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Standards Summary - dQM

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A diagram illustrating how digital quality measurement (dQM) data flows between clinicians, hospitals, and the Centers for Medicare & Medicaid Services (CMS). On the left, icons represent an eligible clinician at the top and a hospital at the bottom. Both send dQM data toward a central CMS building icon. Eligible clinicians transmit DEQM Summary Measure Reports to CMS. Hospitals transmit DEQM Individual Measure Reports to CMS. Arrows between CMS and both the clinician and hospital show bidirectional data ex

 

Digital quality measure (dQM) standards are essential for supporting consistent, valid, and interoperable quality measurement. In health information technology, standards establish agreed upon requirements for how health information is represented, structured, exchanged, and interpreted across systems. These standards may address data models and formats, exchange mechanisms, resource structures, terminology, and the meaning of coded clinical concepts. Together, they help ensure that data used for quality measurement can be exchanged and evaluated consistently across different health information systems. For more information about health IT standards and related initiatives, visit the Interoperability Standards Platform. Learn more about CMS’s transition from eCQMs to dQMs for quality reporting programs here. 

Key standards and implementation guides supporting FHIR-based dQMs:

Clinical Quality Language (CQL) - An HL7 domain-specific language used to express computable clinical logic, including data retrieval criteria, calculations, population logic, and other expressions used in quality measures and clinical decision support. CQL is translated into the Expression Logical Model (ELM), a machine-readable, platform-independent representation of the CQL logic. 

Fast Healthcare Interoperability Resources® (FHIR®) - An HL7 standard for representing and exchanging health information electronically. FHIR provides the foundational resources and data exchange framework used by FHIR-based quality measurement.

Data Exchange for Quality Measures (DEQM) Implementation Guide (IG) - Defines FHIR-based interactions, profiles, and guidance for exchanging quality related date and quality measures reports, including individual, subject-list, and summary reporting scenarios. 

US Quality Core Implementation Guide (IG) - For CMS-focused dQMs, US Quality Core is the emerging FHIR-based clinical data model used to represent quality-related data requirements. It builds on US Core and is intended to support standardized representation and exchange of data used for digital quality measurement.

Quality Improvement Core Implementation Guide (QI-Core) - Defines a set of FHIR profiles with extensions and bindings to create interoperable, quality-focused applications with and support for quality improvement data within healthcare systems in the US Realm used in the creation of dQMs and clinical decision support (CDS) artifacts.

FHIR Quality Measure Implementation Guide (QM IG) - Defines conformance profiles and guidance for quality measures using the FHIR Measure and Library resources, the FHIR Clinical Reasoning Module and CQL. It standardizes how computable quality measure content is represented and exchanged, rather than defining the clinical data model itself.

Health Terminology Standards

Numerous standards development organizations and terminology authorities develop and maintain clinical terminologies. The National Library of Medicine’s (NLM) Unified Medical Language System® Metathesaurus is a large biomedical thesaurus organized by concept, or meaning, and it links synonyms to the concept from nearly 200 different terminologies. However, dQMs use a more focused set of standard terminologies and code systems, depending on the clinical concept being represented. Common examples include SNOMED CT for clinical findings and conditions, LOINC for laboratory tests and observations, RxNorm for medications, and CPT, HCPCS, ICD-10-CM, and ICD-10-PCS for applicable procedures, diagnoses, and administrative or claims-related concepts. NLM’s Value Set Authority Center (VSAC) is the official source of value sets used in CMS programs.

Last Updated: Oct 27, 2026

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