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.
- For hospital reporting guidance, visit QualityNet and the Quality Reporting Center for specific program reporting education.
- For clinician reporting guidance, visit the Quality Payment Program website and the Quality Payment Program Resource Library.
- For information about the Medicare Promoting Interoperability Program, refer to the CMS Promoting Interoperability Program webpage.
For federal health agency programs using eCQMs, refer to specific program requirements.
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.
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.
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.
- 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.
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 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
eCQMs – record and export
eCQMs – import and calculate
eCQMs – report
eCQMs – filter
Note. The Certification Criterion uses ‘CQMs’ within the 2015 Edition when referencing eCQMs.
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.
Introduction to eCQMs
- Pioneers in Quality Video Short - eCQM Basics Series 1 - January 7, 2021
- eCQM Basics - Updated March 2021
- eCQM Communications Resources - Updated March 2021
- eCQM Strategy - eCQI Resource Center - MC Workspace Overview - Updated February 28, 2020
- eCQM 101 - Getting Started with Electronic Clinical Quality Measures for Quality Reporting- Updated March 20, 2019
eCQM Annual Update
- Pioneers in Quality Expert to Expert Webinar eCQM Annual Updates for the 2021 Reporting Period: ED-2 Median Admit Decision Time to ED Departure Time for Admitted Patients - January 2021
- Pioneers in Quality Expert to Expert Webinar eCQM Annual Updates for the 2021 Reporting Period: Stroke Measures & PC-05 Exclusive Breast Milk Feeding - January 2021
- Pioneers in Quality Expert to Expert Webinar eCQM Annual Updates for the 2021 Reporting Period: VTE Measures - January 2021
- Change Review Process (CRP) User Guide - September 2020
- How to Implement eCQM Annual Updates - Updated March 20, 2019
- Measure Collaboration Workspace Series – Session 1 eCQI Resource Center, Hybrid Measure, Measure Collaboration Workspace, and the CMS Measures Inventory Tool - July 15, 2020
- Pioneers in Quality™ Proven Practices: Establish your eCQM A-team - September 5, 2017
- Measure Collaboration Workspace Series –Session 3 - eCQM Data Element Repository (DERep) including health system's experience with using it to implement eCQMs - August 12, 2020
- Measure Collaboration Workspace Series –Session 2 Measure Collaboration Workspace and eCQM Flows and Clinical Flow Prototype – July 29, 2020
- Use of Clinical Dashboards to Drive Performance Improvement for eCQMs - July 31, 2019
- eCQM Implementation Checklist - April 17, 2017
- 36 short educational videos (YouTube) assist providers in implementing CMS Comprehensive Primary Care (CPC), several of which are specifically relevant to electronic clinical quality improvement:
Implementing eCQMs Eligible Hospitals and Critical Access Hospitals
- Pioneers in Quality Expert to Expert Webinar eCQM Annual Updates for the 2021 Reporting Period: Safe Use of Opioids—Concurrent Prescribing (CMS506) - January 2021
- Pioneers in Quality Expert to Expert Series: PC-01 & PC-05 - March 26, 2019
- Pioneers in Quality Expert to Expert Series: CAC-3 & EHDI-1a - March 5, 2019
- Pioneers in Quality Expert to Expert Series: VTE-1 & VTE-2 - February 26, 2019
- Pioneers in Quality Expert to Expert Series: ED-1 & ED-2 - February 12, 2019
- Pioneers in Quality Expert to Expert Series: STK-5 & AMI-8a - January 29, 2019
- Pioneers in Quality Expert to Expert Series: STK-2, -3, & -6 - December 11, 2018
Implementing eCQMs Eligible Professionals and Eligible Clinicians
- Eligible Clinician New eCQMs Finalized for 2019 - March 11, 2019
- Three Eligible Clinician eCQMs with Substantive Changes for the 2019 Performance Year - CMS69, CMS159, and CMS160 - February 27, 2019
- Eligible Clinician eCQM Diabetes Measures - January 30, 2019
- Eligible Clinician eCQM Preventive Care and Screening Measures - January 15, 2019
- ONC's Innovations in the Use of Electronic Health Data for eMeasurement and Quality Improvement webinar YouTube - May 4, 2017
- Health Information Technology (IT) Curriculum Resources for Educators videos were funded by The Office of the National Coordinator for Health Information Technology (ONC) as part of the Workforce Development Programs and provide instructional materials covering areas relevant to improved care delivery. NOTE: Many of these components are over 1 GB in size. Downloading may take up to 10 minutes, depending on your connection. A number of the curriculum components cover electronic clinical quality improvement.
- eCQI Toolkit - March 2017 and eCQI Resources from Mountain-Pacific Quality Health Quality Improvement Organization assist organizations with leveraging health information technology (HIT) and the Plan Do Study Act (PDSA) process improvement methodology to support and advance their health quality improvement initiatives.
eCQI Resource Center
- eCQM Standards Cycle and eCQI Resource Center Updates: CMS Quality Bi-Monthly Forum - March 2021
- eCQI Resource Center Demonstration: The eCQM Data Element Repository (DERep) breadcrumbs and measure detail page - CMS Quality Bi-Monthly Forum - January 2021
- eCQI Resource Center Overview - July 15, 2020
- Includes tools and resources related to the eCQM annual update for the 2021 reporting and performance period and telehealth eCQM reporting implementation and reporting guidance.
- eCQI RC: eCQM Pages - November 13, 2019
- eCQI RC: Key Tools and Resources - November 13, 2019
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.
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.
Find information on various helpdesks and tools for eCQM help is found on the eCQI Resource Center Contact Us page.