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2019 eCQM Specifications - Registries on FHIR Project Update - QI Webinar Series

Tuesday, May 15, 2018   (0 Comments)
Posted by: Bevin Rousopoulos
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PCPI Announcements


May 15, 2018


PCPI Announcements


In this issue...


AMA Prediabetes Measures Available for Public Comment


Measure Harmonization Methodology Project - Peer Review & Public Comment


Now Available - Updated eCQM Specifications for 2019 - PLUS Reading Guide


Influence the future of Clinical Data Registries - join an NQRN work group


Committed to Quality Award - Closing the Referral Loop


New Webinar Series: Quality Improvement Showcase


Member Spotlight: Dermatology event of the Summer - ACEP's Leadership & Advocacy


Industry news: Lean Healthcare Transformation Summit - 2018 MDP Annual Report


Conference Survey Participants: Thank You!

We would like to take a moment to thank all our Spring 2018 conference survey participants for your valuable feedback on your conference experience. Your feedback helps us to improve our offerings and provide an even better experience for our future events.


As an additional thank you for filling out the survey we randomly selected 4 of our survey participants to win a $25 Starbucks e-gift card. The winners for this conference survey are:

  1. Caryn Davidson from the American Society of Plastic Surgeons
  2. Koryn Rubin from the American Medical Association
  3. Martin Gonzalez from the Society of Critical Care Medicine
  4. John Johannides from the American Board of Family Medicine

Survey winners will receive their Starbucks gift cards via email.

Mark your calendars! PCPI's Fall Conference which will be held in Chicago October 17 & 18, 2018. Bookmark our conference web page and stay tuned for more information!


PCPI On the Go

Measurement Science & QI representation at the IAHQ Annual Conference

Samantha Tierney, MPH, Director, Measure Development Operation and Stephen Davidow, MBA-HCM, CPHQ, APR, Director Quality Improvement represented PCPI’s Measurement Science & QI programs as presenters at the IAHQ Annual Conference May 8th in Naperville, IL. Ms. Tierney presented on “Developing and Using Clinical Quality Measures to Drive Improvement”, where participants learned how clinical quality measures developed, the evidence base used, and what that means for care at the point of service. As president of the IAHQ, Mr. Davidow lead the development of this annual event focused on Advancing Knowledge, Improving Care.


All speaker approved presentations from the IAHQ Annual Conference and posters from the inaugural competition will be posted on the IAHQ website TODAY,


Registries on FHIR project update

Seth Blumenthal, MBA, Director, Data and Innovation gave an update on the Registries on FHIR project at the April 24th Surgical Quality Alliance in Washington, DC. Registries on FHIR aims to increase the amount of registry data captured automatically from EHRs. The project team is developing a set of common clinical data elements, based on previous work as much as possible, and plans to test their use in registries and EHRs as part of a demonstration pilot effort. Initial research on how common clinical concepts are currently represented in registries is supported in part by the Duke Clinical Research Institute and the Pew Charitable Trusts.


Find out more about the Registries on FHIR project and access the presentation here.


AMA’s QCDR Conference hosted Measurement Science & QI program experts

The American Medical Association (AMA) hosted their annual conference for the QCDR Steward Community to come together and share their concerns, learn from each other, and discuss the future of QCDRS in the CMS; Quality Payment Program (QPP) - both MIPS and advanced APMs on May 9th.


Stephen Davidow, MBA-HCM, CPHQ, APR, Director Quality Improvement served as a panelist along with Dr. Steven Epstein, American College of Emergency Physicians, and Heather Smith, American Physical Therapy Association, discussed the burden of quality measurement, informed feedback, and continuous improvement under the CMS Quality Payment Program. The session was facilitated by Dr. Robert Phillips, American Board of Family Medicine.


Samantha Tierney, MPH, Director, Measure Development Operation served as a panelist along with Caryn Davidson, American Society of Plastic Surgeons, discussed some common challenges in submitting QCDR measures for approval by CMS. The session was facilitated by Koryn Rubin, American Medical Association.


Measurement Science

AMA Prediabetes Measures Available for Public Comment

The American Medical Association (AMA) convened a cross-specialty, multidisciplinary technical expert panel (TEP) to identify and define new quality measures for prediabetes. The draft measures proposed by this TEP represent the first measures in the U.S. intended to assist in the prevention of type 2 diabetes. The proposed measures address screening for prediabetes, providing intervention for those with prediabetes, and follow-up testing for those with prediabetes. PCPI’s Measurement Science Team serves as consultants to the AMA in support of these efforts.


Currently, eighty-four million Americans have prediabetes and 9 out 10 of these individuals are unaware that they have this condition. CDC-recognized lifestyle change programs are included in the health benefit plans of many private health insurers and the Medicare Diabetes Prevention Program will extend the program to Medicare beneficiaries in April 2018.


The 30-day comment period will close on Thursday, May 31st. All comments are welcome and will be compiled to be shared with the TEP for consideration.View or download the set of draft measures and submit your comments by clicking here.


Please feel free to forward this information to others within your organization or constituency who may offer insight and expertise.


Measure Harmonization Methodology Project - Peer Review & Public Comment

Last year, the PCPI’s Measure Advisory Committee prioritized a project to develop a Measure Harmonization Methodology, intended to educate and assist measure stewards and developers in implementing a standard approach to measure harmonization projects. This methodology was developed and written by the PCPI based on prior harmonization-related publications written by organizations such as the National Quality Forum, responses to a Measure Harmonization survey completed by PCPI membership, and the PCPI’s own measure harmonization experiences.


Beginning on May 7th, this draft paper is available for a 30-day peer review and public comment period. We invite measure stewards and developers to review our draft paper and provide feedback via this link, by June 6th.


Now Available - Updated eCQM Specifications for 2019 - PLUS Reading Guide

The Centers for Medicare & Medicaid Services (CMS) has posted the Electronic Clinical Quality Measures (eCQM) annual update for the 2019 reporting period for Eligible Hospitals and Critical Access Hospitals (CAH), and the 2019 performance period for Eligible Professionals and Eligible Clinicians. PCPI updated sixteen eCQMs included in the program for eligible professionals and eligible clinicians. PCPI’s measurement science team has been actively involved in the annual update process and participated in the CQL pilot testing, including user acceptance testing of the tools (i.e., CMS Measure Authoring Tool (MAT) and Bonnie) used by the measure development community.

CMS has updated eCQMs for potential inclusion in the following programs:

  • The Hospital Inpatient Quality Reporting (IQR) Program
  • The Medicare Promoting Interoperability Program (formerly known as the Medicare Electronic Health Record (EHR) Incentive Program)
  • The Medicaid Promoting Interoperability Program (formerly known as the Medicaid EHR Incentive Program)
  • Quality Payment Program: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs)
  • Comprehensive Primary Care Plus (CPC+)

The eCQMs for 2019 reporting are expressed using the new CQL standard for logic expression and continue to use the Quality Data Model (QDM) as the conceptual model to express clinical concepts. The updated measure specifications are available on the eCQI Resource Center for Eligible Hospitals and Critical Access Hospitals and Eligible Professionals and Eligible Clinicians under the 2019 Reporting/Performance Year. The eCQM value sets for 2019 Reporting/Performance Period are available for download through the National Library of Medicine’s Value Set Authority Center (VSAC). 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 and structured for electronic processing.


The new eCQM Reading Guide provides information on eCQMs such as file naming conventions, understanding an eCQM human-readable rendition, QDM data criteria, value sets, and more, to assist stakeholders in interpreting and understanding eCQMs.

To find out more about eCQMs, view the updated specifications, QDM v5.3 Annotated version, and the new eCQM reading guide, visit the eCQI Resource Center. For questions and comments regarding the updated measures, visit the eCQM Issue Tracker.



Influence the future of Clinical Data Registries - join an NQRN work group

PCPI members have the rare opportunity to influence the future of clinical data registries through participation in one or more of our NQRN work groups. We currently have openings within the following groups:

  • Learning Work Group -- Asses the needs of the registry community, creating and curating practical content to address those needs.
  • Qualified Clinical Data Registries (QCDR) Work Group -- Promotes advocacy for QCDRs and creates resources to aid in the process of becoming and maintaining QCDR stewardship.
  • Interoperability Work Group -- Supports the Registries on FHIR project which focuses on the adoption of common clinical data elements in registries to improve interoperability.
  • Research Work Group -- This is a New Work Group designed to connect registry stewards with the wider community of healthcare information users with distinct research needs.

For more information or if you would like to join one of these groups, please contact either Chrystal Price, Program Manager, NQRN or Seth Blumenthal, Director of Data and Innovation for more details. We look forward to having you in the Work Groups!


Quality Improvement

IAHQ Poster Competition Winner!

At the 2018 IAHQ Annual Conference. PCPI had the opportunity to participate in the poster competition with a poster on “Closing the Referral Loop: Improving the Ambulatory Referral Management Process.” We are proud to announce that PCPI was the recipient of the Committed to Quality Award. This award represents commitment to quality through an organization’s project or program to improve quality and patient safety. The award highlights a project or program designed to address a specific quality or patient safety challenge. Learn more about the Closing the Referral Loop Project and access the full size PDF of this poster here.



PCPI Leading Practices Webinar Series: Quality Improvement Showcase

In case you missed this fantastic session during the PCPI Spring Conference, we’re bringing it to you as a webinar.


Participants will learn cross-cutting lessons they may apply to their own improvement efforts from three highly successful national quality improvement programs.


  • Jason Itri, MD, Associate Professor, Wake Forest Baptist Health, American College of Radiology: The value of peer review in radiology practice
  • Selam Wubu, MPH, Senior Associate, Center for Quality, American College of Physicians: Adult immunization rates
  • Amy Beckrich, CAE, Project Director, Renal Physicians Association: Improving care coordination for chronic kidney disease
  • Moderator: Stephen L. Davidow, MBA-HCM, CPHQ, APR, Director, Quality Improvement, PCPI

When: Wednesday, July 18, 2018 - 12 pm CT/1 pm ET

Register Here.


PCPI Member Spotlight

The Dermatology event of the Summer!

The 2018 AAD Summer Meeting brings the brightest minds in dermatology together for an unforgettable educational experience.


Hear from expert speakers as they discuss the latest advances and trending topics in dermatology. With more than 90 sessions across various tracks, you can easily find the education you’re looking for and bring relevant information back to your practice.

Search the program for the 2018 AAD Summer Meeting.


Plus, the’ve expanded the number of sessions that are eligible for MOC self-assessment credit to include the majority of sessions utilizing an Audience Response System!


When: July 26-29, 2018

Where: Hyatt Regency Chicago - 151 E Upper Wacker Drive, Chicago, IL 60601

Learn more and register to attend.


Celebrate Emergency Medicine’s Accomplishments

The ACEP’s 2018 Leadership & Advocacy Conference (LAC) will celebrate emergency medicine’s accomplishments and continue to work for a better political environment for our specialty and our patients. The LAC continues to get bigger and better and each year we send a stronger message to the United States Congress. We’ll train first-timers to educate your Members of Congress while seasoned participants will build upon your already-valuable Congressional connections.


Join emergency medicine leaders from around the country for ACEP’s Leadership & Advocacy Conference.

  • ACEP's Lobby Day – Spend the day meeting with your legislators and key staff
  • Solutions Forum
  • Essential Groundwork – First time attending the conference? Looking for a refresher on the basics of health policy? Lay the foundation for the rest of the week.
  • A Deeper Policy Dive – Engage in detailed discussions on key issues affecting emergency medicine to get a better understanding of the current health care landscape and EM's role.

When: May 20-23, 2018

Where: Grand Hyatt Washington - 1000 H St. NW, Washington, DC 20001

Learn more and register to attend.


IHMI Discussion Social Media Kit for Panelists

Patient-Entered Wellness Data and Healthy Lifestyles: Tailored Electronic Recommendations to Foster Preventive Care.


An enormous amount of data is generated in healthcare today, but is it the most meaningful? Patient-entered data and innovative approaches to healthy lifestyles could influence providers’ orders, fostering more effective care. Join AMA and IHMI to discuss the patient’s role in health data. Participation is open May 16-25, 2018. Find out more at the AMA Discussion.


Bookmark PCPI’s Event Calendar to stay informed of all PCPI & Member events.


Industry news

Lean Healthcare Transformation Summit - Catalysis 2018

At the 9th Annual Lean Healthcare Transformation Summit, June 14-15 in Chicago, Catalysis Healthcare Value Network members and healthcare leaders from around the world will share their learnings, discuss their cultural transformations and help you discover strategies to transform your healthcare organization, create value, reduce costs, and ultimately enhance quality and patient care. This Summit provides information and collaboration opportunities to be successful in your organization’s journey. Learn more and register.



2018 Measure Development Plan (MDP) Annual Report

The Centers for Medicare & Medicaid Services (CMS) today posted the 2018 Quality Measure Development Plan (MDP) Annual Report, which describes progress in developing clinician quality measures to support the Quality Payment Program. The CMS Quality Measure Development Plan (MDP) is a focused framework to help develop and improve these measures, point out the known measurement and performance gaps, and recommend prioritized approaches to close those gaps. The 2018 MDP Annual Report supplements the MDP with additional information to support measure development and records progress since the first annual report in 2017. The 2018 MDP Annual Report describes efforts including identifying and developing meaningful outcome measures, partnering with patients in the measure development process, partnering with clinicians and professional societies, and funding new measure development.


The strategic approach to measure development outlined in the MDP and additional findings in the Measure Development Plan annual reports provide information and support to key stakeholders who develop clinician quality measures for consideration for the Quality Payment Program.


For more information about the 2018 MDP Annual Report, go to the Quality Payment Program measure development page.


PCPI wants to help share your news

As a benefit of membership with PCPI, we will help share your news via our various media channels. Please contact Membership Manager, Bevin Rousopoulos at for more information.


Get involved with PCPI Today

Want to learn more about PCPI and how you can get involved in our current initiatives to Develop scientifically valid performance measures, Implement quality improvement initiatives, and Access multiple registries to drive optimal outcomes? Contact PCPI Membership Manager, Bevin Rousopoulos at







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