The Centers for Medicare & Medicaid Services (CMS) eCQI Resource Center is a central source of information and resources for electronic clinical quality improvement. To reduce duplicate efforts, the site links to existing tools and resources whenever possible. It includes information from federal health agencies, including CMS, the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), the National Library of Medicine, and the Agency for Healthcare Research and Quality.
FAQs - Frequently Asked Questions
You can find resources for use at various stages of the electronic clinical quality measure (eCQM) lifecycle, digital quality measures, and information about standards and tools to support eCQI, including clinical decision support. The eCQI Resource Center also supports users looking for links to external resources related to eCQMs and data reporting, like ONC Project Tracking System (Jira), the Measure Authoring Development Integrated Environment, and the Value Set Authority Center.
The eCQI Resource Center includes:
- eCQM specifications and supporting materials
- Hospital - Inpatient, includes filter for hybrid measures
- Eligible Clinicians
- Hospital - Outpatient
- eCQM Data Element Repository
- Event listings and news related to eCQMs and eCQI
- CMS Quality Reporting Document Architecture (QRDA) Category I and III Implementation Guides, Schematrons, and Sample Files
- Digital Quality Measures
- Measure Collaboration Workspace
- Standards and data models used in conjunction with eCQMs and eCQI such as Clinical Quality Language, Fast Healthcare Interoperability Resources® (FHIR), Health Quality Measure Format, Quality Data Model (QDM), QI-Core - Quality Improvement Core, and QRDA
- Tools and links to resources used in conjunction with eCQMs and eCQI
The eCQI Resource Center is constantly improving to better meet the needs of its users. Please email us with any questions or feedback. Visit the Contact Us page for questions on standards, eCQMs and CMS quality program information.
The MC Workspace is a collaboration portal that helps quality and health information technology (IT) staff at measured entity organizations implement and use electronic clinical quality measures (eCQMs). It provides tools, resources, and information in one place to support collaboration among the people and organizations that develop, implement, and report eCQMs.
The MC Workspace includes three modules:
- eCQM Concepts: Users can search existing eCQM concepts, comment on concepts suggested by others, and submit new concepts.
- eCQM Testing Opportunities: eCQM developers can share testing opportunities, and stakeholders can find opportunities to participate in eCQM testing.
- eCQM Data Element Repository (DERep): Provides data definitions to support eCQM implementation and data mapping.
A CQL library is a file that contains CQL logic, such as expressions, definitions, functions, and value sets. Libraries are available in formats such as .cql, .xml, and .json. Each measure includes a primary CQL library that defines the logic used for the measure populations.
eCQMs and dQMs can also use shared libraries. Shared libraries allow multiple eCQMs, dQMs, and in some cases Clinical Decision Support (CDS) artifacts, to reuse common definitions and functions, such as Hospitalization. Reusing libraries helps reduce duplication and supports more efficient measure development and implementation.
For more information, see the Libraries section of the CQL Developer's Guide.
You can compare different versions of an eCQM to see what changed between releases. To get started, find the eCQM by using the “Find an eCQM” search on the home page or by selecting a measure from the Hospital Inpatient, Hospital Outpatient, or Eligible Clinician eCQM lists. Once you have located the desired measure, select the year you want to compare and click the orange "Compare" button.
CQL allows a modular, flexible, and robust expression of the logic. It allows logic to be shared between eCQMs, dQMs, and clinical decision support (CDS).
There is information for implementers located throughout the eCQI Resource Center. The Implementation tab of the Get Started with eCQMs page provides a list of key resources.
The CMS CBE endorses quality measures through a transparent, consensus-based review process that supports health care quality improvement. CMS uses CBE-endorsed measures in some of its quality reporting and value-based purchasing programs. However, not all CBE-endorsed measures are used by CMS, and not all measures used by CMS are CBE-endorsed.
The CMS CBE maintains its measure inventory in the Submission Tool and Repository (STAR). Measure identifiers are now referred to as CBE numbers instead of NQF numbers, but the numbers themselves have not changed. CMS has updated this terminology in proposed rules, the CMS Measures Inventory Tool (CMIT), and the eCQI Resource Center, and plans to update it in Qualified Clinical Data Registries (QCDR).
The QDM specifications provide tables for each datatype available for use. For more information, visit the About tab of the QDM page to retrieve the correct version of the specification. The eCQM Data Element Repository (DERep) provides the pertinent attributes for datatypes and the eCQMs that use them.
Explore these resources to get an overview of CQL and learn how to implement CQL.
- Learn more about the fundamentals of CQL and why it is important on the CQL Educational Resources page. Also find past presentations and webinars for the various audiences who might use CQL.
- Attend an upcoming Cooking with CQL, QDM, and FHIR® webinar. The sessions feature open discussion with CQL subject matter experts, demonstrating how to express eCQMs using CQL, and review questions. Visit the eCQI Events page to find registration information.
- Visit the CQL Formatting and Usage Wiki for introductions, tutorials, and walkthroughs.
- Visit the CQL Formatting and Usage Wiki Cooking with CQL Examples to review common questions and answers on CQL.
- Visit the Connect page to find out how to connect to various CQL resources.
CQL can be used with any data model. The examples presented in the Cooking with CQL, QDM, and FHIR® sessions use the Quality Data Model (QDM). QDM data can be represented in Quality Reporting Document Architecture (QRDA) format for electronic quality reporting. QRDA is similar to the Consolidated Clinical Document Architecture (C-CDA) standard. Both QRDA and C-CDA are HL7 Version 3 (V3) standards.
Please email us with any questions or feedback.
Yes, you can use “return” to specify the type of attributes, because it is an arbitrary expression.
For example:
define "Encounter with Assessment Result":
from
"Valid Encounter" Encounter,
["Assessment, Performed": "Specified Assessment"] Assessment
where Assessment.result in "Specified Assessment Result Valueset"
and Assessment.relevantDatetime during Encounter.relevantPeriod
return Encounter
eCQM developers use QDM and Clinical Quality Logic (CQL) to develop and test eCQMs in the Measure Authoring Development Integrated Environment (MADiE). QDM documentation explains how to use the QDM information model to represent eCQM concepts and requirements.
To learn more and connect with others who use QDM, visit the Connect tab on the eCQI Resource Center QDM page for information about the Quality Data Implementation (QDI) User Group.
Comments submitted through the Suggested eCQM Concepts module are posted as comments on the specific concept submission. The comments are intended for the concept submitter to review. When appropriate, comments may also be shared with the relevant CMS measurement group for consideration during concept evaluation and measure development activities.
To set up an account on the eCQI Resource Center:
- Find the “Log in” option in the main menu bar at the top of any page on the website.
- Select “Manage Your Account.” This opens the Log in page.
- Select the “Create new account” tab.
- Create an account by completing all information fields.
- Select email preferences.
- Check the Captcha box to confirm you are not a bot.
- Select “Create New Account.” You will receive a “Welcome” email with a temporary password. We recommend you go to “Reset your password” and enter the user name or email you used to set up the account and change your password.
- If you do not get an email, please email the eCQI Resource Center for assistance.
Please look for events on the eCQI Resource Center calendar. Please also visit the eCQI Resource Center QDM Connect page to learn about QDM and to register for the QDI User Group distribution list. The QDI User Group addresses questions about how to use various information models (e.g., QDM, QI-Core) to express information required for authoring, understanding, and implementing eCQMs. Submit all requests for QDI User Group discussions to ecqi@lantanagroup.com.
To learn about current Clinical Quality Language (CQL) execution tooling, review the CQL GitHub tooling repository, which includes the CQL-to-ELM translator, execution engines, and related implementation tools. You can also review the eCQI Resource Center's CQL Execution Framework page and the CQL specification's Reference Implementations documentation for information about available execution frameworks and supporting tools. Available tooling includes open-source ELM evaluation engines for JavaScript and Java, as well as a .NET toolkit that supports ELM translation and evaluation.
To post a question or issue, follow these steps:
- Create an account on the ONC Project Tracking System (Jira).
- Once logged in, select “Projects” from the top menu bar and chose "View All Projects."
- Select “QDM Issue Tracker (QDM)” from the list.
- Click the “Create” button at the top of the page to open the “Create Issue” window.
- Complete each information field to provide details of your question or issue.
- Click the “Create” button at the bottom of the window.
We recommend using Visual Studio (VS) Code. VS Code has a CQL extension.
Information on negation in the QDM is available in the negation rationale attribute documentation in QDM v5.6. It is covered in sections 5.10, 6.2, and 6.6, which describe how eCQM developers can use negation rationale and the QDM datatypes that support it.
CQL is the language used to express measure logic, and that logic is stored in CQL libraries. MADiE (Measure Authoring Development Integrated Environment) is the CMS-supported tool used to author, test, and maintain eCQMs and dQMs. MADiE provides an integrated environment that helps measure developers create measure logic, validate it against test cases, and export measure artifacts. For eCQM/dQMs used in CMS quality programs, measure developers are required to use MADiE.
No. "Medication, not Administered" does not imply that a medication order was placed. In QDM, it represents a medication administration that did not occur and includes a documented reason (negation rationale) for why the action was not performed. Because medications can be administered without a medication order, a medication order should not be inferred from "Medication, not Administered."
Expression Logical Model (ELM) is the machine-readable representation of Clinical Quality Language (CQL) logic used in QMs. ELM provides the information needed for software to process and evaluate measure logic and is available in XML (.xml) and JSON (.json) formats. The advantage of ELM is that it translates complex CQL expressions into a standardized format that can be used consistently by implementation and execution tools, reducing the need for developers to interpret or process CQL directly. Refer to the CQL Educational Resources page for additional guidance.
Nine QDM datatypes include the action “Recommended,” which indicates that a clinician suggested a treatment, procedure, assessment, or other intervention to a patient. “Ordered” indicates that the clinician formally requested or prescribed the action. “Performed” indicates that the action was completed.
“QDM Recommended” refers to a clinician recommendation and does not represent a clinical decision support (CDS) proposal.
"Medication, Discharge" represents medications included on a patient's discharge medication list and intended for use after the patient leaves the hospital. These medications are the reconciled medications documented at discharge. Some may be newly prescribed, while others may already be available in the home or obtained over the counter. Therefore, “Medication, Discharge” is not limited to medication orders.
"Medication, Order" represents a medication that has been ordered or prescribed. However, it does not distinguish between medications intended for administration immediately before discharge and those intended for use after discharge.
"Medication, Active" represents a medication that is documented as being actively taken by the patient during the time period of interest. In QDM, this datatype indicates that the medication is being taken by the patient and may be represented at a point in time or over a period during which the medication remains active on the medication record.
"Medication, Discharge" events should start and end within the episode of care, even though the patient may not begin taking the medication until after discharge. The expectation is that discharge medications will correspond to the subsequent home medication list for medications relevant to the eCQM, although changes may occur between episodes of care.
For FHIR-based data exchange, US Core represents active medications using MedicationRequest resources with an appropriate status and intent. The setting for discharge medications can be identified using the category element, allowing discharge medications to be represented separately. QDM v5.5 introduced a setting attribute for Medication, Discharge that aligns with the US Core category and supports the transition to FHIR-based representations.
eCQM developers can model the prescriber of a medication or the type of provider who performed an action by using QDM attributes and entities. QDM includes entities such as Patient, Care Partner, Practitioner, Organization, and Location that can be used to describe the person, organization, or location associated with a QDM action.
For example, a “Medication, Order” prescriber can be modeled as a Practitioner and further described by role or specialty, such as a physician who specializes in internal medicine. eCQM expressions can also indicate that the prescriber is the same individual as the participant in an Encounter, Performed.
Because health IT systems vary in the information they capture and exchange, eCQM developers should test these expressions in real-world settings to determine whether the required data are available and can be retrieved reliably.
CMS first implemented CQL beginning with the calendar year 2019 performance/reporting period eCQMs. CQL replaces the logic expressions previously defined in the Quality Data Model (QDM). Beginning with QDM v5.3, QDM includes only the conceptual model for defining the data elements (the data model).
The eCQM DERep is an online repository that provides data elements, definitions, and clinical information for eCQMs used in CMS quality reporting programs for hospitals and eligible clinicians.
The CMS DEL is a separate resource that provides data elements, response options, and health IT standards for CMS assessment instruments, such as the Minimum Data Set, Outcome and Assessment Information Set, and Hospice Item Set.
In short, the eCQM DERep supports eCQMs, while the CMS DEL supports CMS assessment instruments.
QDM does not define formatting conventions for CQL logic. Developers should use QDM documentation for guidance on QDM datatypes and attributes.
For conventions and best practices related to writing CQL, see the CQL Formatting and Usage Wiki. The Wiki provides guidance that promotes consistency, readability, maintainability, and reuse of CQL expressions.
CMS also publishes an annual QDM-based CQL Style Guide, which applies these conventions to QDM-based eCQMs used in CMS quality reporting programs and promotes consistent use of libraries, aliases, definitions, functions, and other CQL components. Developers creating eCQMs for CMS programs should follow these best practices.
This information is in the CQL-based Health Quality Measure Format (HQMF) Implementation Guide (IG). This document describes constraints on the HQMF Normative edition Release 1 (HQMF R1) header and body elements for the CQL-based HQMF. Volume 3 of the IG references QDM. CMS is currently using QDM v.5.6 and CQL-based HQMF STU 4.1 addresses QDM v5.6.
Users do not need an account to view information contained within the MC Workspace. You need an eCQI Resource Center account if you would like to subscribe to notifications, add a suggested eCQM concept, or add a comment on an existing suggested eCQM concept.
Users with an active eCQI Resource Center account can receive email alerts by subscribing to pages of interest.
- To subscribe, log in to the eCQI Resource Center, navigate to a page, and select Receive updates on this topic in the upper-right corner. When you subscribe successfully, the link changes to Stop receiving updates on this topic. Select that link at any time to stop receiving alerts.
- To manage your subscriptions, log in and select My Account in the upper-right corner of the page. Open the Subscriptions tab to view or manage page subscriptions. To stop receiving news and event emails, select the Edit tab, choose the opt-out option, and then select Save.
Note: Not all eCQI Resource Center pages support subscriptions. If you have any questions on this feature, email the eCQI Resource Center team.
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The event you have tried to add to your calendar contains invalid event information.
The error returned to AddEvent:
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This is an error caused by the security settings set for your mailbox and not caused by the event from the eCQI Resource Center. If issues persist, please contact your information technology department or local administrator.
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Users with active accounts can update their personal time zone. You can manage your eCQI Resource Center account by logging into the website and selecting “My account” at the upper right side of the page. The “Edit” tab allows you to select your time zone. Select “Save” when updates are complete.