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 consistently identify, represent, and evaluate data from electronic health records (EHRs) and other health information systems in a structured and computable manner, supporting quality measurement, benchmarking, and regulatory reporting. By using standardized vocabularies and data representations, healthcare organizations can improve interoperability, reduce ambiguity in how clinical concepts are represented, and increase the consistency and reliability of performance measures used to assess the quality of care.
Value sets are developed, maintained, and published through the National Library of Medicines’ Value Set Authority Center (VSAC), which serves as the central repository for standardized code groupings used in measures. When a measure concept can be represented appropriately by a single code, the measure specification may use a direct reference code (DRC) rather than a value set. DRCs reference a specific code directly from a terminology or code system, while value sets group multiple codes that represent the intended clinical or administrative concept. Using both value sets and DRCs allows measure developers to select the level of terminology specificity appropriate for each data element and supports consistent, interoperable, and reliable quality measurement across health information systems.
