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CMS Transitioning to New Health IT Standard for Reporting eCQMs

November 1, 2017
by Heather Landi
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The Centers for Medicare & Medicaid Services (CMS) announced that following more than one year of testing and input from the vendor and implementer communities, electronic clinical quality measures (eCQMs) in CMS quality programs will be transitioned to use the Clinical Quality Language (CQL) standard (CQL Release 1, Standard for Trial Use (STU) 2) for logic expression.

CQL is a Health Level Seven International standard and aims to unify the expression of logic for eCQMs and Clinical Decision Support (CDS). CQL provides the ability to better express logic defining measure populations to improve the accuracy and clarity of eCQM, according to a CMS press release. More information can be found on the eCQI resource page here.

Eligible hospitals, professionals, and clinicians will use CQL-based eCQMs are part of programs such as the Hospital Inpatient Quality Reporting Program, EHR Incentive Programs, and Merit-based Incentive Payment System (MIPS) in 2019.

“Measures expressed using CQL logic will continue to use the Quality Data Model (QDM) as the conceptual model to express clinical concepts contained within quality measures. Refer to the QDM v5.3 Annotated version and current version of the CQL standard to better understand how they work together to provide eCQMs that are human readable, yet structured for electronic processing,” CMS stated.

The transition to reporting CQL-based measures will begin with the calendar year (CY) 2019 reporting period for Eligible Hospitals and Critical Access Hospitals (CAHs), and CY 2019 performance period for Eligible Professionals (EPs) and Eligible Clinicians. To support the transition, CMS will publish CQL-based eCQMs in Spring 2018 for potential inclusion in the following programs:

Hospital Inpatient Quality Reporting Program

Medicare Electronic Health Record Incentive Program for Eligible Hospitals and CAHs

Medicaid EHR Incentive Program for EPs, Eligible Hospitals, and CAHs

Quality Payment Program: The Merit-based Incentive Payment System (MIPS) and Alternative Payment Models

Draft eCQM specifications using CQL will be available through November 13, 2017 on the CQM Issue Tracker via the following tickets. Please note, that these draft specifications are for informational review only and are not intended for implementation and/or submission:

Eligible hospital and critical access hospital measures (CQM-2858)

Eligible professional and eligible clinician measures (CQM-2860)

CMS also has developed a number of resources and tools:

CQL-based Health Quality Measure Format (HQMF) Implementation Guide Release 1, STU 2.1 - Defines the approach to using the CQL with the QDM and HQMF to define eCQMs. This STU 2.1 includes a Terminology section and vocabulary management guidance. 

CQL Formatting and Usage Wiki - A collaborative workspace for the development of CQL formatting conventions and usage patterns for the representation of logic within quality measures.  

CQL GitHub Tools Repository - Provides tooling in support of the standard, including the CQL-to-ELM translator, with a reference implementation for syntactic and semantic validation of CQL and example measures used by the translator.

Measure Authoring Tool - A web-based tool that allows measure developers to author eCQMs using the QDM. 

Bonnie Testing Tool - A tool designed to support streamlined and efficient pre-testing of eCQMs.

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