Standards Summary

Key standards for eCQM data capture, calculation, exchange, and reporting:   

Clinical Quality Language (CQL) – expression language used to communicate specific data to be retrieved and logic needed to evaluate eCQMs. The machine-readable Expression Logical Model (ELM) is a representation of the CQL.

Health Quality Measure Format (HQMF) – a standard format to describe eCQM metadata, like the numerator, 
denominator, exclusions, and exceptions, using XML documents.

Clinical Quality Language-Based Health Quality Measure Format (CQL-Based HQMF) – an implementation guide for how to use the HQMF base standard with QDM and CQL to author eCQMs.

Quality Data Model (QDM) – a standard information model used to define and standardize data elements, attributes, and their relationships for clinical concepts used in eCQMs.

Quality Reporting Document Architecture (QRDA) – standard format for reporting eCQM data in a structured, consistent representation. QRDA I is used for individual patient data and QRDA III for aggregate patient data.

Health Terminology Standards

eCQMs rely on standardized health terminology to ensure consistent, accurate, and interoperable reporting across healthcare systems. Key terminology standards include Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) for capturing detailed clinical concepts, Logical Observation Identifiers, Names and Codes (LOINC) for identifying lab tests and clinical observations, Medical Prescription Normalized (RxNorm) for representing medications, Current Procedural Terminology (CPT) for types of encounters, and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for coding diagnoses. These standards enable eCQMs to extract and compare data from electronic health records (EHRs) in a structured way, supporting quality measurement, benchmarking, and regulatory reporting. By using common vocabularies, healthcare organizations can improve data exchange, reduce ambiguity, and enhance the reliability of performance metrics used to assess patient care outcomes.

eCQM value sets are developed and maintained using the Value Set Authority Center (VSAC), which serves as the authoritative source for standardized clinical code groupings used in measures. In addition to value sets, direct reference codes are identified in VSAC when a single, precise code is sufficient to capture a concept without requiring a broader grouping. This dual approach enhances the specificity and flexibility of eCQMs, enabling accurate data capture, interoperability, and reliable quality measurement across diverse electronic health record (EHR) platforms.