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My focus in this blog is to provide some clarity around the different types of HEDIS measures. I know it’s easy to get confused: different measure types, different rules for source data, different technologies and methods for reporting measure results to NCQA.
We have been using terms like ‘admin measures,’ ‘hybrid measures’ and ‘measure types’ for many years now. More recently, digital measures have also been introduced, and with them terminology including dQMs, ECDS (commonly mistaken for a measure Type – more on that later) and QDM-CQL and FHIR-CQL, the measure logic language/standards used to implement digital quality measures. These, of course are important for vendors and others who plan on ‘running’ these measures, i.e. take advantage of their ability to be automatically converted into machine-executable logic. The good news, as you’ll see below, is that as of MY 2022, QDM-CQL will be completely discontinued.
A note on terminology: digital measures are generally referred to as eCQMs or dQMs. eCQM is commonly used for measures coming out of CMS, most of them targeting providers. dQM is the term we have been using on the payer side, specifically by NCQA. Going forward, it is important that we consistently use this terminology: Digital quality measures (dQMs) are quality measures expressed in a digital format using highly standardized language and data definitions that enable sharing of the fully specified measure electronically between systems. dQMs may utilize a broad array of data from multiple electronic sources including, but not limited to, EHRs, registries, case management systems, HIEs, wearable devices and administrative claims. Electronic clinical quality measures (eCQMs) use data derived from electronic medical records and are a subset of dQMs.
Although the current state of quality measures is quite complex, the move towards an ‘all-dQM’ ecosystem will reduce most of the confusion we see today. From this point forward, NCQA will use and promote a simplified set of terminology as shown in the table below.
I created this simple matrix showing ‘what’s what’ allowing us to quickly compare and understand the major aspects of HEDIS measures as they are evolving towards MY 2022.
In the future this table will look much simpler. NCQA’s stated key goals for HEDIS measures are to
1. Convert many of the traditional HEDIS measures into dQM format
2. develop new HEDIS dQMs for HEDIS ECDS Reporting when possible to allow for greater use of electronic clinical data in its native formats. These measures will be specifically developed to take advantage of the continued maturation of interoperability standards (FHIR APIs).
I want to further clarify the term ECDS. While many in the field, (including me until recently) refer to ‘ECDS measures,’ it is important to note that such a concept does NOT exist. When we look at the HEDIS measure specs, they are clearly called ‘ECDS-reported measures.’, That is how we should refer to them going forward. The confusion is in part understandable, not just because we all like to simplify – sometimes too much – but also, because ECDS-reported
measures allow for different data sources, i.e. input, which conceptually is data points that are being ‘measured’ to come to a reportable conclusion.
With ECDS-reported measures NCQA has significantly expanded the allowed data sources beyond traditional claims plus supplemental data or data from medical records review (MRR) to include broader use of those various systems housing relevant clinical information (hence the name Electronic Clinical Data Systems – ECDS). The major data categories allowed for ECDS Reporting are:
1. Electronic Health Records (EHRs)/personal health records (PHR)
2. Health Information Exchanges (HIEs) and clinical registries
3. Case Management Systems
4. Administrative (includes, but is not limited to, medical and pharmacy claims, enrollment and member demographic information)
As you can see in the table, QDM-CQL-based measure logic will be discontinued for MY 2022. As time goes on, additional rows and columns in the table will become obsolete, until only dQMs remain. It is likely that Traditional reporting will be replaced mostly by ECDS Reporting, with surveys potentially having an updated/digital reporting equivalent to what exists today.
· Do you understand how traditional measures, ECDS and dQM are different?
· Do you understand the ‘roadmap’ for HEDIS measures?
· Are you using ECDS measures?
· What questions do you have that haven’t been answered?
· What resources would you like to have from the community, NCQA and/or vendors?
Share your thoughts with us in the Community Forum.
Michael Klotz, Healthcare IT Entrepreneur, MK Advisory Services
Michael is a Healthcare IT entrepreneur, consultant and expert in the flow of data between patients, providers and payers (the healthcare data ecosystem), healthcare interoperability, digital quality and digital prescriptions. He applies his understanding of technology and standards, including HL7 FHIR, the regulatory environment, NCQA’s quality measures, the emerging digital quality standards (QDM-CQL, FHIR-CQL) and NCPDP standards to simplifying and automating secure data exchanges between patients, providers and payers.
Michael has built three successful companies, brought the first SaaS platforms for Medical Records Review to market and has been delivering strategic solutions for 120+ consulting clients for over 20 years.