- CMS recently announced that its quality programs will transition to the CQL standard (CQL Release 1, Standard for Trial Use (STU 2) for logic expression. Using CLQ will allow for better aligned standards between clinical decision support and electronic clinical quality measures (eCQMs).
Eligible hospitals, professionals, and clinicians will use CQL-based eCQMs are part of programs such as the Hospital Inpatient Quality Reporting Program, EHR Incentive Programs, and Merit-based Incentive Payment System (MIPS) in 2019.
CQL is a Health Level Seven (HL7) international standard designed to unify the expression of logic for eCQMs and clinical decision support. The standard will improve logic expression “defining measure populations to boost the accuracy and clarity of eCQMs,” the federal agency stated.
According to a product brief provided by HL7, the standard will benefit health data exchange by creating a common language for sharing quality knowledge and data.
Clinical decision support and eCQMs are closely related and share some common requirements. However, HL7 noted clinical decision support and eCQMs often use different approaches to represent patient health data and computable expression logic. The CQL specification attempts to allow for common representation of expression logic used by both eCQMs and clinical decision support data standards.
“Rather than having an unscalable network of point-to-point communication channels, each with its own set of transformations, different organizations will only need to transform their content to a CQL-compatible format to communicate effectively with any other point in the network of providers that comprises today’s healthcare system,” stated HL7.
Some quality vendors may also opt to use CQL as an international specification in the future, the organization stated.
Eligible professionals and eligible clinicians using CQL for the 2019 performance period will still use the same data model for quality measures.
“Measures expressed using CQL logic will continue to use the Quality Data Model (QDM) as the conceptual model to express clinical concepts contained within quality measures,” clarified CMS.
“Refer to the QDM v5.3 Annotated version and current version of the CQL standard to better understand how they work together to provide eCQMs that are human readable, yet structured for electronic processing,” the federal agency continued.
Transiting to CQL-based measures will start in the 2019 reporting period for eligible hospitals and critical access hospitals (CAHs). Eligible professionals (EPs) and eligible clinicians will begin using CQL-based measures for reporting starting in the 2019 performance period.
CMS stated it will publish CQL-based eCQMs in spring of 2018 for potential inclusion in the Hospital Inpatient Quality Reporting Program, Medicare EHR Incentive Program for eligible hospitals and CAHs, Medicaid EHR Incentive Program for EPs, eligible hospitals, and CAHs, and the Quality Payment Program.
Draft eCQM specifications using CQL will be available through Nov. 13, 2017 on the CQM Issue Tracker. Draft specifications are for informational review only and are not intended for implementation or submission.
CMS also recently issued a guide to assist eligible clinicians in meeting requirements for the prevention of information blocking attestation under MIPS.
All eligible clinicians reporting on the advancing care information performance category must attest to the prevention of information blocking attestation to avoid payment penalties.
“If you are reporting as a group, the prevention of information blocking attestation by the group applies to all MIPS eligible clinicians within the group,” clarified CMS. “Therefore, if one MIPS eligible clinician in the group fails to meet the requirements of the Prevention of Information Blocking Attestation, then the whole group would fail to meet the requirement.”
DirectTrust CEO and President David Kibbe stated his disapproval of the attestation as it may punish providers for problems more likely caused by non-compliant vendors.
“In my opinion, ONC and CMS can do more to clarify the minimal requirements for interoperable health information exchange necessary for providers and their EHR vendors/health IT vendors to avoid a charge of ‘information blocking,'” Kibbe stated.