QRDA - Quality Reporting Document Architecture
The Quality Reporting Document Architecture (QRDA)
is the data submission standard used for a variety of quality measurement and reporting initiatives. QRDA creates a standard method to report quality measure results in a structured, consistent format and can be used to exchange eCQM data between systems.
Current QRDA Reference and Implementation Guides:
2020 Reporting and Performance Period
The 2020 CMS QRDA Category I Implementation Guide for Eligible Hospitals for 2020 eCQM reporting is based on the HL7 Clinical Document Architecture (CDA) Release 2: Quality Reporting Document Architecture (QRDA) Category I, Release 1, Standard for Trial Use Release 5.1 (published December 2018).
- 2020 CMS QRDA I Implementation Guide for Hospital Quality Reporting
- 2020 CMS QRDA I Schematrons and Sample Files for Hospital Quality Reporting
2019 Reporting and Performance Period
The 2019 CMS QRDA Category I Implementation Guide for Eligible Hospitals for 2019 eCQM reporting is based on the HL7 Implementation Guide for Clinical Document Architecture (CDA) Release 2: Quality Reporting Document Architecture (QRDA) Category I, Release 1, Standard for Trial Use Release 5 (published December 2017).
- 2019 CMS QRDA I Implementation Guide for Hospital Quality Reporting
- 2019 CMS QRDA I Schematrons and Sample Files for Hospital Quality Reporting (Updated February 2019)
The 2019 CMS QRDA Category III Implementation Guide for Eligible Clinicians and Eligible Professionals for 2019 eCQM reporting is based on the HL7 Implementation Guide for Clinical Document Architecture (CDA) Release 2: Quality Reporting Document Architecture (QRDA) Category III, Release 1, Standard for Trial Use Release 2.1 (published July 2017).
- 2019 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals
- 2019 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians and Eligible Professionals (Updated February 2019)
- Addendum to 2019 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals
Overview
QRDA is a Health Level Seven International (HL7) Clinical Document Architecture (CDA)-based standard. It further constrains CDA Release 2 for exchange of electronic clinical quality measure (eCQM) data. QRDA was adopted by the Office of the National Coordinator for Health Information Technology (ONC) as the standard to support both QRDA Category I (individual patient) and QRDA Category III (provider’s aggregate) data submission approaches for quality reporting.
- QRDA Category I (QRDA I) is an individual-patient-level report. It contains quality data for one patient for one or more eCQMs.
- QRDA Category III (QRDA III) is an aggregate quality report. It has been expanded to support the exchange of Promoting Interoperability measures and improvement activities for the CMS Quality Payment Program. A QRDA III report contains quality data for a set of patients for one or more eCQMs, Promoting Interoperability measures, and/or improvement activities.
The HL7 Clinical Quality Information (CQI) Workgroup maintains and updates both HL7 QRDA I and III standards to ensure alignment with other quality related standards.
CMS publishes QRDA implementation guides (IGs), Schematrons, and sample files annually to provide technical guidance for implementing the HL7 QRDA I and III standards for reporting to CMS quality reporting programs. The CMS IGs further constrain the HL7 QRDA standards to support CMS specific requirements, such as requiring CMS program names. The CMS IGs also provide submission guidance for a specific performance/reporting period. Schematron files contain a list of assertion rules used to validate that generated QRDA reports conform to the requirements specified in the IGs.
Connections between Standards
Healthcare organizations receive the measure specifications, expressed in HQMF using QDM and CQL and then report results to CMS using QRDA.
Resources for use when implementing QRDA:
CMS QRDA Pre-Submission Validation Tools Guide - Resource which 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.
QRDA III Converter - Converter tool which 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-CQM Sandbox - Cypress testing environment which contains resources and tools for the QRDA Category I and Category III standards. The QRDA Validator provides implementers with the ability to validate the conformance of the latest HL7 QRDA Category I and Category III standards. Note that CMS programs may have additional program specific requirements for QRDA submissions to these programs, which are specified in the CMS QRDA Implementation Guide.
Visit the eCQI Tools & Key Resources Library for a complete list of tools and resources used with eCQMs and eCQI.
2018 Reporting Period QRDA Reference and Implementation Guides
For 2018 reporting, there are two CMS QRDA Implementation Guides: one CMS Implementation Guide for Eligible Hospitals and a separate CMS Implementation Guide for Eligible Clinicians and Eligible Professionals.
- 2018 CMS QRDA I Conformance Statement Resource
- 2018 CMS QRDA I Implementation Guide for Hospital Quality Reporting
- 2018 CMS QRDA I Schematrons and Sample Files for Hospital Quality Reporting
- Addendum to 2018 CMS QRDA Category I Implementation Guide for Hospital Quality Reporting
- Sample Hybrid Hospital-Wide Readmission Measure QRDA I file
- Guidance for reporting diagnostic test data in the Diagnostic Study Performed (V3) template of QRDA Category I files
- 2018 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals (Updated July 2018)
- 2018 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians and Eligible Professionals (Updated October 2018)
2017 Reporting Period QRDA Reference and Implementation Guides
- 2017 CMS QRDA I Implementation Guide for Hospital Quality Reporting
- 2017 CMS QRDA I Schematrons and Sample Files for Hospital Quality Reporting (Updated July 2017)
- 2017 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals
- 2017 CMS QRDA III Schematrons and Sample Files for Eligible Clinicians and Eligible Professionals
- 2017 CMS QRDA I Conformance Statement Resource
- Technical Guidance for Valid Reporting of Custodian ID using CMS Certification Numbers in QRDA I Files for Hospital Quality Reporting
- Technical Instructions for QRDA I Submissions for CY 2017 eCQM Reporting
2016 Reporting Period QRDA Reference and Implementation Guides
- 2016 CMS QRDA Implementation Guide for Eligible Professional Programs and Hospital Quality Reporting
- 2016 CMS QRDA Implementation Guide Appendix for Eligible Professional Programs and Hospital Quality Reporting (February 2016)
- CMS eCQM EP QRDA Cat III IPP_IPOP Issue Overview
- 2016 CMS QRDA I Schematrons and Sample Files for Hospital Quality Reporting v2.3 (Updated October 2016)
- 2016 CMS QRDA III Schematrons and Sample Files for Eligible Professional Programs v2.3 (Updated October 2016)
- 2016 CMS QRDA I Schematron Guidance for Hospital Quality Reporting and Eligible Professional Programs v2.3 (New October 2016)
- 2016 CMS QRDA III Schematrons and Sample Files for Eligible Professional Programs v2.2
- Additional 2016 QRDA Guidance
2015 Reporting Period QRDA Reference and Implementation Guides
- 2015 CMS QRDA Implementation Guide for Eligible Professional Programs and Hospital Quality Reporting
- Addendum to 2015 CMS QRDA Implementation Guide for Eligible Professional Programs and Hospital Quality Reporting
- 2015 CMS QRDA III Sample Files for Eligible Professionals (Updated October 2015)
2014 Reporting Period QRDA Reference and Implementation Guides
- 2014 CMS QRDA I Implementation Guide for Hospital Quality Reporting (Effective July 1, 2014)
- 2014 CMS QRDA I Sample Files for Hospital Quality Reporting (April 2014)
- 2014 CMS QRDA I Implementation Guide for Eligible Professional Programs
- 2014 CMS QRDA III Implementation Guide for Eligible Professional Programs
- 2014 CMS Performance Rate Calculation Requirement for Eligible Professionals QRDA III
- Guide to the Quality Reporting Document Architecture, QRDA, for 2014 eCQMs
General QRDA Education
- QRDA Tutorial - HIMSS 2017 (YouTube)
- QRDA Submissions to CMS HIMSS 2016- March 1, 2016
CMS QRDA Category I (for patient level data)
- 2020 CMS QRDA I Implementation Guide, Schematron, and Sample File for Hospital Quality Reporting- June 17, 2019
- CMS QRDA Category I Implementation Guide Changes for CY 2019 Hospital Quality Reporting - March 27, 2019
- CMS QRDA Category I Implementation Guide Changes for CY 2018 for Hospital Quality Reporting - March 19, 2018
- Technical Guidance for Valid Reporting of Custodian ID using CMS Certification Numbers in QRDA Category I Files for Hospital Quality Reporting Programs - CMS Quality Partner Call on August 21 , 2017
- Technical Instructions for QRDA Category I Submissions for eCQM Reporting to the Hospital IQR and the Medicare EHR Incentive Programs for Eligible Hospitals and Critical Access Hospitals - July 25, 2017
- CMS QRDA Implementation Guide Changes for CY 2017 Hospital Quality Reporting - March 28, 2017
- How to Correct Common Schema Validation Errors for 2016 QRDA I Submissions - February 17, 2017
- View Webinar (YouTube)
- Qs&As
- Device, Order Not Done Issue Guidance - CMS Quality Partner and Vendor Workgroup Calls on January 23 and 26, 2017
- 2016 CMS QRDA Implementation Guide Changes for Eligible Hospitals/Critical Access Hospitals - December 17, 2015
CMS QRDA Category III (for aggregate data)
- Updated 2018 CMS QRDA Category III IG for Eligible Clinicians and Eligible Professionals Presentation - CMS Quality Partner and Vendor Workgroup Calls on August 21 and 23, 2018
QRDA Category I and Category III
- 2019 CMS QRDA I and III Updates - CMS Quality Vendor Workgroup Call on February 28, 2019
- 2018 CMS QRDA I Conformance Statement Resource and 2019 CMS QRDA III Implementation Guide, Schematron, and Sample Files Overview - CMS Quality Partner and Vendor Workgroup Calls on December 10 and 13, 2018
- Changes in the 2017 CMS QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals and the 2018 CMS QRDA I Hospital Quality Reporting Implementation Guide - CMS Quality Partner Call on July 17, 2017
Get Involved
There is not a formal QRDA user group at this time, although there are active standards communities where QRDA is discussed and reviewed.
The HL7 Clinical Quality Information Work Group Wiki serves as a collaborative workspace for the development of technology standards in support of measuring and improving health, health care, and health care quality. 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.
Seek Help and Provide Feedback
Questions and comments related to the development and implementation of QRDA can be posted to the ONC Jira QRDA Issue Tracker.