eCQI Tools & Key Resources

Bonnie FHIR was sunsetted June 28, 2024. Measure developers should use the Measure Authoring Development Integrated Environment (MADiE).

Bonnie Prior was sunsetted June 28, 2024. Measure developers should use the Measure Authoring Development Integrated Environment (MADiE).
 

Bonnie QDM was sunsetted June 28, 2024. Measure developers should use the Measure Authoring Development Integrated Environment (MADiE).

The value set Binding Parameter Specification (BPS) is generated by the National Library of Medicine (NLM) as part of the Value Set Authority Center’s (VSAC) Downloadable Resources. The BPS details the usage of value sets by electronic clinical quality measures (eCQMs), the binding of value sets to QDM categories, and the value sets object identifiers (OIDs) used to create grouping value sets. It also lists other select value set metadata, allowing eCQM implementers and vendors to use the BPS to track versions and other parameters of the value sets for each eCQM release. Users can access the BPS metadata file for any released set of CMS eCQM value set files through the NLM's VSAC Downloadable Resources. Access requires a free Unified Medical Language System (UMLS) license.

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.

Clinical Decision Support (CDS) Hooks is a Health Level Seven International® (HL7®) specification managed by the HL7 Clinical Decision Support (CDS) Workgroup providing a way to embed additional, near real-time functionality within a clinician’s workflow of an electronic health record. A specified event(s) within the clinician’s workflow triggers the CDS service, which gathers the appropriate specified data elements through secure Fast Healthcare Interoperability Resources® (FHIR®) services. By utilizing FHIR services, CDS Hooks provides interoperability between multiple stakeholders operating on different platforms.

The FHIR service app can return appropriate guidance, such as proposed alternative medication or formulary information. CDS Service vendors can test CDS Service functionality using the CDS Hooks Sandbox. More advanced functionality is under development, such as the multi-interested party Da Vinci Burden Reduction Project and provides use cases for alerts/notifications, prior authorization, and document exchange. The Agency for Healthcare Research and Quality's CDS Connect Project provides a web-based platform to assist with development of CDS artifacts and CDS Hooks.

Certified Health Information Technology (IT) Product List (CHPL) is a comprehensive and authoritative listing of all health IT modules certified by the ONC Health IT Certification Program. All products listed are tested by an ONC-Authorized Testing Lab (ONC-ATL) and certified by an ONC-Authorized Certification Body (ONC-ACB) to meet criteria adopted by the Secretary of the Department of Health and Human Services (HHS). For additional information on how to navigate the CHPL, please refer to the CHPL Public User Guide.

ClinFHIR is an open-source tool providing an educational environment and also allows health information technology developers to create or search for Fast Healthcare Interoperability Resources® (FHIR®)-based resources. It serves as a training tool to help people wanting to learn more about FHIR visualize how the parts combine to represent clinical information in a structured and coded manner. It also serves as a development tool with features to build some of the required artifacts, particularly as an aid to learning.

CMS Measures Inventory Tool (CMIT) is the repository of record for information about CMS quality measures. CMS and its partners use the inventory to inform stakeholders, manage its measure portfolio, and guide measure development. The functions allow users to find measures quickly, compile and refine sets of related measures, identify measures across the continuum of care, and help coordinate measurement efforts across all conditions, settings, and populations.

A CMS Electronic Health Record (EHR) Certification ID is a number generated by the Certified Health Information Technology (IT) Product List (CHPL) and used for reporting to CMS. It represents a single product or combination of products in the CHPL. The CMS EHR Certification ID is different from the CHPL product number. In the CHPL, this is the number generated when the hospital/clinician selects EHR Certification ID for a suite of products making up the hospital's/clinician's EHR solution. If a product changes, then a different CMS EHR Certification ID will be generated. The CMS EHR Certification ID is only unique to the product suite. If two different hospitals/clinicians happen to use the same products, then they will both have the same CMS EHR Certification ID.

CMS requires the CMS EHR Certification ID in several of its quality reporting programs. Check with individual quality reporting programs for requirements.

CMS Help Desks listed on the Electronic Clinical Quality Improvement (eCQI) Resource Center Contact Us page provide information and assistance regarding electronic clinical quality measures and tools used in CMS quality reporting programs.

The CMS Measures Under Consideration Entry/Review Information Tool (CMS MERIT) is the web-based data collection portal allowing measure developers to submit candidate measures to CMS for consideration. The Tool walks the submitter through the process of providing information. Each submitter has a dashboard allowing them to track the progress of their submitted measure and to communicate with CMS through the comment function. The Tool also provides a view of all measures submitted for the current year. Another purpose of CMS MERIT is to give federal officials, the consensus-based entity multi-stakeholder groups, and other stakeholders more information as they review measures.

The CMS Measures Management System (MMS) Hub is a resource providing information about the MMS, guidance for measure developers (content previously found in the Blueprint), and quality measure-related news and events. It includes information on measure development, measure implementation, measure maintenance, tools, templates, opportunities to participate in public comment and technical expert panels, and more.

The CMS Quality Reporting Document Architecture (QRDA) Implementation Guides (IGs) are based on the Health Level Seven International® QRDA IGs. The CMS QRDA Category I IG is used for Hospital Inpatient Quality Reporting, Hospital Outpatient Quality Reporting, and the Medicare Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals. The CMS QRDA Category III IG is used for the Eligible Clinician programs addressing aggregate reporting requirements for Primary Care First, traditional Merit-based Incentive Payment System (MIPS) programs, Alternative Payment Model Performance Pathway, and MIPS Value Pathway.

The CMS Quality Reporting Document Architecture (QRDA) Pre-Submission Validation Tools are resources offering QRDA validation tools available to submitters. The intent is to give users a single point of reference for these tools and assist them in selecting the most appropriate tool to meet their individual needs. The tools cover

• Cypress
• Hospital Quality Reporting System via Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP)

The Clinical Quality Framework (CQF) is a collaborative community of participants from the public and private sectors focused on providing tools, services, and guidance to facilitate the harmonization of standards for clinical decision support and electronic clinical quality measures use in clinical quality improvement.

The Clinical Quality Framework (CQF) Ruler comprises a collection of plugins tailored for the HAPI Fast Healthcare Interoperability Resources® (FHIR®) JPA server providing an implementation of the FHIR Clinical Reasoning Module for processing quality measures and serves as a knowledge artifact repository and clinical decision support service.

Clinical Quality Language (CQL) is a Health Level Seven International® mixed normative/standard for trial use and it is part of the effort to harmonize standards between electronic clinical quality measures and clinical decision support. CQL provides the ability to express logic that is human readable yet structured enough for processing a query electronically.

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 a set of JavaScript libraries that can execute CQL artifacts expressed as JavaScript Object Notation Expression Logical Model.

The Clinical Quality Language (CQL) Formatting and Usage Wiki is a collaborative workspace for the development of CQL formatting conventions and usage patterns for the representation of logic within quality measures. All users have editing rights, able to submit edits, add comments and concerns. Items on the Wiki are a work in progress and subject to change.

A Clinical Quality Language (CQL) library is a container for artifact logic/expressions. A CQL library contains declarations which specify the items found in the library. Every electronic clinical quality measure has at least one CQL library. For more information, see the CQL Style Guide and the Health Level Seven International® CQL Author’s Guide.

Clinical Quality Language (CQL) Runner is an online platform for ad hoc testing of CQL.

The Clinical Quality Language (CQL) Style Guide provides standardized expressions of electronic clinical quality measure (eCQM) concepts across eCQMs and defines a uniform “look and feel” to eCQM logic using CQL. The CQL Style Guide focuses on a set of common best practices that have been implemented across CQL-based eCQMs in CMS quality reporting programs. The CQL Style Guide also promotes the use of consistent language within the framework of CQL, including libraries, aliases, definitions, and functions, and provides guidance on other conventions, such as operator precedence. eCQM stewards or developers who are developing or specifying eCQMs for potential inclusion in CMS reporting programs should follow these best practices.

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 on the Health Level Seven International® website.

Crucible is a suite of open-source testing tools for Health Level Seven International® Fast Healthcare Interoperability Resources® (FHIR®) provided to the FHIR development community to help promote correct FHIR implementations. It currently can test for conformance to the FHIR standard, score patient records for completeness, and generate synthetic patient data.

Cypress, with the fully integrated Cypress Validation Utility + Calculation Check (CVU+), is an open source testing tool used by vendors to certify their electronic health records (EHRs) and health information technology (IT) modules for calculating electronic clinical quality measures (eCQMs). Cypress is an official testing tool for the ONC EHR Certification Program. Testing involves Cypress generating synthetic patient records for the subset of published eCQMs selected for certification and testing the ability of the EHR systems and health IT modules to accurately record, import, calculate, filter, and report eCQMs.

The Cypress Tech Talks are an open forum for discussing technical implementation and tool issues with the Cypress support team.

The De Novo Measure Scan (DNMS) is an advanced feature of the Environmental Scan Support Tool (ESST) on the controlled access CMS Measures Inventory Tool (CMIT) site. You must have a CMIT login to access. The DNMS helps measure developers conduct early and frequent environmental scans while developing new measures. The DNMS uses a Clinical Quality Measure ontology to describe a measure and represent quality measure concepts. Components of the ontology include target population, health status or utilization, change concept, expected output of the change concept, and care setting. The DNMS uses structured search terms to represent the measure concepts to build a new measure and uses artificial intelligence to identify and prioritize the most relevant PubMed, PubMed Central, and CINAHL related literature.

The Health Level Seven International® (HL7®) Data Exchange for Quality Measures (DEQM) Implementation Guide (IG), provides a framework defining conformance profiles and guidance to enable the exchange of quality improvement information including quality measure reporting (e.g., for transferring quality information from a health care provider to a payor) using Fast Healthcare Interoperability Resources® (FHIR®)-based resources. 

The sponsoring HL7 workgroup, Clinical Quality Information, manages the changes of this FHIR IG, which the workgroup incorporates as part of the standard balloting process. The update cycle follows closely with the Quality Measure IG and Quality Improvement Core (QI-Core) Implementation Guide (IG). 

The DEQM IG supports data exchange and reporting scenarios including individual reporting, summary reporting, and gaps in care reporting. The DEQM Individual MeasureReport profile supports individual reporting and the DEQM Summary MeasureReport profile supports summary reporting. These profiles support the Quality Reporting Document Architecture (QRDA) Category I and QRDA Category III reporting use cases in the Quality Data Model-Clinical Quality Language-QRDA paradigm.

The Electronic Clinical Quality Improvement (eCQI) Resource Center User Group is a volunteer forum of eCQI Resource Center users that use the site to obtain resources necessary for electronic clinical quality measure (eCQM) development, implementation, reporting, and education on key eCQM and eCQI concepts and standards. The eCQI Resource Center User Group meets quarterly on the 3rd Tuesday at 3:00pm ET.

This document describes the versions of the standards and code systems used in conjunction with the updated eCQMs for potential use in CMS programs for a given reporting/performance period.

The Measure Collaboration Workspace Electronic Clinical Quality Measures (eCQM) Concepts Module gives users the ability to suggest new eCQM concepts and comment on other's suggested eCQM concepts.

CMS encourages all stakeholders, including patients and point of care clinicians, to suggest eCQM concepts and offer comments on others' suggested eCQM concepts. 

The eCQM Data Element Repository (DERep) provides clarification, definitions, and clinical focus for the data elements associated with electronic clinical quality measures (eCQMs) used in CMS quality reporting and incentive programs. Users can filter information by data element, eCQM, Quality Data Model (QDM) attribute, QDM category, QDM datatype, or QDM entities.

The electronic clinical quality measure (eCQM) Flows are flowcharts designed to assist in the interpretation of the eCQM logic and provide the calculation methodology to determine measure scores. These flows provide an overview of each of the population criteria components and associated data elements that lead to the inclusion, exclusion, or exception into the eCQM’s denominator and numerator, if applicable.

The eCQM flows are available for eligible clinician eCQMs, eligible hospital/critical access hospital eCQMs, and outpatient quality reporting eCQMs.

The Electronic Clinical Quality Measure (eCQM) Implementation Checklist assumes a health care practice/organization has determined which quality measures to report. The checklist provides the necessary technical steps health information technology developers, implementers, and health care organizations must take to update their systems and processes with the eCQM Annual Update for the upcoming reporting and performance periods. The most recent eCQM Annual Update should be applied to electronic health record systems for use in electronic quality reporting.

The Electronic Clinical Quality Measure (eCQM) Known Issues 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. This includes discrepancies between eCQM narrative and logic, value sets, and/or technical, standard, or logic-related issues.

The Electronic Clinical Quality Measure (eCQM) Logic and Implementation Guidance is a resource document which provides guidance for understanding, using, and/or implementing eCQMs. This document includes useful context and details regarding topics such as Clinical Quality Language representation in the technical specifications, applying data elements and value sets/coding, and the ONC Project Tracking System (Jira) to provide feedback on the eCQMs.

The Electronic Clinical Quality Measure (eCQM) Testing Opportunities Module of the Measure Collaboration Workspace allows eCQM developers to announce opportunities to test eCQMs. eCQM developers can use testing to assess a variety of things such as eCQM feasibility, reliability, validity, and usability. Interested parties wanting to participate in testing eCQMs should contact the eCQM developer directly.

The Environmental Scan Support Tool (ESST) is a tool within the CMS Measures Inventory Tool (CMIT) environment, intended to automate environmental scans required in the information gathering process to develop and maintain quality measures. The ESST uses an automated natural language processing approach that rapidly scans literature in PubMed, PubMed Central, and CINAHL to

• Identify relevant documents (abstracts and full-text articles)
• Identify and extract the specific knowledge within each relevant document that applies to the measure’s potential opportunity for improvement

The Federal Register is the official daily publication for rules, proposed rules, and notices of federal agencies and organizations, as well as executive orders and other presidential documents. The Federal Register is published by the Office of the Federal Register, National Archives and Records Administration.

Fast Healthcare Interoperability Resources® (FHIR®) is an open-source Health Level Seven International® standard for exchanging health care information electronically. It is the next generation exchange framework being adopted by the health care community to advance interoperability.

The Fast Healthcare Interoperability Resources® (FHIR®) Electronic Clinical Quality Measure (eCQM) Examples is a webpage in the Quality Measure Implementation Guide containing example eCQMs using FHIR.

The Fast Healthcare Interoperability Resources® (FHIR®) Implementation Guide Registry is a list of many of the implementation guides defined by the FHIR community.  

The Fast Healthcare Interoperability Resources® (FHIR®) Terminology Service for Value Set Authority Center (VSAC) Resources is a representational state transfer application programming interface service for accessing the VSAC value sets and supported code systems. It assumes working knowledge of FHIR resources. Access requires a free Unified Medical Language System (UMLS) license.

Global Common Library is a shared Clinical Quality Language (CQL) library which contains CQL expressions for all eCQM developers to use when specifying electronic clinical quality measures. For more information, see the CQL Style Guide.

The Guide for Reading Electronic Clinical Quality Measures (eCQMs) is a resource to help measured entities, quality analysts, implementers, and health information technology vendors understand eCQMs. The Guide provides background on eCQM packages, which are the building blocks of eCQMs, and an overview for a user to understand the human-readable format of eCQMs. The Guide also provides information related to value sets, Quality Data Model data criteria, and more.

The Office of the National Coordinator for the Health Information Technology (ONC) Certification Program is a voluntary certification program established by ONC to provide for the certification of health information technology. The program ensures that Certified Health Technology meets the technological capability, functionality, and security requirements adopted by the U.S. Department of Health and Human Services. The ONC develops the functional and conformance testing requirements for the testing and certification criteria related to electronic clinical quality measures (eCQMs).

This Health Level Seven International® (HL7®) Clinical Quality Language (CQL)-Health Quality Measure Format (HQMF) Implementation Guide (IG) defines an approach to using CQL with the Quality Data Model (QDM) and HQMF to define electronic clinical quality measures (eCQMs). The IG describes the use of CQL to express the logic and the US Domain conceptual data model, QDM, to express the individual data types and their attributes for an eCQM detailed using the HQMF standard.

The Health Level Seven International® (HL7®) Quality Reporting Document Architecture Category I Implementation Guide (HL7 QRDA I IG) describes constraints on HL7's Clinical Document Architecture Release 2 (CDA R2) to create a QRDA I document. QRDA Category I is for reporting quality data at the individual patient level.

The Health Level Seven International® (HL7®) Quality Reporting Document Architecture Category III Implementation Guide (HL7 QRDA III IG) describes constraints on HL7's Clinical Document Architecture Release 2 (CDA R2) to create a QRDA III document. QRDA Category III is for reporting aggregated quality measure data and supports reporting for improvement activities and Promoting Interoperability measures.

The Hospital Quality Reporting (HQR) Secure Portal is the only CMS-approved website for secure communications and health care quality data exchange between quality improvement organizations, hospitals, physician offices, nursing homes, end-stage renal disease networks and facilities, and data vendors. It provides secure data exchange to and within various CMS quality reporting programs, including Hospital Inpatient Quality Reporting, Hospital Outpatient Quality Reporting, Inpatient Psychiatric Facility Quality Reporting, Prospective Payment System-Exempt Cancer Hospital Quality Reporting, Ambulatory Surgical Center Quality Reporting, and the Medicare Promoting Interoperability Program.  

For hospital quality reporting, users must create a Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) account to log into HQR. Submitters can navigate within the HQR system and perform tasks based on the program data that are submitted, such as data submissions, data results, program reporting, and administration. For information on registering for a HARP account and additional resources, visit the Registering for HARP page on QualityNet. Please contact the Centers for Clinical Standards and Quality (CCSQ) Service Center at (866) 299-8912 or QNetSupport@cms.hhs.gov for assistance.

Health Quality Measure Format (HQMF) is a Health Level Seven International® standards-based representation of a quality measure as an electronic document. A quality measure expressed in this way is referred to as an electronic clinical quality measure.

Inferno is a rich and rigorous testing suite for Health Level Seven International® Fast Healthcare Interoperability Resources® (FHIR®) to help measure developers implement the FHIR standard consistently. Two options are available for measure developers wanting to use Inferno. The Inferno Program Edition is used to help test requirements of the Standardized Application Programming Interface for Patient and Population Services criterion § 170.315(g)(10) in the 2015 Edition Cures Update. The Inferno Community Edition contains a community-curated set of tests and tools for select FHIR Implementation Guides.

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. ONC 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://www.healthit.gov/isa/about-isa.

The Measure Authoring Development Integrated Environment (MADiE) is a software tool redefining the electronic clinical quality measure (eCQM) development and testing process by making it a self-contained process including dynamic authoring and testing within a single application. MADiE allows eCQM developers to author eCQMs using Quality Improvement (QI)-Core, the Quality Data Model (QDM), Fast Healthcare Interoperability Resources® and to test and verify eCQM behavior. MADiE helps eCQM developers execute eCQM logic against the constructed test cases and evaluates if the eCQM logic aligns with the intent of the eCQM.

The Measure Authoring Development Integrated Environment (MADiE) User Group is an open forum to discuss the status of the tool and gather community and user feedback on planned enhancements and releases. The User Group is scheduled to meet on the third Thursday of every month. Register for the MADiE User Group via the meeting appointment.

The Measure Authoring Tool was sunsetted June 28, 2024. Measure developers are to use the Measure Authoring Development Integrated Environment (MADiE).

The Measure Collaboration (MC) Workspace is a web-based tool bringing together a set of interconnected resources, tools, and processes to promote transparency and better interaction across interested parties that develop, implement, and report electronic clinical quality measures.

The Measure Collaboration (MC) Workspace User Guide provides instructions for the use of each module in the MC Workspace.

The Measures Management System (MMS) is a standardized system for developing and maintaining the quality measures used in CMS’s various quality initiatives and programs. The primary goal of the MMS is to provide guidance to measure developers to help them produce high-caliber health care quality measures.

The ONC ASTP Project Tracking System (Jira) is a collaboration platform hosted by the Office of National Coordinator for Health Information Technology (ONC)/Assistant Secretary for Technology Policy (ASTP). It provides users with a common place to transparently log, track, and discuss issues with subject matter experts on many topics, including electronic clinical quality measure (eCQM) implementation. CMS uses Jira during most phases of the eCQM lifecycle, including development, implementation, and maintenance.  The ONC/ASTP Project Tracking  System (Jira) and Confluence have a 90-day account deactivation policy for all users who have not logged into systems for a period of 90 days or longer. 

Reminder: 
This is an open platform that does not intend for users to communicate sensitive or confidential information such as protected health information and personal identifiable information.

Pioneers in Quality™ is a collaborative Joint Commission program to improve health care quality and patient safety through education (e.g., webinars for continuing education units), innovation, and recognition of pioneering practices for Joint Commission interested parties. Started in 2016 to assist hospitals on their electronic clinical quality measure (eCQM) journey to improve eCQM data use for quality improvement, Joint Commission has expanded the program over time to include additional key components related to eCQM and chart-abstracted data.

Postman is a collaboration platform for application programming interface development and testing. It is also a hypertext transfer protocol (HTTP) client that tests HTTP requests through which one obtains different types of responses utilizing a graphical user interface. Postman provides a simple endpoint interaction method for posting requests and updates to Fast Healthcare Interoperability Resources® (FHIR®) servers and participants may use for testing FHIR-based electronic clinical quality measures during Health Level Seven International® Connectathons.

Public comments ensure measures are developed and maintained using a transparent process with balanced input from relevant interested parties. Public comment periods provide an opportunity for the widest array of interested parties to provide input on the measures, both under development and in use, and can provide critical suggestions not previously considered by the measure developer or its Technical Expert Panel. Electronic clinical quality measure (eCQM) public comments can be made in response to a new eCQM's call for comments, eCQMs in the pre-rulemaking and rulemaking process, eCQMs in testing, eCQMs undergoing updates, and updates to standards and tools used with eCQMs.

Health Level Seven International® (HL7®) provides a list of Fast Healthcare Interoperability Resources® servers publicly available for testing. These are public services provided by volunteers and HL7 makes no representations concerning their safety or reliability.

The Quality Data Implementation (QDI) User Group is a group of volunteer members who use the Quality Data Model (QDM) and Fast Healthcare Interoperability Resources® (FHIR®)-related standards. The group seeks to understand data capture and use with respect to workflow in health information technology implementations such that measure requests for data are feasible and provide accurate, comprehensive, and reliable data for evaluation. The data model efforts support the electronic clinical quality improvement landscape and the evolving transition from the QDM to the FHIR model (Quality Improvement Core) for authoring electronic clinical quality measures and digital quality measures. The QDI User Group meets at 3:00 p.m. ET on the third Wednesday of every month.

The Quality Data Model (QDM) is a conceptual information model defining principal concepts (classes) of information, their related attributes, and their relationships. The Model provides a standardized way to express what needs to be retrieved from electronic records to enable quality performance measurement. The QDM is the current structure for electronically representing quality measure concepts for stakeholders involved in electronic quality measure development and reporting.

The Quality Data Model (QDM) Known Issues provides identified issues relative to working with the QDM. Many of these issues originated as tickets in the ONC Project Tracking System (Jira) QDM Issue Tracker project and all were discussed by the Quality Data Implementation Group.

The Health Level Seven International® (HL7®) Quality Improvement Core (QI-Core) Implementation Guide (IG) defines a set of Fast Healthcare Interoperability Resources® (FHIR®) profiles with extensions and bindings needed to create interoperable, quality-focused applications. The profiles in this IG derive from and extend the US Core profiles to provide a common foundation for building, sharing, and evaluating knowledge artifacts across quality improvement efforts in the US Realm.

The sponsoring HL7 workgroup, Clinical Quality Information (CQI), manages changes to this FHIR IG, which are incorporated as part of the standard balloting process. The current roadmap follows closely behind the base FHIR roadmap and the US Core IG. The CQI Workgroup will continue to ballot QI-Core versions annually; each annual QI-Core version will build on the respective US Core version which, in turn, addresses updated versions of USCDI (US Core Roadmap). 

To assist measure developers and implementers in the transition from QDM-based eCQMs to FHIR-based eCQMs, CQI developed the QDM to QI-Core Mapping. Each version of the QI-Core publication updates details related to applicable specifications.

The Quality Payment Program (QPP) Developer Tools allow industry developers, who build software for participating clinicians, to integrate their software directly with CMS applications and data. Available tools include Submissions Application Programming Interface (API), Submissions Developer Preview environment, Measures, Activities, Benchmarks Repository, and Quality Reporting Document Architecture III Conversion Tool Open Source Package. These include documentation for reporting eCQMs. Additionally, there is information on submitting data through the CMS Web Interface and developer documentation on the Eligibility API.

The Quality Payment Program (QPP) Resource Library is the one-stop shop for all QPP resources. It provides educational materials supporting clinicians’ participation in QPP. All QPP webinar resources, including slides, transcripts and recordings from recent presentations, can be found on the QPP Webinar Library. Measure specifications and benchmarks are located within the Full Resource Library section of the QPP Resource Library.

The Quality Reporting Document Architecture (QRDA) is a standard document format for the exchange of electronic clinical quality measure data.

The Quality Reporting Document Architecture (QRDA) III Converter tool converts QRDA III files to the Quality Payment Program (QPP) JavaScript Object Notation format for QPP data submission. The tool can also be used to test whether the QPP system can consume QRDA III files and allows you to see whether the files comply with the CMS QRDA III Implementation Guide for the performance period and be successfully submitted to QPP.

Quality Reporting Document Architecture (QRDA) Known Issues provide implementation information for QRDA Implementation Guides or supporting documents with known technical issues for which a solution is under development but may not be published. This includes issues such as discrepancies between conformance assertions and message text, non-critical conformance assertion errors, and typographical errors.

The Quality Measure Implementation Guide (IG), or QM IG, is intended to provide guidance on the representation of quality measures including electronic clinical quality measures (eCQMs) using Fast Healthcare Interoperability Resources® (FHIR®) Clinical Reasoning Module. It provides requirements for eCQM structure, metadata, definitions, and logic for use when authoring, packaging and evaluating quality measures.

Established by CMS, QualityNet provides health care quality improvement news, resources, data reporting tools, and applications used by measured entities and others. QualityNet, the one-stop shop for CMS quality programs, provides information on quality data reporting programs associated with the Hospital Inpatient Quality Reporting Program and other hospital inpatient quality programs, Hospital Outpatient Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Inpatient Psychiatric Facility Quality Reporting Program, Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program, and End-Stage Renal Disease Quality Incentive Program. CMS encourages interested parties, advocates, and others to register for email notifications to receive information on enhancements and new releases, timelines or process/policy modifications, and alerts about applications and initiatives. The CMS Hospital Quality Reporting program notification and discussion lists are available for signup on QualityNet.

The Submission Tool and Repository (STAR) is a measure database of quality performance measures submitted to the CMS consensus-based entity (CBE) for endorsement review. The database includes historical data for measures submitted for endorsement and maintenance to date. The CMS CBE updates the STAR database regularly as the Partnership for Quality Measurement receives submissions for endorsement review for new and maintenance measures. 

Synthea™ is an open-source, synthetic patient generator that models the medical history of synthetic patients. It provides realistic, but not real, patient data and associated health records covering every aspect of health care. The resulting data is free from cost, privacy, and security restrictions, enabling research with health information technology data that is otherwise legally or practically unavailable.

Browse and download pre-generated synthetic records

The Technical Release Notes (TRNs) are resource files, which provide an overview of technical changes, e.g., logic and terminology, for each electronic clinical quality measure (eCQM) in the most recent eCQM Annual Update for CMS reporting/performance periods. Each grouping, e.g., Eligible Clinician, Hybrid Measures, has their own TRN file.

The Unified Medical Language System® (UMLS®) is a set of files and software bringing together health and biomedical vocabularies and standards to enable interoperability between computer systems. The UMLS integrates and distributes key terminology, classification and coding standards, and associated resources to promote creation of more effective and interoperable biomedical information systems and services, including electronic health records. Software developers can use UMLS to enhance or develop applications, such as electronic health records, classification tools, dictionaries and language translators. Use of UMLS allows end users to view codes, synonyms, and definitions used terminologies such as Common Procedural Terminology and International Classification of Diseases-10th Revision-Clinical Modification and relationships between concepts. Access requires a free UMLS License.

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.

The Value Set Authority Center (VSAC) is a value set authoring tool and repository. It is the source of truth for value sets for CMS's electronic clinical quality measures. The National Library of Medicine maintains the VSAC and provides access via web browsers and APIs. The VSAC provides downloadable resources for all measure releases that provide full eCQM value sets, the Binding Parameter Specification, and the complete lists of Direct Reference Codes, retired codes, and utilized code systems. The VSAC provides users with tools to search existing value sets, create new value sets, and maintain value set content consistent with current versions of the terminologies they use. Access requires a free Unified Medical Language System License. 

The Value Set Authority Center (VSAC) Collaboration Tool provides a central site where value set authors can post value sets for collaborative discussion. Teams can share threaded discussions about the value sets, view recent value set expansions posted by other value set authors, organize their value sets by usage and by team’s workflow needs, collaborate with other value set authors to harmonize value sets, and receive activity and change notifications from VSAC. Access requires a free Unified Medical Language System (UMLS) license.

The VSAC Support Center is the Help section of the VSAC website. It provides information on how to use the VSAC, specific information for value set authors and stewards (e.g., how to create value sets), and additional information such as release notes and how to use the VSAC Collaboration Tool, and VSAC Application Programming Interface Resources.

The Value Set Authority Center (VSAC) Sharing Value Set (SVS) Application Programming Interface (API) allows the user to retrieve a single value set's expansion, with or without its metadata and definition version, using RetrieveMultipleValueSets and RetrieveValueSet, respectively. It is based on the Integrating the Healthcare Enterprise (IHE) SVS Technical Framework, section 2.2.21 SVS integration Profile and the IHE SVS XML Schema. Access requires a free Unified Medical Language System (UMLS) license.