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 HEDIS 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 HEDIS. At this stage, organizations may publicly state that they:

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

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 Digital HEDIS Results

After implementation, organizations may use digital HEDIS results for official reporting. Organizations are responsible for ensuring results are accurate and ready for reporting.

What is Comparative Testing?

Comparative testing (formerly parallel testing) is optional and may be used to compare digital and traditional results to support validation and confidence.

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 and navigating validation milestones with NCQA.

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