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Tuesday, November 27, 2012

Hashtag Soup: Relating QDM, HQMF, eMeasures, QueryHealth, QRDA, SIFramework and MeaningfulUse Stage2

This showed up in my inbox yesterday:
Hello Keith, 
I am trying to figure out how the following abbreviations are connected - NQF's QDM, HQMF, eMeasures, Query Health, QRDA, QDM based QRDAs, others.
Rather than individual definitions, I am a bit in the dark around how each of these are interconnected.

Appreciate your help.
Warm Regards, Shyam 
It's a question worthy of a full post, rather than a brief answer, so here goes.

QDM is the National Quality Forum's (NQF) Quality Data Model.  It is an information model representing the essential data needed to generate quality measures.  Because it is an information model, it doesn't necessarily go into the level of detail needed in an implementation, but it certainly describes the high level structures that an implementation needs to compute quality measures.

eMeasures is a term describing the electronic representation of quality measures.  In common use, it often refers to the electronic measures that NQF developed to represent the quality measures required under the ONC & CMS Meaningful Use regulations.  It is also used to refer to the HL7 HQMF.

HQMF stands for Health Quality Measure Format.  This is an HL7 Draft Standard for Trial Use (DSTU).  The DSTU is presently being reballoted by HL7 for a second release.  This is an electronic format for the representation of quality measures.  Release 1 is currently used by NQF to deliver eMeasures for Meaningful Use.  Release 2 was developed in large part based on pilot work being developed by Query Health.

Query Health is an ONC Standards and Interoperability Framework project whose purpose is to develop standards to enable sending the questions to the data.  Its key goal is to enable clinical research.  We used HQMF in query health because the kinds of questions that Quality Measures need answers too are often the same kinds of questions that show up in Clinical Research.  HQMF is a declarative format for expressing those questions.  We revised and prototyped a new schema for HQMF that is simpler, easier to read, and able to be computed in a variety of programming environments.  I've written quite a bit about Query Health on this blog.

QRDA stands for Quality Reporting Data Architecture.  If HQMF/Query Health/eMeasures represent the question, then QRDA represents the answers.  QRDA is an HL7 implementation guide on CDA Release 2 that describes the format for reporting quality data on a single patient (Category I), or aggregate results on multiple patients (Category III).  The former is a DSTU, the latter nearly so.  There is also an implementation guide showing how data modeled using the QDM can be represented in a QRDA.  Both Category I and Category III specifications have been identified as being required standard formats for reporting quality measures under the Meaningful Use 2014 Certification Criteria.

MAT is the Measure Authoring Tool.  This is a tool for creating eMeasures currently being maintained by NQF, but which will be transitioned to a new maintainer in early 2013.

VSAC is the NLM Value Set Authority Center, where value sets used for eMeasures and other standards used in Meaningful Use regulation are published.

If you want a poster-sized PDF of the content, you can get it via Google Drive:


  1. Keith

    I'm curious as to why QRDA Category II isn't ever mentioned -- only I and III.

    Is there some reason why QRDA Category II isn't used (or needed) but Category I is?


    1. QRDA Category II is a format that is used to go from Category I (raw patient data) to Category III (aggregate summary data). CMS isn't interested in this format for reporting, because it doesn't summarize the data, only makes it easier to generate the summary.

  2. Hello Keith,

    This is a really good picture giving the overall interaction. Much appreciated.

    Warm Regards..Shyam

  3. Hi Keith,
    Nice drawing and writeup, thanks.
    In your spare time,it would also be useful to add three additional elements:
    1) Measure Authoring Tool
    2) NLM Value Set Authority Center (VSAC)
    3) A placeholder 'Quality Module' that consumes the eCQMs and produces the quality values.


  4. This very helpful. Thanks! Is there someplace where the HQMF eMeasure schema XSD is published?

  5. I work as a Product Manager for a vendor, working on all of the changes needed for certification on the 2014 regs. We have really been struggling weeding through the implementation guide for the QRDA I. We finally were able to get some sample reports which has been helpful to compare field for field with the guide, but now we have found some discrepancies. Can you provide direction on who to contact to answer our questions?
    Thanks - love the blog!

  6. Hello, Keith...This is very helpful for measure developers, as we try to keep all the pieces in mind. There are some interesting recent developments that could be reflected in the next version of your map, such as the move of the QDM stewardship to the HL7 Clincal Decision Work Group and the move of the MAT to Health Care Innovation Services

  7. Hi Keith,...Appreciate this post. I am unclear as to how to acquire the poster sized PDF, which I would like to have. I'm new to your blog and site and would appreciate some direction. Thanks!

  8. Hi can any one send me sample files for QRDA 3 for NQF measures like NQF-0421, NQF-0033, NQF_0034 having morethan one population and stratification which can we validate in Cypres tool please..

    1. I need also, please anyone can provide?