The Path to Digital HEDIS^®

Milestones on the Path to Digital HEDIS

As the healthcare industry rapidly evolves, so too does the way we measure its quality. For decades, health plans have relied on the traditional HEDIS submission process —manual chart abstraction, clinical review, and coding— to report on care quality. To ensure consistency and accuracy, HEDIS vendors have participated in NCQA’s Measure Certification program, which validates that the logic used to calculate measure results meets NCQA standards and produces reliable, comparable outputs. 

With the transition to digital measurement and the adoption of digital HEDIS, the era is shifting to one of great interoperability, automation, and real-time insights. Customers utilizing Digital Content Services participate in alternative validation efforts. NCQA offers a progressive validation pathway, and customers can publicly share their achievements based on key milestones in this journey.

Milestone 1: Contracting with NCQA

The journey begins when an organization licenses NCQA’s Digital Content Services. At this stage, organizations may publicly state that they:

• Have contracted with NCQA, and
• Are officially using Digital Content Services.

This milestone signals a formal commitment to digital transformation and alignment with NCQA’s digital standards.

Milestone 2: Validation Through Test Executions

Once implementation is underway, organizations must pass NCQA’s test executions. These tests validate that the digital measures are functioning as intended. Upon successful completion, organizations may:

• Claim they use NCQA-Certified Digital HEDIS measures, and
• Display the NCQA-Certified Digital HEDIS seal.

Implementation steps and validation criteria are detailed in the Digital Content Services Handbook, which guides organizations through this critical phase.

Milestone 3: Public Reporting of HEDIS Measure Outputs

After achieving successful implementation and completing one measurement year of parallel testing, organizations may begin using data generated by Digital Content Services for official reporting programs.

What is Parallel Testing?

Parallel testing is a transitional step that ensures accuracy during the shift to digital HEDIS. During this phase:

• Health plans report both traditional and digital HEDIS results for the same measurement year.
• This step is mandatory for at least one measurement year.
• It enables direct comparison between traditional and digital outputs, ensuring alignment and building trust in the new digital process.
• Currently, participation in parallel testing is for only organizations that report through NCQA’s Interactive Data Submission System (IDSS). Organizations that do not submit through IDSS are not eligible and digital results cannot be used for public reporting. If you have questions about what results you may use for reporting , contact NCQA through my.ncqa.org.

Download the NCQA Parallel Testing Information Sheet to learn how health plans and vendors can validate digital HEDIS results for MY 2024 using side-by-side IDSS submissions.

From Measure Certification to Digital HEDIS

Whether your organization is a long-standing Measure Certification vendor, partners with one, or is just beginning to explore the digital future of HEDIS, now is the time to act. Understanding the digital path forward means embracing new standards like FHIR® and CQL, navigating validation milestones with NCQA, and planning for parallel testing as a bridge to fully digital submissions. 

Now is the time to assess your readiness, elevate your data strategy, and build systems that deliver real-time insights and measurable value.