This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they can benefit from implementing better data quality control practices and present new developments in eCQM data collection and reporting.

1. Thanks to recent public and private sector trends linking reimbursements to health outcomes, hospital executives are
now paying close attention to their institution’s quality metrics. Of particular interest are electronic Clinical Quality
Measures (eCQMs), which hospitals are now required to use to provide such data to the Centers for Medicare and
Medicaid Services (CMS), the Joint Commission, patient registries and other organizations.
Several factors will further elevate the importance of quality reporting, including:
• The announced goal of CMS to tie 50% of all traditional Medicare payments to quality or value by 2018
through new payment models, including ACOs.1
• The continued evolvement of Electronic Health Records (EHR) incentive programs for the meaningful use of
certified EHR technology by eligible hospitals and providers, including physicians, physician assistants, nurse
practitioners, clinical nurse specialists, and certified registered nurse anesthetists.2
• Hospitals’ increasing use of quality data in structured formats to manage quality and population health and
coordinate care across their networks.
eCQMs:
It’s Time to Make Data Quality the No. 1 Priority
50% of all traditional Medicare payments
will be tied to quality or value by 2018
Since 2011, the EHR Meaningful Use program has been the prime driver for the development and adoption of
eCQMs. From the outset, however, CMS has focused on determining whether professionals and hospitals were able
to report quality metrics with “the necessary technological capability, functionality, and security.”3
In other words, eCQMs have been all about technology. But what’s missing in the CMS certification criteria is
something far more important – requirements relating to the quality of the data. Given the difficulty of data quality
management, it’s not surprising to find that the American Medical Informatics Association (AMIA) reports that
“healthcare providers generally lack faith in the accuracy and completeness of eCQMs.”4

2. As healthcare moves inexorably toward widespread use of value-based payment models, the quality of eCQM content
can no longer be neglected. Although it will be a long time before eCQMs can be fully automated, hospitals must take
action today to:
Beginning in 2017, CMS will penalize hospitals
for patients who contract MRSA
Poor Quality Puts Hospitals at Risk
Each new CMS quality measure clearly indicates that it plans to link payments or financial incentives to a hospital’s
performance on quality benchmarks. For example:
• CMS lowered its 2016 payments by 1% for 758 hospitals with high rates of potentially avoidable
infections and complications as part of its Hospital-Acquired Conditions Reduction Program.5
• Beginning in 2017, CMS will penalize hospitals for patients who contract MRSA (methicillin-resistant
staphylococcus aureus) infections during their stay – a move that could cost many institutions millions
of dollars in Medicare revenue.6
In fact, hospitals already are experiencing the cumulative effect of this transformation. One survey in 2015 found
that 42% of hospitals received 10% or more of their revenue from value-based contracts. And, as a portent for the
unprepared, more than one in five hospitals anticipated that these types of contracts will constitute 50% or more of
their revenue by 2017.7
In parallel with this trend is an increased emphasis on electronic reporting. As we’ve seen, CMS programs as well as
other quality initiatives are now mandating that eligible hospitals and providers electronically submit their quality
reports. In light of this transformational shift to value-based healthcare and eCQMs, hospitals need to better
understand how poor data quality is affecting their finances, reputation and physician relationships.
1. Meet increasing eCQM reporting demands
2. Ensure the accuracy and completeness of eCQM clinical data without disrupting clinical
workflows or overburdening physicians and the clinical staff
This white paper will examine eCQM data quality issues and their implications. It will raise questions hospitals
should consider when developing strategies to improve their eCQM capabilities. Lastly, it will outline how they
can benefit from implementing better data quality control practices and present new developments in eCQM data
collection and reporting.

3. Elusive Data
To improve the accuracy and completeness of their eCQM data, hospitals
must first identify what’s causing most of the problems. Their source often
can be traced to the inability to capture the right data in the right format in
the right place.
Remember, today, e-measure calculations are done using only the structured
data collected in certified EHR technology (CEHRT). Data is often missing or
incomplete because it is captured on paper but not electronically. Or even if
captured electronically, it is not in a structured format.
And even when structured data is captured, it may only be available in a
different setting of care or a standalone special software system. When a
hospital’s internal systems (such as those in labs or emergency departments)
have this necessary data but are not interoperable with EHRs, CEHRT data
becomes inaccurate.
For example, if the date and time of a urinary catheter insertion in the
emergency department (ED) patient resides in the ED information system
and not in the CEHRT being used to calculate and submit eMeasures,
the hospital will not be able to accurately calculate the relevant Catheter
Associated Urinary Tract Infection (CAUTI) e-measures.8
Typically, eCQM
reporting compared to manual abstraction will show a significant under-
reporting of performance.
Inefficiencies in Workflow and Data Extraction
In their efforts to collect and share the right data in the right formats,
hospitals often must adjust various clinical workflow processes. Many also
set up makeshift quality control monitoring systems to review eCQMs for
omissions and errors. These changes can disrupt or delay workflows and
overburden the clinical staff.
Despite the significant resources hospitals spend on EHRs and their promise
of supporting eCQMs, data extraction remains a vexing challenge that will
only be exacerbated by the increases in electronic quality measurements.
CMS estimates that data capture using CEHRT could save a hospital up to
800 hours of chart abstraction in one quarter of quality reporting. In the
near term, however, much of this “saved” time will be shifted from traditional
abstractors to the nursing staff or even senior medical, quality or IT leaders
who inevitably will have to deal with the data inaccuracies.
Key Benefits
An effective eCQM solution
enhances data integrity
and enables hospitals and
physician to:
• Develop clinical protocols
better aligned with quality
initiatives and reporting needs
• Reduce abstraction burdens
• Gain access to richer and more
useful information for better
decision-making
• Redeploy valuable clinical
quality management resources
from low-value data capture to
high-value analysis and on-the-
floor support for clinicians
• Improve workflows and
operational efficiency

4. The evolution of eCQMs will need a more holistic approach that encompasses and integrates all components in the
data collection and extraction processes. This would enable hospitals to fully align clinical workflows with the IT
capabilities required to successfully submit accurate, high fidelity data to regulatory bodies and patient registries
Not Just an IT Challenge
As of January 2016, nearly 5,000 hospitals and more than 460,000 health-care providers had received nearly $32
billion in Medicare and Medicaid incentive payments through the CMS Meaningful Use program since 2011.9
Clearly,
the program has been successful in attaining its primary goal – encouraging a more rapid implementation of electronic
health records at hospitals, physician practices and other providers of medical care.
But this is only the first baby step towards a much more complex and difficult objective – the efficient electronic
exchange of standardized, high quality health information. Yet because eCQMs are an offshoot of Meaningful Use,
many hospitals see eCQMs as simply an IT function that could easily be built into their current EHR system. As we’ve
seen, this narrow view undervalues the importance of data quality, which impacts not only a hospital’s scores on CMS
and other programs but also clinical and operational decision-making.
eCQMs: Which Approach is Right For You?
Various stand-alone eCQM solutions offer an alternative. When deciding which approach – built in or bolted on
– would be the right choice to develop or expand their eCQM capabilities, hospitals should consider asking such
questions as:
• Does the eCQM provider have the in-depth clinical knowledge needed to help us optimize data
collection and extraction without affecting our clinical workflow?
• Will we be able to easily gather and share the required data within our existing hospital
information systems?
• Will the eCQM solution work well with the reporting requirements of other organizations such as
The Joint Commission?
• Is the eCQM certified by the Office of The National Coordinator (ONC) certification for all its
electronic Quality Measures for both eligible hospitals and physicians?
• Is the quality control process for eCQMs designed with sufficient safeguards, rigor and
transparency to enable hospitals to monitor and ensure data accuracy and integrity?
• Will the EHR/eCQM modules be easy to use?
• Can the eCQM provider help our executives and clinical staff make better use of the data results?

5. New Developments in eCQM Data Quality Management
Ideally, an eCQM solution should be able to easily integrate clinical data in various formats and calculate and submit
a variety of other quality measures. Since data quality is so critical, it also should make the data collection process
transparent so that inevitable quality problems can be identified and resolved before submission.
One exciting advance in quality data management is the new Q-Apps technology platform from Q-Centrix. This cloud-
based, patient-centric solution was recently introduced as the first fully-integrated healthcare quality information
system and was newly certified by the ONC as an EHR Module for all inpatient and ambulatory Clinical Quality
Measures.10
It empowers users to easily drill down into the quality data to check and confirm accuracy and offers
other benefits, including:
Looking for an eCQM Partner? Talk to Us.
Visit www.q-centrix.com or call us at (603) 294-1145.
• Transparency throughout the entire eCQM lifecycle, a gap in most EHR systems
• Concurrent review capabilities, not only of eCQMs but also Core Measures, patient registries and any
other clinical care protocols
• Access to the market-leading expertise of Q-Centrix’s 600+ quality information specialists who can
provide an additional level of data accuracy validation
1 http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-
reimbursements-from-volume-to-value.html
2 https://ehrincentives.cms.gov/hitech/loginCredentials.action
3 https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/certification.html
4 http://www.healthleadersmedia.com/technology/amia-seeks-overhaul-electronic-clinical-quality-reporting-measures
5 http://khn.org/news/758-hospitals-penalized-for-patient-safety-in-2016-data-table/
6 http://www.fiercehealthfinance.com/story/medicare-penalties-mrsa-infections-could-cost-some-hospitals-millions/2016-01-04
7 http://www.kaufmanhall.com/thought-leadership/resources/full-details/momentum-toward-value-based-payment-in-hospitals-growing-significantly-new-sur-
veys-find
8 https://www.healthcatalyst.com/electronic-clinical-quality-measures-impact-data-quality
9 http://www.bna.com/fewer-doctors-hospitals-n57982068638/
10 http://www.q-centrix.com/intelligence/q-centrix-achieves-certification-its-q-apps-technology-platform-ehr-module-all
There’s no question that eCQMs will play an increasingly prominent role in quality management as well as payment
and incentive models. Some experts believe that, in the near future, CMS will require hospitals and physicians to verify
the quality of their eCQM data.
Q-Centrix processes more than one million quality data transactions annually and provides comprehensive clinical
surveillance, abstraction, analysis and improvement services to hundreds of hospitals. Talk to us to learn more about
our Q-Apps platform for eCQMs and how we can customize a service to fit your needs and ensure your data quality.