The Facilities for Medicare & Medicaid Providers (CMS) is transferring steadily towards using FHIR-based digital high quality measures (dQMs). CMS believes dQMs will allow a extra dynamic, interoperable, and complete method to high quality measurement than the digital scientific high quality measures (eCQMs) at present in use.
Because it seeks public suggestions on draft dQM packages, CMS officers held a webinar in January to elucidate the anticipated transition.
One of many webinar audio system was Joel Andress, the digital high quality measurement lead at CMS, who heads up efforts to develop and implement a method to transform CMS high quality measurement to a digital format. The objectives are to scale back reporting burden for care suppliers and promote knowledge interoperability.
“We’re hoping to set expectations for upcoming modifications in how high quality measures are developed, applied, and reported throughout our applications and provides you a chance to actively take part in that transition,” Andress stated.
He famous that digital high quality measures allow alignment between scientific care, reporting necessities, and program accountability which have lengthy been sought in CMS high quality applications.
“Our perception is that by implementing digital high quality measures, we’ll be capable of help the long-term sustainability of those applications and higher enchancment within the high quality of care in our supplier programs,” Andress stated.
He defined what it implies that CMS applications are transitioning from conventional measures to FHIR-based digital high quality measures. These modifications could embody up to date measure logic, new knowledge necessities, and enhanced technical specs, and are designed to enhance measure validity, improve the interoperability of the info being collected, and help automated reporting inside CMS’ applications, he defined.
“We’re in search of to make sure that there may be an alignment between human-readable and computable specs that we have developed within the FHIR customary, guarantee that there is a feasibility of gathering required knowledge components in EHR programs, and attempt to get a way of what the potential influence on reporting workflows and supplier burden could be given the modifications to those measures,” he stated.
The suggestions interval will give CMS a possibility to acquire clear perception into the transition of digital high quality measurement, equip stakeholders with the context wanted to know what CMS is altering about these measures and the presentation of data concerning them, and to allow significant participation within the growth and implementation course of.
These measures transformed to FHIR will finally signify a subset of digital high quality measures that will probably be a way more expansive class and incorporate different sources of information and reporting. Whereas associated, Andress defined, digital high quality measures are distinct from the present program eCQMs and are constructed on a unique knowledge mannequin and technical basis.
The eCQMs have been used for a few years throughout CMS High quality Reporting Packages. They’re based mostly on the High quality Information Mannequin, or QDM, which is designed particularly for CMS use and primarily for reporting from digital well being information.
The eCQMs have enabled automated reporting in comparison with guide abstraction, however are restricted of their interoperability and are carefully tied to EHR-based knowledge sources. Digital high quality measures, then again, are constructed on FHIR customary and use interoperable knowledge, Andress stated. They use that as an interoperable knowledge mannequin. Designed to be modular, reusable, and scalable throughout applications and use circumstances, the measures can embody knowledge necessities that aren’t confined to a single system.
Digital high quality measures broaden the idea of information sources to incorporate medical units, scientific programs, patient-facing purposes, and different digital well being applied sciences past conventional EHRs.
Changing eCQMs to dQMs
Andress defined that “changing eCQMs to dQMs preserves current measure intent whereas modernizing the technical basis, and that positions CMS high quality applications for higher interoperability, lowered reporting burden, and extra complete and well timed high quality insights.”
FHIR, he added, supplies a complete framework for implementing scientific high quality measures and provides a standardized set of assets and operations that help the illustration, sharing, and analysis of scientific information artifacts. “Moreover, it isn’t constrained merely to the standard measurement goal, and which means the info are interoperable for quite a lot of functions, not merely inside our reporting applications,” Andress stated. “The framework allows standardization and interoperability by utilizing constant knowledge codecs and constructions and facilitating seamless integration throughout the varied healthcare programs.”
FHIR’s modular design and RESTful APIs help speedy implementation, scalability, and adaptableness to the evolving necessities. Information collected for the aim of CMS’ program are reusable for various functions, growing the effectivity of the info assortment, he stated. FHIR additionally helps environment friendly dealing with of enormous knowledge units and allows population-level evaluation and reporting.
At the moment, there are 157 assets in FHIR, and Andress shared some frequent assets in use with CMS digital high quality measures included on this public remark interval.
The scientific module consists of allergy intolerance, situation issues, process, and care plans assets. Some assets could reference different assets, resembling service requests. The diagnostics module consists of remark and diagnostic report.
Andress defined that the QI-Core Implementation Information (IG) is a FHIR-based implementation information developed to standardize how scientific knowledge are represented for high quality measurement and enchancment. It supplies a bridge between scientific care knowledge and digital high quality measures. This IG ensures constant and interoperable illustration of scientific ideas wanted for high quality measurement, facilitates the transition from conventional eCQMs based mostly on the QDM to FHIR-based digital high quality measures, and helps high quality reporting applications, scientific determination help, and inhabitants well being initiatives.
“In a nutshell, the QI-Core IG is a foundational information that defines how scientific knowledge must be represented in FHIR in order that high quality measures will be correct, interoperable, and implementable,” he stated.
Different IGs which are key to the implementation of measures embody the High quality Measure IG, or QM IG, which basically defines how a measure is constructed, and the DEQM, or Information Trade for High quality Measures IG, which defines find out how to change digital high quality measurement knowledge between programs, i.e., find out how to report the measures to CMS when it is time to take action.
Andress described a device known as MADiE (Measure Authoring Improvement Built-in Atmosphere) that’s designed for the creation, testing, and administration of each eCQMs and digital high quality measures.
“MADiE streamlines the event, testing, and administration of high quality measures to enhance healthcare reporting outcomes. MADiE’s position can also be to publish the artifacts which are there so that you can help you within the implementation of those measures,” he stated. “A lot of what you will be reviewing within the public remark starting immediately comes from the MADiE system.”
With the dQM public remark interval, CMS is publishing the dQM measure packages for these measures CMS has transformed to the FHIR customary, he stated. “The publication of those packages containing these recordsdata that I’ve described consists of what we imagine to be an acceptable illustration of the artifacts that may publish in future annual updates for these dQMs. So basically we’re presenting to you what we predict measure packages would appear to be as soon as we applied FHIR digital high quality measurement reporting.”
Andress concluded by sayiing that stakeholders now have a solution to see how CMS has mapped out these measures, what they appear to be, and supply suggestions. “We additionally need to hear about any ambiguities in how we have introduced the supplies, whether or not or not one thing’s lacking that may be vital to incorporate, or if one thing is introduced in a method that’s troublesome to make use of.”
The draft dQM packages can be found by way of ONC JIRA tickets, together with 17 hospital inpatient digital high quality measures, 4 hospital outpatient digital high quality measures, and 49 eligible clinician digital high quality measures. Check case exports are offered for a few of these measures, and public feedback are open by way of Feb. 23, 2026.
