eCQM Overview

Electronic Clinical Quality Measures (eCQM) are digital tools used to assess patient care quality, based on data extracted from electronic health records (EHR). These measures are designed to ensure that healthcare delivery aligns with evidence-based standards and improves patient outcomes. Similar to Hospital Inpatient Quality Reporting (IQR) and Promoting Interoperability, eCQMs are used in CMS programs and apply to both inpatient and outpatient settings. Inpatient eCQMs require more complex documentation due to longer length of stays, multiple comorbidities, and risk adjustments. Outpatient eCQMs focus on timeliness and appropriateness of care, especially in the emergency and imaging departments.

For CDI specialists, eCQMs represent a critical intersection between clinical documentation and quality reporting. Whether you're new to the concept or deeply involved in quality initiatives, understanding eCQMs is essential for aligning documentation practices with performance metrics.

Why eCQMs matter to CDI:

• Data-driven quality: eCQMs rely on structured data from EHRs, making accurate and complete documentation vital
• Regulatory compliance: Many eCQMs are tied to CMS programs like the IQR and Promoting Interoperability, affecting reimbursement and public reporting
• Clinical alignment: eCQMs reflect clinical best practices; CDI professionals can help ensure documentation supports these standards, reducing gaps between care delivery and reported outcomes
• Risk adjustment: eCQM reporting is affected by risk adjustment by keeping comparisons equitable between providers, reducing bias by having controls for confounding factors that could skew performance metrics, and helping ensure that differences in outcomes are due to quality and not patient mix

Here are a few widely used inpatient eCQMs that impact hospital performance and patient care:

• STK-2: Discharged on antithrombotic therapy
  • Evaluates whether ischemic stroke patients are discharged on appropriate antithrombotic medication
• CMS122: Diabetes: Hemoglobin A1c poor control (>9%)
  • Measures the percentage of diabetic patients with poorly controlled blood sugar levels
• CMS165: Controlling high blood pressure
  • Assesses the percentage of patients aged 18–85 diagnosed with hypertension whose blood pressure is adequately controlled
• CMS104: Influenza immunization
  • Tracks whether patients aged six months and older received or were offered the flu vaccine during flu season
• CMS146: Appropriate testing for pharyngitis
  • Ensures patients diagnosed with pharyngitis receive a strep test before being prescribed antibiotics

Outpatient eCQMs include:

• CMS996v5 (OP-40) appropriate treatment for ST-segment elevation myocardial infarction (STEMI) patients in the emergency department (ED)
  
  • To evaluate whether patients with STEMI receive timely and appropriate treatment in the ED
• CMS1206v2 (OP-ExRad) Excessive radiation dose or inadequate image quality for diagnostic CT in Adults
  
  • Assesses whether adult patients undergoing diagnostic CT scans receive appropriate radiation doses and image quality.

CMS updates eCQMs annually and revises their specifications to reflect:

• Changes in clinical guidelines and evidence-based medicine
• Updates to code sets (e.g., ICD-10, SNOMED CT, LOINC)
• Logic corrections and clarifications
• Public feedback and stakeholder input

These updates are typically released in the second quarter of the calendar year and apply to the following year's reporting period. For example, updates published in mid-2025 are intended for the 2026 fiscal year reporting/performance period.

To effectively support eCQMs, CDI professionals should review and understand measure specifications, including measure logic and definitions, and stay up to date with changes in logic, code sets, and clinical evidence. Regular internal audits of documentation and coding should be conducted to ensure alignment with eCQM requirements and to monitor performance trends.

CDI professionals should educate providers on documentation practices that support eCQM reporting, such as capturing specific diagnoses, procedures, and clinical indicators. Collaboration with IT, quality, compliance, and billing teams is essential to ensure data integrity and interoperability.

Key takeaways for CDI professionals:

• Familiarize yourself with the structure of eCQMs, including their numerator, denominator, and exclusion criteria.
• Collaborate with quality teams to understand which eCQMs your organization reports and how documentation impacts measure performance.
• Advocate for documentation practices that support accurate data capture, especially in areas like problem lists, medication reconciliation, and clinical assessments.

Whether you are just beginning to explore eCQMs or refining your role in quality improvement, your expertise in documentation is a powerful asset in driving measurable, meaningful care. CDI professionals should stay informed through the eCQI Resource Center, which provides timelines, measure specifications, and implementation guidance.

The ACDIS Regulatory Committee thanks Jenny Esper, RHIA, CDIP, CCS, CCDS, for serving as lead author for this work.