Standards Support and Harmonization of Electronic Clinical Quality Measures (eCQMs)


The Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111–5) was enacted on February 17, 2009 to improve healthcare quality, safety, and efficiency through the promotion of health information technology (HIT) and electronic health information exchange.  The HITECH Act also amended several sections of the Social Security Act and in doing so established the availability of incentive payments to eligible professionals and eligible hospitals to promote the adoption and meaningful use of interoperable HIT. Title IV, Division B of the HITECH Act established incentive payments under the Medicare and Medicaid programs for certain professionals and hospitals that meaningfully use Certified Electronic Health Record (EHR) Technology.  The Centers for Medicare & Medicaid Services (CMS) is charged with developing the Medicare and Medicaid EHR Incentive Program and determining the clinical quality measures (CQMs) for reporting that meet one of the criteria for meaningful use.

Clinical quality measurement is an essential tool supporting the transition from fee-for-service payment to reimbursement for care based on quality such as bundled payments and value-based purchasing. Other CMS payment programs that utilize electronic reporting of clinical quality measures and associated standards as part of their requirements include the Inpatient Quality Reporting program (IQR), the Quality Physician Payment Program (QPP) (formerly Physician Quality Reporting System (PQRS)), and the Comprehensive Primary Care Initiative (CPCI). Driven in large part by the Medicare and Medicaid Electronic Health Record Incentive Program (EHR Incentive Program), clinical quality measurement is rapidly shifting from manually intensive chart-abstracted and claims-based measures to electronic clinical quality measures (eCQMs) that can be computed automatically from EHR data. Measurement of quality in this manner has evolved concurrently with a parallel set of initiatives in which clinical decision support (CDS) EHR functionality provides the clinical guidance, based on the same semantic foundation, which is to enable scalable clinical quality improvement. This results in improved performance on eCQMs. CMS requires an agile, scalable and cost-effective approach for developing and distributing eCQMs and CDS interventions that will facilitate improved quality of care and produce accurate and reliable measurement across provider/hospital organizations and EHR platforms.

Our Engagement:

ESAC, Inc. is supporting the mission of HHS and CMS at multiple levels:

  • Providing Program/Project Management of the eCQM Standards development, support and harmonization to improve quality measurement. 
  • Transitioning eCQMs to FHIR to reduce burden.
  • Providing subject matter expertise on the eCQM Standards for the CMS quality Reporting Programs, Quality Physician Payment (QPP) Program and Hospital Inpatient Quality Reporting (HIQR) Program.
  • Management of the eCQI Resource Center website,, the one-stop shop for information on eCQMs. 
  • Working with numerous stakeholders via the HL7 Clinical Quality Improvement (CQI) Work Group, to ensure the base eCQM standards are up to date and implemented for quality measurement and reporting.


eCQM Standards are updated annually and communicated via educational webinars and the eCQI Resource Center website to the eCQI ecosystem. Support is provided to explore the use of FHIR for CMS Quality Reporting Program, including leading the effort for the eCQM Measure Conversions, chairing the HL7 Clinical Reasoning Track at Connectathons and guiding eCQM FHIR pilot work.

Other Projects:

We are quite impressed with not only by the technical skills provided by ESAC's software engineers but also by the depth and breadth of their subject matter experts who have provided guidance on standards and interoperability, quality assurance, and project management issues.


ESAC's technical savvy and personable staff provides tremendous value to projects involving multi-center coordination and high dimensional data management. They merge a fundamental understanding of biology with expertise in data quality control and data security. Integrating all of these factors is key to delivering a secure and fast data portal for the scientific community.

Program Manager

ESAC continues to be an exceptional collaborator providing on-site contractors with both the expertise for building new tools and data integration platforms, and the subject matter expertise in the biosciences needed to manage projects and provide significant added value beyond the technology development.

Innovation Center for Biomedical Informatics at Georgetown University Medical Center

ESAC significantly improved the quality of bioinformatics applications of the NCI CBIIT program using industry best practices to ensure systems were validated both functionally and scientifically for use by the community.

Program Manager

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