eCQMs: Electronic Clinical Quality Measures
An electronic clinical quality measure (eCQM) is defined by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) as “a clinical quality measure that is expressed and formatted to use data from electronic health records (EHR) and/or health information technology systems to measure health care quality, specifically data captured in structured form during the process of patient care.”1 In other words, an eCQM measures quality of patient care—in hospitals and by health professionals—through electronic data. eCQMs are generated by a provider’s EHR system, and are also reported electronically.2 Ultimately, eCQMs contribute to two of CMS’s goals: electronic clinical quality improvement (eCQI), which means using common standards and technologies for improved quality of patient care and patient outcomes; and ultimately, value-based payment models that incentivize better outcomes and lower costs for patients and health care providers.3
eCQMs measure many aspects of patient care, including patient and family engagement, patient safety, care coordination, population/public health, efficient use of health care resources and clinical process/effectiveness.2 Among other elements, a properly reported eCQM must include a title, time period, developer, description, rationale, scoring explanation, clinical recommendation, observations and population.4 As stated by CMS, an example of an eCQM, titled “Diabetes: Foot Exam,” might be described as the “percentage of patients 18–75 years of age with diabetes who had a foot exam during the measurement period,” with the period defined as January 1, 20xx to December 31, 20xx; the measure developer as the National Committee for Quality Assurance; the population as patients 18–75 years of age with diabetes and a visit during the measurement period; and the rationale being that diabetes can lead to severe nerve damage and possible foot amputation if not maintained correctly.4 Such an eCQM involves comprehensive measurement and reporting of patient care over a concrete period of time.
Because eCQMs are versatile and adaptable, they can serve a variety of purposes for professional associations that report to CMS. For example, Yazdany et al.5 developed four eCQMs for rheumatoid arthritis (RA) approved by an interdisciplinary panel of health care professionals: RA disease activity assessment, functional status assessment, disease-modifying drug use and tuberculosis screening (p. 2). Meanwhile, the “Hospital Harm: Opioid-Related Adverse Events” eCQM, which measures opioid-related adverse respiratory events in hospital settings, fits the quality assessment goals of specialists in anesthesiology, rather than in RA.6 Additionally, eCQMs can be used by researchers such as Kannan et al.,7 who included eCQMs in their study on EHR-based specialty data registries and aimed to assess the usefulness of EHR data collection tools in chronic diseases registries.
Given the various roles eCQMs play—as electronic reporting measures for specialty associations and individual health professionals, and as indicators of the success of electronic data collection in health care—it is important to verify their efficacy in improving eCQI and providing incentives. According to Heisey-Grove et al.,8 an eCQM-based incentive program launched by CMS in 2011 prompted 63,000 health care providers to report at least one time over three years on their progress toward blood pressure control among hypertensive patients (p. 440). This suggests that CMS’s incentives encouraged the reporting of eCQMs and provider engagement.8 However, the same authors later found that physicians in smaller and more rural practices were less likely than other physicians to report hypertension control, suggesting that eCQMs as reporting measures may not be universally accessible, nor do they always have the same effect on patient care.9 Additionally, Knierim et al.’s10 study showed that time to report eCQMs varied by measure (cholesterol management versus blood pressure management) and practice type (e.g., clinician- versus hospital-owned practices; p. 8). These authors suggest that CMS programs relying on EHR and eCQMs should considers the time and effort needed to make electronic reports.10
In sum, more research is needed to show the accessibility and practicality of eCQMs for diverse groups of health professionals across the United States. Regardless, eCQMs represent CMS’s steps to improve eCQI through EHR and to move toward a value-based payment system for health professionals.
1. eCQI Resource Center. eCQMs. July 11, 2019; https://ecqi.healthit.gov/glossary/ecqms.
2. Centers for Medicare & Medicaid Services. Clinical Quality Measures Basics. June 17, 2019; https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html.
3. eCQI Resource Center. Electronic Clinical Quality Improvement (eCQI). About eCQI July 19, 2019; https://ecqi.healthit.gov/about-ecqi.
4. Health Services Advisory Group (HSAG), Lantana Consulting Group, National Quality Forum (NQF). Guide for Reading Eligible Professional (EP) and Eligible Hospital (EH) eMeasures: Version 4. May 2013.
5. Yazdany J, Robbins M, Schmajuk G, et al. Development of the American College of Rheumatology’s Rheumatoid Arthritis Electronic Clinical Quality Measures. Arthritis Care and Research. 2016;68(11):1579–1590.
6. Centers for Medicare & Medicaid Services. Hospital Harm: Opioid-Related Adverse Events (eCQM). May 31, 2019.
7. Kannan V, Fish JS, Mutz JM, et al. Rapid Development of Specialty Population Registries and Quality Measures from Electronic Health Record Data*. An Agile Framework. Methods of Information in Medicine. 2017;56(99):e74–e83.
8. Heisey-Grove D, Wall HK, Helwig A, Wright JS. Using electronic clinical quality measure reporting for public health surveillance. MMWR. Morbidity and Mortality Weekly Report. 2015;64(16):439–442.
9. Heisey-Grove DM, Wall HK, Wright JS. Electronic clinical quality measure reporting challenges: findings from the Medicare EHR Incentive Program’s Controlling High Blood Pressure Measure. Journal of the American Medical Informatics Association. 2018;25(2):127–134.
10. Knierim KE, Hall TL, Dickinson LM, et al. Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health. JAMA Network Open. 2019;2(8):e198569–e198569.