Back to top

Getting Started with 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 healthcare 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 clinical data to assess the outcomes of treatment by measured entities.
  • eCQMs reduce the burden of manual abstraction and reporting for measured entities.
  • eCQMs foster the goal of access to real-time data for point of care quality improvement and clinical decision support.

Measured entities use eCQMs to provide feedback on their care systems and to help them identify opportunities for clinical quality improvement. eCQMs are reported to CMS, The Joint Commission, federal health agencies, and commercial insurance payers in programs that track and/or reimburse measured entities based on quality reporting.

Review eCQM Basics, eCQM 101 - Getting Started with eCQMs for Quality Reporting Programs, and visit the Educational Resources tab to learn more about eCQMs.

Report eCQMs

For current CMS programs, eligible hospitals, critical access hospitals, and/or eligible clinicians, must use the most current version of eCQMs when reporting eCQMs.

For federal health agency programs using eCQMs, refer to specific program requirements.

The Meaningful Measures Initiative

CMS’s comprehensive Meaningful Measures Initiative identifies high priority areas for quality measurement and improvement. Its purpose is to improve outcomes for patients, their families and providers while also reducing burden on measured entities. The Meaningful Measure Areas serve as the connectors between CMS strategic goals and individual measures/initiatives.

Meaningful Measures Framework graphic

​The eCQM Strategy Project

The eCQM Strategy Project supported the CMS Patients Over Paperwork initiative to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. The project provided CMS with an understanding of eCQM implementation and reporting burden and made recommendations for improvement in the use of eCQMs in CMS quality reporting programs. Read the report here.

Many different organizations may participate in the development and maintenance of electronic clinical quality measures (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 incentive programs. Information on the clinical quality measure and eCQM lifecycle is available in the Blueprint for the CMS Measures Management System (Blueprint) and on the eCQM Lifecycle webpage. The Clinical Quality Language (CQL) Style Guide is for use by measure developers. It provides examples to standardize expression of measure concepts across eCQMs and define a uniform look and feel to eCQM logic using CQL. The Guide provides a set of common best practices for implementation across CQL-based eCQMs used in CMS quality reporting and incentive programs. 

eCQM Lifecycle

The eCQM Lifecycle is a series of stages eCQMs progress through development (conceptualization, specification, and testing), implementation, and maintenance. CMS and measure developers provide 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 eCQMs users 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. Use the Change Review Process (CRP) Guide to participate in the eCQM updates.

Structure of eCQMs

To facilitate reporting from an electronic health record (EHR) and/or other health information technology, eCQMs are made of electronic specifications. Health Quality Measure Format (HQMF), CQL, Expression Logical Model (ELM), and other Health Level Seven International® (HL7) standards, are used for electronically documenting eCQM content. 

Coding of information for eCQMs consists of

  • Computable representations of the eCQM, which contain important details about the measure, the definition of the data elements, and the underlying logic of the measure calculation. The files include
    • HQMF XML syntax (.xml). The HQMF includes a header and a body. The header identifies and classifies the document and provides important metadata about the measure. The MAT User Guide, Chapter 6: Measure Details discusses the metadata, which populates the header. The HQMF body contains eCQM sections (e.g., definitions, population criteria, supplemental data elements).
    • Shared CQL libraries (.cql, .xml, and .json). The shared libraries are the basic units of sharing CQL. They consist of a foundation of CQL statements used within a measure. Every measure has at least one main CQL library referenced from HQMF.
      • CQL file (.cql). The CQL file provides the expression logic for data criteria, population criteria, and supplemental data elements. It provides a formal description of the computable content in the measure and organized into libraries for reusing or sharing between measures and other artifacts.
      • Expression Logical Model (ELM) XML document (.xml). ELM provides a machine-readable representation of the measure’s logic in XML. The intent of the ELM file is for machine processing and provides the information needed to retrieve data from an EHR automatically.
      • ELM JavaScript Object Notation (JSON) file (.json). The JSON file is the ELM file in JavaScript Notation, as opposed to XML.
  • Human-readable representation of the eCQM displays the eCQM content in a human-readable format directly in a web browser, Hypertext 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 an extraction from the HQMF header.
  • Value sets and direct reference codes (DRCs) convey specific coded value(s) allowed for the data elements within the eCQM. Identification of value sets is via an object identifier (OID) and each value set includes several metadata elements that describe the inclusion and exclusion criteria for the codes in the set. 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 referenced directly in the eCQM logic to describe a data element or one of its attributes. Find value sets and DRCs 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 in front of the number. The eCQM Version Number indicates 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. Use the eCQM Naming and Terminology Guide for guidance regarding common words, phrases, and technical terms used in conjunction with eCQMs.

eCQM Information Value
eCQM Identifier (MAT) 123
eCQM Version number 1
CMS eCQM identifier CMS123v1

Health IT Certification for eCQM Reporting

The ONC Health Information Technology (IT) Certification Program is a voluntary certification program established by the Office of the National Coordinator for Health Information Technology (ONC) to provide for the certification systems to health IT standards, implementation specifications, and certification criteria adopted by the Health and Human Services (HHS) Secretary (Secretary). The ONC Health IT Certification Program supports the availability of certified health IT for its encouraged and required use under federal, state, and private programs.

The ONC develops the functional and conformance testing requirements for the testing and certification of Health IT Modules to the certification criteria adopted by the Secretary, including certification criteria related to electronic clinical quality measures (eCQMs). Only ONC-approved test methods can be used to test products intended for certification in the ONC Health IT Certification Program (please note that any individual or organization may submit test methods to ONC for approval). Currently, ONC has approved the Cypress open source testing tool and NCQA’s alternative test method. Test methods (test procedures, test data, and test tools) are used by ONC-Accredited Testing Laboratories (ATLs) and ONC-Authorized Certification Bodies (ONC-ACBs) to evaluate the conformance and functionality of Health IT Modules. The 2015 Edition test procedures and certification companion guide aid stakeholders in the development and testing of health IT modules.  

Regulation Text Citation

Certification Criterion

Testing Information

§ 170.315(c)(1)

eCQMs – record and export


§ 170.315(c)(2)

eCQMs – import and calculate


§ 170.315(c)(3)

eCQMs – report


§ 170.315(c)(4)

eCQMs – filter


Note. The Certification Criterion uses ‘CQMs’ within the 2015 Edition when referencing eCQMs.

Visit  ONC’s Certification of Health IT webpage for detailed information on ONCs certification program and the detailed information on the 2015 Edition Test Method.

Read the Standards and Certification Regulations.

Learn more regarding the 2015 Edition Final Rule. The Health IT Certification Criteria (2015 Edition) builds on past rulemakings to facilitate greater interoperability for several clinical health information purposes and enables health information exchange through new and enhanced certification criteria, standards, and implementation specifications. Taking into account public comments received on the 2015 Proposed Rule, the final rule continues to focus on the establishment of an interoperable nationwide health information infrastructure. The CQM certification criteria § 170.315(c) (1) – (c) (4) were established in the 2015 Edition Final Rule.

Learn more regarding the ONC Cures Act Final Rule and ONC Interim Final Rule. These rulemakings support the seamless and secure access, exchange, and use of electronic health information. The CQM certification criteria at § 170.315(c)(1), (c)(2) and (c)(4) had minor security modifications in the ONC Cures Act Final Rule, and the criterion at § 170.315(c)(3) was modified by the ONC Interim Final Rule.

Use the Certified Health IT Product List (CHPL) to view health information technology successfully tested and certified for use.

Provide feedback on health IT eCQM Certification at

The eCQM tools and resources provide a foundation for the development, testing, certification, publication, implementation, reporting, and continuous evaluation of quality measures and their improvement. You can refine the tool list by selecting a category of interest and/or a role that best describes your needs, or you can also click a specific tool from the list below to view additional details.
Search or filter above,
then click Apply to see results

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 Measure Collaboration Workspace, the CMS Measures Management System Get Involved webpage, and the Engage in electronic clinical quality improvement (eCQI) page for a list of current opportunities.

Provide Feedback

CMS, through the ONC Project Tracking System (Jira), allows stakeholders to submit issues with eCQM implementation and development and receive feedback. Submit eCQM technical questions to the eCQM Issue Tracker. For known issues about eCQMs, see the eCQM Known Issues Jira project.

Seek Help

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


Last Updated: Jun 10, 2021