Get Started with eCQMs

Atom is an open-source text editor that can expand its utility by installing packages. The Language-CQL plug-in package has functionality for Clinical Quality Language (CQL) syntax and semantic (error) highlighting and Fast Healthcare Interoperability Resources® model validation. Atom is also capable of performing measure evaluation and testing for eCQMs using the open-source CQL Evaluation Engine to locally execute CQL files. Comparable plugins and functionality are available in VS Code.

Note, GitHub announced that support for all projects under the Atom organization will be sunsetting on December 15, 2022.

Bonnie is a software tool that allows eCQM developers to test and verify the behavior of their eCQM logic. The Bonnie Fast Healthcare Interoperability Resources (FHIR) application allows measure developers to load FHIR measures they have constructed using the Measure Authoring Tool (MAT), which helps measure developers execute the measure logic against the constructed patient test deck, and evaluates whether the logic aligns with the intent of the measure.

The Bonnie Prior tool supports an earlier version of the QDM than the Bonnie QDM environment.

Bonnie is a software tool that allows eCQM developers to test and verify the behavior of their eCQM logic. The Bonnie QDM application allows measure developers to load Quality Data Model (QDM) based measures they have constructed using the Measure Authoring Tool (MAT), helps measure developers execute the measure logic against the constructed patient test deck, and evaluates whether the logic aligns with the intent of the measure.

The value set Binding Parameter Specification (BPS) is generated by the National Library of Medicine (NLM) and is a record of the value set metadata information that defines the code lists specified by current CMS eCQMs. Measure implementers and vendors use the BPS to track versions and other parameters that define the code lists 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 Value Set Authority Center Downloadable Resources.

Clinical Decision Support (CDS) Connect is an Agency for Healthcare Research and Quality (AHRQ)-sponsored online platform for sharing interoperable CDS resources. Resources include standards-based CDS logic, implementation guides, pilot demonstration reports, and open-source software tools for CDS developers.

Clinical Decision Support (CDS) Hooks is a Health Level Seven International® (HL7®) specification managed by the HL7 Clinical Decision Support (CDS) Workgroup that provides a way to embed additional, near real-time functionality within a clinician’s workflow of an EHR. 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-stakeholder Da Vinci 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 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 that provides an educational environment and also allows 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.

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 (CDS) and electronic clinical quality measures (eCQM) use in clinical quality improvement.

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.

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

A CMS 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 that make 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 eCQI Resource Center Contact Us page provide information and assistance regarding eCQMs and tools used in CMS quality reporting programs.

The CMS Measures Under Consideration Entry and/ Review Information Tool (CMS MERIT) is the web-based data collection portal that allows a measure developer to submit candidate measures to CMS for consideration. The Tool walks the submitter through the process of providing information. Each submitter has a dashboard that allows 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 Measure Applications Partnership Workgroups, and other stakeholders more information as they review measures.

The CMS Quality Reporting Document Architecture (QRDA) Implementation Guides (IGs) are based on the HL7 QRDA IGs. CMS's QRDA Category I IG is used for Hospital Inpatient Quality Reporting (IQR), Hospital Outpatient Quality Reporting (OQR), and Medicare and Medicaid Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals (CAHs). CMS's QRDA Category III IG is used for the Eligible Clinicians and Eligible Professionals Programs that address aggregate reporting requirements for Primary Care First (PCF), Merit-Based Incentive Payment System (MIPS) programs, and Medicaid Promoting Interoperability (PI).

The CMS Quality Reporting Document Architecture (QRDA) Pre-Submission Validation Tools are resources which offers 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) Ruler is an implementation of the Fast Healthcare Interoperability Resources'® (FHIR's) 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 (STU) and it is part of the effort to harmonize standards between electronic clinical quality measures (eCQMs) and clinical decision support (CDS). 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.

Clinical Quality Language (CQL) Execution Framework is a set of CoffeeScript libraries that can execute CQL artifacts expressed as JavaScript Object Notation (JSON) Expression Logical Model (ELM).

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

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

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 edit rights to be able to submit edits, add comments and concerns. Items on the Wiki are a work in progress and subject to change.

The CQL-to-ELM Translator is an open-source reference implementation that translates the high-level CQL syntax into the Expression Logical Model (ELM) representation. The reference implementation is used in support of CQF implementations as a tool to enable CQL output to be uniformly and automatically translated into ELM XML or 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® (HL7) 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 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 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 Data Exchange for Quality Measures Implementation Guide (IG), or DEQM, provides a framework that defines conformance profiles and guidance to enable the exchange of quality information and quality measure reporting (e.g., for transferring quality information from a health care provider to a payer). The DEQM expects to use quality measures specified in accordance with the Quality Measure IG and Quality Improvement Core Framework (QI-Core).

The DEQM IG supports the data exchange and reporting scenarios including individual reporting, summary reporting, and gaps in care reporting. Individual reporting is supported by the DEQM Individual MeasureReport profile and summary reporting is supported by the DEQM Summary MeasureReport profile. These are similar to the QRDA Category I and QRDA Category III in the QDM-CQL-QRDA paradigm.

The De Novo Measure Scan (DNMS) is an advanced feature of the Environmental Scanning Support Tool (ESST) on the controlled access 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 (CQM) 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 Technical Release Notes (TRNs) are resource files which provide an overview of technical changes, e.g., logic and terminology, to each eCQM in the most recent eCQM Annual Update for CMS reporting/performance periods.

The Measure Collaboration Workspace Electronic Clinical Quality Measures (eCQM) Concepts Module gives users the ability to suggest new measure 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 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 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).

The eCQM flows are available for eligible professional/eligible clinician eCQMs and eligible hospital/critical access hospital eCQMs.

The eCQM Implementation Checklist assumes that a health care practice/organization has determined which measures to report on. It provides the necessary technical steps health information technology (IT) 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 your system for use in electronic quality reporting.

The 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 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 (CQL) 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 eCQM Testing Opportunities Module of the Measure Collaboration Workspace allows measure developers to announce opportunities to test eCQMs. Measure developers can use testing to assess a variety of things such as eCQM feasibility, reliability, validity, and usability. Stakeholders interested in testing eCQMs contact the measure developer directly.

The Technical Release Notes (TRNs) are resource files which provide an overview of technical changes, e.g., logic and terminology, to each eCQM in the most recent eCQM Annual Update for CMS reporting/performance periods.

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 (NLP) 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 (NARA).

FHIR is an open-source Health Level Seven International (HL7®) standard for exchanging healthcare information electronically. It is the next generation exchange framework being adopted by the healthcare community to advance interoperability.

FHIR eCQM Examples is a website containing example eCQMs using FHIR.

The 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 (REST) application programming interface (API) 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 created in the Measure Authoring Tool. It contains CQL expressions for all measure developers to use when specifying electronic clinical quality measures. For more information, see the CQL Style Guide.

The Guide for Reading eCQMs is a resource to assist stakeholders in interpreting and understanding eCQMs. The guide provides information on eCQMs such as file naming conventions, understanding an eCQM human-readable rendition, value sets, QDM 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 IT. 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 (HHS). 

This Health Level Seven International® (HL7®) Implementation Guide (IG) defines an approach to using the Clinical Quality Language (CQL) with the Quality Data Model (QDM) and Health Quality Measure Format (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.

Health Quality Measure Format (HQMF) is an HL7 standards-based representation of a quality measure as an electronic document. A quality measure expressed in this way is also referred to as an electronic clinical quality measure (eCQM).

The 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 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 healthcare quality data exchange between quality improvement organizations (QIOs), hospitals, physician offices, nursing homes, end-stage renal disease (ESRD) networks and facilities, and data vendors. It provides secure access for data exchange such as the CMS Data Element Library, End-Stage Renal Disease Quality Reporting System, QIOs, Quality Improvement and Evaluation System Business Intelligence Center, and Hospital Quality Reporting.

Inferno is a rich and rigorous testing suite for Health Level Seven International® (HL7) Fast Healthcare Interoperability Resources® (FHIR) to help developers implement the FHIR® standard consistently. Two options are available for developers wanting to use Inferno. The Inferno Program Edition is used to help test requirements of the Standardized API 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.

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 the industry use to fulfill specific clinical health information technology interoperability needs.

The Measure Authoring Tool (MAT) is a web-based tool that allows measure developers to author eCQMs using either the Clinical Quality Language (CQL) and the Quality Data Model (QDM) or Fast Healthcare Interoperability Resources® (FHIR®). The MAT provides the capability to express complex measure logic and export measures in several formats.

The MAT (Measure Authoring Tool) and Bonnie User Group is a community of users that benefit from shared experiences and questions. It provides a forum for the MAT and Bonnie development team to easily reach out to the community with information on upcoming releases, proposed features, and focus group opportunities. To join, please navigate to the MAT website and go to the Training and Resources tab for information on how to register for the User Group.

The Measure Collaboration (MC) Workspace is a web-based tool that brings together a set of interconnected resources, tools, and processes to promote transparency and better interaction across stakeholder communities that develop, implement, and report eCQMs.

The Measure Collaboration (MC) Workspace User Guide provides detailed 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 healthcare quality measures.

The Measures Management System (MMS) Blueprint is a resource located on the MMS Hub website that provides a standardized system for developing and maintaining the quality measures used in various quality initiatives and programs. It includes information on measure development, measure implementation, measure maintenance, tools, forms, and templates. Information in the MMS Hub is applicable to all measure developers, regardless of level of experience or whether the intent of the measure(s) is for use in a CMS program or some other purpose.

The National Committee for Quality Assurance (NCQA) eCQM Certification Program uses an alternative ONC-approved methodology for testing Health IT's ability to accurately calculate eCQMs in order to produce Quality Reporting Document Architecture (QRDA) reports. The NCQA eCQM Certification Program is for use in the ONC HIT Certification Program.

The National Quality Forum (NQF) Quality Positioning System (QPS) is a web-based inventory tool developed by the NQF to help people find and select NQF-endorsed measures. Users can search QPS for NQF-endorsed measures by NQF measure number, type of measure, title, keyword, or measure steward and view measure-related information. With QPS, a user can find NQF-endorsed measures on particular topics or NQF measure selection attributes, identify measures that are no longer endorsed, track measures that are important to them, see which measures others are using, and provide measure use feedback to NQF.

The ONC Project Tracking System (Jira) is a collaboration platform hosted by the HHS's Office of National Coordinator for Health Information Technology (ONC). It provides users with a common place to transparently log, track, and discuss issues with subject matter experts on many topics. CMS uses Jira during most phases of the eCQM measure lifecycle, including development, implementation, and maintenance.

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

Postman is a collaboration platform for application programming interface (API) 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 is currently utilized for testing of Fast Healthcare Interoperability Resources® (FHIR)-based eCQMs during Health Level Seven International® Connectathons and provides a simple endpoint interaction method for posting requests and updates to FHIR servers.

Public comments ensure that measures are developed and maintained using a transparent process with balanced input from relevant stakeholders. 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 (TEP). 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® (FHIR) servers that are publicly available for testing. These are public services provided by volunteers and HL7® makes no representations concerning their safety or reliability.

The Quality Data Model (QDM) is a conceptual information model that defines 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 QDM Known Issues provides identified issues relative to working with the Quality Data Model. Many of these issues originated as tickets in the ONC Project Tracking System (Jira) QDM Issue Tracker project and all were discussed by the QDM User 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.

As an HL7 FHIR IG, changes to this specification are managed by the sponsoring workgroup, Clinical Quality Information and incorporated as part of the standard balloting process. The current roadmap follows closely behind the base FHIR roadmap, and the US Core IG.

Quality Data Model (QDM) to QI-Core Mapping: This version of QI-Core updates mappings from QI-Core to the QDM and is based on US Core version 3.1.1 (based on FHIR R4), FHIR version R4.0.1, and QDM version 5.6.

The Quality Measure Implementation Guide (IG), or QM IG, is intended to provide guidance on the representation of electronic clinical quality measures (eCQMs) using Fast Healthcare Interoperability Resources® Clinical Reasoning Module, Quality Improvement (QI)-Core IG, and Clinical Quality Language. It provides requirements for measure structure, metadata, definitions, and logic to be used when authoring and evaluating eCQMs.

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 QRDA 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 that support clinicians’ participation in QPP.

Key 2022 resources include:

• MIPS Eligibility and Participant Quick Start Guide
• Quality Payment Program Access User Guide
• MIPS Measure Specifications
  • Quality and Quality Benchmarks
  • Data Validation Criteria
  • Promoting Interoperability
  • Improvement Activities
  • Cost
  • Technical User Guides (multiple links)
• QPP Final Rule Resources

All QPP webinar resources, including slides, transcripts and recordings from recent presentations, can be found on the QPP Webinar Library.

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

The Quality Reporting Document Architecture (QRDA) III Converter tool converts QRDA III files to the QPP JSON (JavaScript Object Notation) format for Quality Payment Program (QPP) data submission. The tool can also be used to test whether QRDA III files can be consumed by QPP and allows you to see whether it complies with the most current QRDA III Implementation Guide and can be successfully submitted to QPP.

QRDA Known Issues provide implementation information for QRDA Implementation Guides (IGs) 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.

QualityNet is a website which provides healthcare quality improvement news, resources, data reporting tools, and applications used by healthcare providers and others. It provides quality improvement information associated with the inpatient (IQR) and outpatient (OQR) hospital quality programs, Ambulatory Surgery Center Quality Reporting (ASCQR), Inpatient Psychiatric Facility Quality Reporting Program (IPFQR), PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) and End Stage Renal Disease (ESRD) Facility quality programs. Users are able to subscribe to the CMS Hospital Quality Reporting program notification and discussion lists available.

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 healthcare. 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 Unified Medical Language System® (UMLS®) is a set of files and software that bring 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 CPT and ICD-10-CM and relationships between concepts. Use requires a free UMLS license.

United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.

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 FHIR model validation. This free text editor can be used to facilitate measure evaluation and testing for eCQMs using the open source CQL Evaluation Engine.

The Value Set Authority Center (VSAC) is a value set authoring and repository for value sets. 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 downloadable access to the value sets and the Binding Parameter Specification. 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. Use requires a free UMLS 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. Use requires a free 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 API Resources.

The Value Set Authority Center (VSAC) Sharing Value Set (SVS) Application Programming Interface (API) 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. Use of VSAC SVS API assumes working knowledge of Fast Healthcare Interoperability Resources®. Access requires a free Unified Medical Language System (UMLS) license.