Electronic Specifications for Clinical Quality Measures

Eligible Professionals (EPs), Eligible Hospitals, and Critical Access Hospitals (CAHs) beyond their first year of Meaningful Use participation will submit clinical quality measures (CQMs) electronically beginning with CY/FY 2014.  For Stage 2 MU reporting requirements, reporting periods and the various reporting options; please see the information contained in the main page on Stage 2 of the EHR Incentive program.

What are Electronic Specifications? 

In order to report CQMs from an electronic health record (EHR), electronic specifications (e-specifications) must be developed for each CQM. The e-specifications include the data elements, logic and definitions for that measure in an Health Level Seven (HL7) standard known as the Health Quality Measures Format (HQMF) which represents a clinical quality measure as an electronic Extensible Markup Language (XML) document that can be captured or stored in the EHR so that the data can be sent or shared electronically.

For more information about the standards and composition of electronic specifications, please refer to the October 2012 Guide for Reading EP and EH Measures (PDF).

Electronic Specifications for 2012 and 2013

• Eligible Professionals
  To view the 44 measure specifications, look at the EP Measure Specifications Zip file.
  You can also view the Eligible Professional Clinical Quality Measure document, which identifies the specific number of numerators, denominators, and exclusions reported for these measures. Reporting will require a numeric value for each numerator, denominator, and exclusion, if applicable.
• Eligible Hospitals and CAHs
  The HITSP Technical Note will allow you to view the electronic specifications for eligible hospitals. For the two Emergency Department (ED) Throughput measures, ED-1/NQF 0495 and ED-2/NQF 0497, there is information on the numerators/denominators/exclusions in the Emergency Department Throughput Measures Stratification document.

Electronic Specifications for 2014 - CMS eCQM Library for 2014
In order to allow participants to successfully report CQMs electronically for 2014, CMS is providing a set of electronic specifications for clinical quality measures (eCQMs) for eligible professionals and eligible hospitals for use in the EHR Incentive program for electronic reporting.  These electronic specifications contain multiple parts which allow certified EHR technology systems to be program to accurately capture, calculate, and report clinical quality measures electronically for the 2014 CQMs.  Each eCQM can be described in 3 different ways depending on the intended use:

• HTML  -  This is a human readable format so that the user can understand both how the elements are defined and the underlying logic used to calculate the measure.
• XML – This is a computer readable format which enables the automated creation of queries against an EHR or other operational data store for quality reporting.
• Value Sets – Value sets are the specific codes used by developers to program the system to accurately capture patient data in the EHR system.    

The full set of all versions of eCQM for the 2014 program are available on the CMS eCQM Library webpage.

Value Set Authority Center (VSAC)

The value sets for each measure are maintained by The National Library of Medicine Value Set Authority Center (VSAC).  Through the VSAC, providers, vendors, and developers can access the value sets for each eCQM for the EHR Incentive program.

• Data Elements Catalog (DEC) The data elements catalog is the list of data elements the ONC specified in the EHR certification rule for use in e-clinical quality measures.  A data element is a representation of a clinical concept that represents a patient state or attribute.  This may be a diagnosis, lab value, gender, etc. which is encoded using standardized terminologies.   The DEC is maintained by NLM and available through the VSAC.  
• Value Sets-Value sets define clinical concepts unambiguously.  They provide list of numerical values and the individual descriptions from standard vocabularies used to define the clinical concepts (e.g. diabetes, clinical visit) within the quality measures. The standard vocabularies used are referenced in the ONC certification rule. NLM maintains the value sets with the VSAC.     

Access to the Value Set Authority Center requires a free Unified Medical Language System® Metathesaurus License  through the National Library of Medicine.

Additional Resources

• Guide to the QRDA for 2014 eCQM (PDF)