, functions, terminology, data criteria, supplemental data elements, and risk adjustment variables used in eCQM calculation.
Machine-Readable (XML) (Contained within the zip file) - Translates metadata from human-readable header into computer code. The XML also contains code to reflect the population criteria.
Technical Release Notes (TRNs) - Provides a list of all changes since the last version for the eCQM or hybrid measure.

3. Reference eCQM data elements

Navigate to the eCQM Data Element Repository (DERep)
Select the desired filter option: EC eCQMs, Hospital - Inpatient eCQMs, Hosptial - Outpatient eCQMs, or Hybrid Measures. Select “Apply.” You can also use the search option.
Locate the desired measure and select the link.
Select a specific data element for specific information such as clinical focus, QDM Datatype, QDM Attributes, and other eCQMs using the data element.

4. Download value sets

Examples and potential changes

The National Library of Medicine (NLM) publishes updates to the eCQM value sets annually as part of the AU. VSAC updates the terminologies with new releases as they come, but that is not the same as updating the value sets. It is up to the measure developer to actually update the value set. Examples include:

International Classification of Diseases (ICD)-10 Clinical Modification (CM) and Procedure Coding System (PCS)
SNOMED CT
Logical Observation Identifiers Names and Codes (LOINC)
RxNorm

The changes to the value sets may consist of:

Deletion of expired codes
Addition of relevant replacement codes
Addition of newly available codes representing concepts consistent with the intent of the value set and corresponding eCQM(s) and hybrid measure(s)

Find the selected reporting/performance period value sets, DRCs, and BPS from NLM’s VSAC using your UMLS license log in. Note the Specifications and Data Elements tab of each individual eCQM and hybrid measure on the eCQI Resoure Center provides a link to the value sets for use in that specific measure.

2. Download value sets by (eCQM) CMS ID, Value Set Name, or QDM category.

3. Review the DRCs, BPS, and value sets to track retired code lists and confirm your electronic health record (EHR) is ready to support the most current eCQM release.

4. Use the value set compare feature in VSAC to identify the changes from the last version to the most recent expansion version of a value set more easily

5. Evaluate changes to the eCQM or Hybrid Measure

Key Points to Consider

Are there new data elements you need to capture?
Are there changes to the eCQM or hybrid measure logic that may have workflow implications?
Are there changes that may impact calculation such as updates to inclusion/exclusion criteria?

1. Perform a Gap Analysis

Compare the eCQM metadata (content in the header of the HQMF) using the Compare feature on the Measure Information tab of each individual eCQM page. Note: The Compare feature is not available for new eCQMs, nor does it compare the logic.

To use the Compare feature, navigate to an individual measure page (as described in earlier steps). Header text describes how the compare tool highlights changes between versions. Select the year desired for comparison and select the Compare button. It is possible to compare two previous versions, but you must select a previous year’s measure version to start.

The table will display two columns comparing the years selected with the newest on the right, allowing you to see exactly where all changes are in relation to the previous version.

2. Read the Technical Release Notes

The TRNs provide an overview of technical changes, e.g., logic and terminology to each measure. Read these notes to identify the updates requiring action on your part such as updating diagnosis codes and/or data fields available in your EHR or an end user’s workflow. Note new measures do not have technical release notes.

Access a measure's release notes by selecting the "Release Notes" tab on the far right above the compare page.

3. Read the eCQM Logic and Implementation Guidance

This guidance provides general logic and implementation guidance along with detailed information on topics such as measure versioning and time interval calculations.

Find the relevant eCQM Logic and Implementation Guidance document by navigating to the eCQM Resources tab on the Eligible Clinician, Hospital - Outpatient, and/or Hospital - Inpatient eCQMs webpages.

4. Define what system requirements are needed to implement the update

This will be system-specific. Work with your health IT department to define system requirements needed to implement the update. Reference the Workflow Assessment for Health Information Technology (IT) Toolkit.
Compile a list of system requirements across the eCQMs and hybrid measures the measured entity will report, as well as overall workflow impacts.
Data Capture
- Consider new query builds in your EHR.
- Consider interfaces to bring data from disparate applications into certified EHR technology.
- Deploy alerts, reminders, and order sets judiciously.
Once you have captured the current state of the existing process, work with stakeholders and key performers to revise the process according to the desired changes. Consider where/how to capture data (e.g., cardiovascular services) and evaluating aspects of care coordination or transitions of care.

5. Consider potential workflow impacts

Implementing eCQM updates may create significant and unforeseen impacts. The most effective way to identify and manage workflow impacts and interactions is to conduct a careful workflow analysis of the existing process. Consider the following:

The flow of information, in paper or electronic formats, among people in a clinical environment
The activities of everyone involved during a patient visit or hospitalization
The workflow between health care organizations
What people know, learn, and understand about the process

6. Compile a list of system requirements across the measures the organization will report, as well as overall workflow impacts.

7. Implement system changes to support data capture for the updated measures.

8. Educate clinicians on changes to data entry or workflow, if any.

6. Validate Data

Implementing the new process will allow you to use available data, knowledge of patient population, and secondary data sources to review performance, including:

Data capture
Mapping
eCQM or hybrid measure
Value set

Access the CMS QRDA Pre-Submission Validation Tools.

The Hospital Quality Reporting (HQR) System, includes troubleshooting functionality in the test portion of the HQR System, such as checking for valid submission period dates and providing eCQM outcome information. Submitters can perform all functions for validation of CMS QRDA Category I files in the test portion of the HQR System and receive succinct and informative feedback. Users have simultaneous access to the test and production portions of the HQR System as they prepare for production QRDA Category I file submissions for eCQM and hybrid measure reporting to CMS quality reporting programs.
The Cypress QRDA Validation Utility (CVU) conformance tool provides implementers with the ability to validate the conformance of QRDA Category I and Category III documents to CMS implementation guides and verify the results of eCQM calculation. The most recent release, along with release notes, are available on the Cypress website. Version 7.3 includes the fully integrated Cypress Validation Utility + Calculation Check (CVU+) supporting the 2015 Edition Cures Update Certification for the ONC Certification Program for eCQMs. This version also supports testing the EH/CAH eCQMs, the Eligible Clinician eCQMs, and the Outpatient eCQMs updated for calendar year 2025 reporting.

7. Prepare to report the updated eCQMs

Review the QRDA Reference and Implementation Guides for eCQMs.
Review the eCQM Known Issues (eKI) Jira Tracker. The eKI dashboard provides implementation information for eCQMs with known technical issues for which a solution is under development but not yet available in a published eCQM specification.

8. Report eCQMs

For hospital reporting guidance, visit QualityNet and the Quality Reporting Center for specific program reporting education.
For clinician reporting guidance, visit the Quality Payment Program website and the Quality Payment Program Resource Library.
For information about the Medicare Promoting Interoperability Program, refer to the CMS Promoting Interoperability Program webpage.
For federal health agency programs using eCQMs, refer to specific program requirements.

9. Reach out for help

Visit the Contact Us page.

eCQM Annual Update Implementation Checklist

Preparation Checklist

Implementation Checklist

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