eCQMs

Electronic clinical quality measures (eCQMs) use data electronically extracted from electronic health records (EHRs) and/or health information technology systems to measure the quality of health care provided. The Centers for Medicare & Medicaid Services (CMS) use eCQMs in a variety of quality reporting and value-based purchasing programs.

There are several benefits of using eCQMs:

  •  eCQMs use detailed clinical data to assess the outcomes of treatment by healthcare providers and organizations
  •  eCQMs reduce the burden of manual abstraction and reporting for provider organizations
  •  eCQMs foster the goal of access to real-time data for bedside quality improvement and clinical decision support

Hospitals and providers use eCQMs to provide feedback on their care systems and to help them identify opportunities for clinical quality improvement. eCQMs are also used in reporting to CMS, The Joint Commission, and commercial insurance payers in programs that reimburse providers based on quality reporting.

Find eCQMs:

Eligible Hospital (EH) and Critical Access Hospital (CAH) eCQMs and supporting materials are on the Eligible Hospital/Critical Access Hospital page of this website.  

Eligible Professional (EP) and Eligible Clinician eCQMs and supporting materials are on the Eligible Professional/ Eligible Clinician page of this website.

Report eCQMs:

For current CMS programs, Eligible Hospitals, Critical Access Hospitals, Eligible Clinicians, and/or Eligible Professionals must use the most current version of eCQMs when reporting eCQMs. For hospital reporting guidance, visit Quality Net  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 Promoting Interoperability Program, refer to the CMS Promoting Interoperability Program webpage.

For HHS programs using eCQMs, refer to specific program requirements.eCQI Graphic for Healthcare Goals

Many different organizations may participate in the development and maintenance of eCQMs.The CMS Measures Management System is a standardized system and provides details on the process for developing and maintaining the quality measures used in CMS's various quality reporting and initiative programs. Information on the CQM and eCQM development lifecycle is available in the Blueprint for the CMS Measures Management System (Blueprint) and on the eCQM Lifecycle webpage.

eCQM Lifecycle:

The eCQM Lifecycle is a series of phases eCQMs progress through when being developed, tested, implemented, and updated. CMS provides several opportunities for stakeholders to engage throughout the measure lifecycle. 

Updates to eCQMs:  

CMS requires eCQMs approved for CMS programs to be updated annually to reflect changes in evidence-based medicine, code sets, and measure logic. CMS works with measure stewards, measure developers, and users of the eCQMs to ensure necessary changes are reflected in the Annual Update. Additionally, CMS may provide addenda to the eCQM Annual Update periodically within the year to ensure updated code systems are reflected in the eCQM specifications and supporting materials.

Structure of eCQMs:

To be reported from an EHR, eCQMs are made of electronic specifications. Health Quality Measure Format (HQMF), a Health Level Seven International (HL7) standard, is used for electronically documenting eCQM content. These electronic specifications include:

  • Computable representation of the eCQM: Contains important details about the measure, how the data elements are defined, and the underlying logic of the measure calculation. The files include:
    • HQMF XML syntax. The HQMF includes a Header and a Body. The header identifies and classifies the document and provides important metadata about the measure. The body contains eCQM sections (e.g., definitions, population criteria, supplemental data elements).
    • CQL
    • Expression Logical Model (ELM) XML document
    • ELM JavaScript Object Notation (JSON)

  • The Human-readable representation of the eCQM displays the eCQM content in a human-readable format directly in a web browser, Hyper Text Markup Language (HTML) file (.html). This file does not include the underlying HQMF syntax, but the narrative content at the top of the HTML is extracted from the HQMF header.

  • Value sets and direct reference codes (DRCs) convey specific coded values that are allowed for the data elements within the eCQM. Value sets are identified by an object identifier (OID) and include several metadata elements. The value set includes a list of codes (i.e., the value set “expansion code set”) acceptable or valid for a specific data element in the measure, descriptors of those codes, the code system from which the codes are derived, and the version of that code system. DRCs are specific codes that are referenced directly in the eCQM logic to describe a data element or one of its attributes. Value sets and DRCs are found in the VSAC.

Naming eCQMs:

CMS created a unique “CMS eCQM Identifier” to name eCQM files. The naming convention adds the eCQM identifier assigned to the eCQM in the Measure Authoring Tool (MAT) with the “eCQM Version Number”. “CMS” is placed in front of the number. The eCQM Version Number is used to indicate the published version of the eCQM. For example, based on this naming convention, Eligible Professional measure (NQF0056-Diabetes: Foot Exam) would be CMS123v1 for the first version of the measure.

eCQM Information

Value

eCQM Identifier (MAT)

123

eCQM Version number

1

CMS eCQM identifier

CMS123v1

The eCQM tools and resources referenced in this section are openly available and are provided for stakeholder use. They provide a foundation for the development, testing, certification, publication, implementation, reporting, and continuous evaluation of quality measures and their improvement. Tools and resources are listed in alphabetical order and may also be searched by category. To search by category, select the categories of interest from the drop down menu and select Apply.

Category: Implementation

The Binding Parameter Specification is a metadata file that contains no terminology codes. This file provides a record of the value set metadata information that defines the value set code lists specified by published CMS eCQMs. Measure implementers and vendors can use the BPS to track versions and other parameters that define the value set code lists for each eCQM release. The BPS contains...

Category: Development, Testing

Bonnie is a software tool that allows eCQM developers to test and verify the behavior of their eCQM logic. The main goal of the Bonnie application is to reduce the number of defects in eCQMs by providing a robust and automated testing framework. The Bonnie application allows measure developers to independently load measures that they have constructed using the MAT. Developers can then...

Category: Development, Testing

This user group is a community of Bonnie users that benefit from one another’s experience and questions, and allows the development team to easily reach out to the community regarding new releases, proposed features, and focus group opportunities.  Follow these instructions to join:

Category: Continuous Evaluation/Feedback, Development, Publication

The CDS Connect Project demonstrates a web-based repository service to enable the Clinical Decision Support (CDS) community to identify evidence-based standards of care, translate and codify information into an interoperable standard, and leverage tooling to...

Category: Development, Testing

Cedar is a free, open source tool for testing the strength of electronic Clinical Quality Measure (eCQM) collection systems that receive Quality Reporting Document Architecture (QRDA) files.

Category: Certification

The Certified Health IT Product List (CHPL) is a comprehensive and authoritative listing of all certified Health Information Technology which has been successfully tested and certified by the ONC Health IT Certification program. All products listed on the CHPL have been tested by an ONC-Authorized Testing Labs (ONC-ATLs) and certified by an ONC-Authorized Certification Body (ONC-ACB) to meet...

Category: Continuous Evaluation/Feedback

CQF Framework is a collaborative community of participants from the public and private sectors focused on providing the tools, services and guidance to facilitate the functional exchange of health information. CQF Framework focuses on identifying, defining, and harmonizing electronic standards that promote integration between CDS and eCQM.

Category: Publication

The CMS Measure Inventory Tool (CMIT) is the repository of record for information about the measures which CMS uses to promote healthcare quality and quality improvement. CMS and its partners use this measure inventory to inform stakeholders, to manage its measure portfolio, and to guide measure development. The inventory contains information describing each of the measures including title,...

Category: Reporting

This tool details the different aspects of multiple QRDA validation tools that are available to submitters. It is intended 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 tool covers:

  • Cypress QRDA Validation Utility
  • Pre-Submission Validation Application (PSVA)
  • ...
Category: Development, Implementation

CQL Online is a tool developed by ESAC, Inc. to provide a "sandbox" where electronic Clinical Quality Measure (eCQMs) developers and implementers can "play" around with the Clinical Quality Language (CQL). The tools allows users to get a feel for what CQL looks like and how to write proper expressions in this new and powerful language.

More specifically, CQL Online is a syntax directed...

Category: Implementation

The HL7 CQL specification defines both a high-level, author friendly syntax for expressing clinical knowledge, as well as a machine friendly, syntax-independent canonical representation of clinical knowledge called Expression Logical Model (ELM). The high level syntax is designed to support measure and...

Category: Certification, Testing

Cypress is an open source Cypress is an open source testing tool used by vendors to certify their EHRs and health information technology (IT) modules for calculating 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...

Category: Continuous Evaluation/Feedback

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

Category: Certification, Testing

The Cypress QRDA Validator provides implementers with the ability to validate the conformance of QRDA Category I and Category III documents to the 2016, 2017, and 2018 CMS implementation guides:

  • 2016 (EP/EH)
  • 2017 (EP/EH)
  • 2018 (EH Only)

The Cypress QRDA Validator provides implementers with the...

Category: Implementation

This webpage is designed to support the eCQI implementation activities of the entire care team.

Category: Publication

This website provides eCQI resources and connections with the community of professionals who are dedicated to clinical quality improvement for better health. Provides eCQM electronic specifications and their updates along with tool and resource links. “The one-stop shop for the most current resources to support electronic clinical quality improvement.”

Category: Continuous Evaluation/Feedback, Testing

These open source libraries provide a proof-of-concept implementation of eCQMs against patient information represented in Fast Healthcare Interoperability Resources (FHIR). These libraries reuse the calculation engine developed within Bonnie and Cypress and adapt it to a FHIR data model. They can be used as a...

Category: Implementation, Reporting

These IGs are developed by CMS to support Quality Reporting Document Architecture (QRDA) Implementation for Eligible Professionals, Eligible Clinician, and Eligible Hospitals for eCQM reporting.

Category: Implementation

These IGs are developed and published to provide a standard structure to construct a quality measure including metadata, data criteria, population criteria, etc. based on the QDM.

Category: Continuous Evaluation/Feedback

Kaizen, or continuous improvement, is a long-term approach to work that systematically seeks to achieve incremental changes in order to improve efficiency and quality. It focuses on removing process waste and maximizing value to the customer (in this case the patient). CMS and ONC have focused on eCQM development and implementation.

Category: Development

The MAT is a web-based tool that allows measure developers to author eCQMs using the Quality Data Model (QDM). The tool provides the capability to express measure logic and export measures. The MAT provides the capability to express complex measure logic and export measures in several formats, including a human-readable document which can be viewed in...

Category: Implementation

This document provides guidance for those interested in understanding, using, and/or implementing eCQMs.

Category: Continuous Evaluation/Feedback, Development, Implementation, Testing

The Blueprint is a guidance document which provides a standardized system for developing and maintaining the quality measures used in various quality initiatives and programs. Includes information on Measure Development Concepts, Measure Lifecycle, eCQM Lifecycle, as well as Tools, Appendices, and Forms.

Category: Development, Implementation, Publication

The CMS Measures Inventory is a compilation of measures used by CMS in various quality, reporting, and payment programs. The Inventory lists each measure by program and contains descriptive information including, but not limited...

Category: Certification, Testing

The same eCQMs that are used for CMS Quality Payment Program (QPP) reporting can also be submitted for recognition under NCQA’s Patient-Centered Medical Home (PCMH) recognition programs. This NCQA-provided crosswalk identifies the eCQMs that are tested under the NCQA eMeasure (eCQM) Certification program, accepted in the NCQA PCMH Recognition Program, as well as those selected as core America’...

Category: Certification, Testing

The National Committee for Quality Assurance (NCQA) eCQM test methodology was approved by the Office of the National Coordinator for Health IT (ONC) for use in the ONC HIT Certification Program. See press release...

Category: Implementation

QPS is a web-based tool developed by the National Quality Forum (NQF) to help people select and use NQF-endorsed measures. It allows a user to search for NQF-endorsed measures in a number of ways: export search results; and view types of measures. Using QPS, a user can find NQF-endorsed measures on particular topics, track and get reminders about measures that are important...

Category: Certification, Continuous Evaluation/Feedback, Implementation, Testing

The ONC Project Tracking System is a JIRA (Atlassian, Inc) based collaboration platform hosted by the HHS’s Office of National Coordinator for Health Information Technology (ONC) that supports the implementation of health information technology. It provides internal and external users with a common place to...

Category: Implementation

Pioneers in Quality (PIQ) is a Joint Commission program to assist hospitals on their journey towards electronic clinical quality measure adoption that includes educational programs (e.g., webinars for CEUs), a resource portal, recognition categories, an advisory council, a modified annual report, speaker’s bureau outreach, a peer–to–peer solution exchange, as well as having a strong focus on...

Category: Reporting

popHealth is an open source software tool that can automate the reporting of summary quality measures and streamline the exchange of summary quality data. popHealth can be used by developers to better understand quality measurement and reporting. The tool has also proven valuable for its individual parts: standardized data importer/exporter; user interface; and most importantly its quality...

Category: Reporting, Testing

PSVA is a downloadable tool that operates on a user's system which allows submitters to catch and correct errors prior to data submission to CMS. The application provides validation feedback within the submitter's system and allows valid files to be separated and submitted while invalid files are identified for error correction.

Category: Reporting, Testing

As of Calendar Year 2017, Quality Reporting Document Architecture (QRDA) Category I files are submitted by Eligible Hospitals (EHs) to fulfill a portion of the mandatory electronic Clinical Quality Measure (eCQM) reporting requirements for the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) and Medicare Electronic Health Record (EHR) Incentive...

Category: Reporting, Testing

Designed for IT developers and available in the CMS...

Category: Development

QDM is an information model that defines relationships between patients and clinical concepts in a standardized format to enable electronic quality performance measurement. The model is the current structure for electronically representing quality measure concepts for stakeholders involved in electronic quality measurement development and reporting. The QDM provides the language that...

Category: Reporting

QualityNet provides healthcare quality improvement news, resources and data reporting tools and applications. QualityNet is the only CMS-approved site for secure communications and healthcare quality data exchange between healthcare organizations and facilities.

Category: Reporting

Developer tools for the Quality Payment Program allow industry developers who build software for participating clinicians to integrate their software directly with CMS applications and data. 

The following tools are available:

  • Submissions Application...
Category: Implementation

The Quality Reporting Standard Sandbox is a Standards Implementation & Testing Environment which contains resources and tools for the QRDA Category I and Category III standards. The SITE QRDA Validator provides implementers with the ability to validate the conformance of HL7 QRDA Category I, R2 and QRDA Category III, R3 standards. Note that CMS programs may have additional program specific...

Category: Implementation

Release notes are files which provide an overview of technical changes in the eCQM Annual Update.

Category: Implementation

Release notes are files which provide an overview of technical changes in the eCQM Annual Update.

Category: Development, Implementation, Publication

The United States Health Information Knowledgebase (USHIK) is a registry and repository of health care-related metadata, specifications, and standards. The CMS Quality Programs portal provides the ability to view, download, and compare eCQM specifications, data elements, value sets...

Category: Development

UMLS® is a set of files and software that brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems. UMLS® is used to enhance or develop applications, such as electronic health records, classification tools, dictionaries and language translators.

Category: Development, Implementation, Publication, Testing

The Value Set Authority Center (VSAC) is a central repository for the official versions of value sets that support the electronic Clinical Quality Measures. The National Library of Medicine (NLM) maintains the NLM Value Set Authority Center and provides downloadable access to the value sets and the Binding Parameter Specification. The VSAC provides measure developers with tools to search...

Category: Development

The VSAC Collaboration Tool provides a central site where value set authors can post value sets for collaborative discussion. In that site, teams can share threaded discussions about the value sets, view recent value set expansions posted by site members, organize their value sets by usage and by team’s workflow needs, and receive activity and change notifications from VSAC. VSAC authors and...

Get Involved:

CMS provides several opportunities to provide input on eCQM development and updates, public calls for measures, comments on measures under development, and participation on technical expert panels. Visit the CMS Measures Management System Get Involved webpage and the Engagement webpage for a list of current opportunities.

Provide Feedback:

CMS through ONC provides JIRA tracker tools to allow stakeholders to submit issues with eCQM implementation and development and receive feedback. Submit eCQM technical questions to the CQM Issue Tracker.

Seek Help:

Information on various helpdesks and tools for eCQM help is found on the eCQI Resource Center Contact Information page.

Last Updated: June 11, 2018