Real-time Digital Quality Measure Calculation
Reusing the CMS-owned Next Generation Measures Calculator to return actionable results within days, not years
Measure calculator for ~70 converted dQMs
Quality Measurement at CMS Has a Timing Problem
Today
Care → data submission → feedback. By the time a provider learns a screening was missed, the measurement year has closed and the patient has moved on. The measures record what happened. They do not change what happens.
With NGMC + EHR extraction
A running result inside the measurement period. The clinic sees which patients are missing a qualifying test while there is still time to order it. Performance improves because the care improved.
Concept of Operations — Three Zones
Provider Environment
Clinical data already captured in the course of care — encounters, diagnoses, labs, orders.
Data Extraction new build
Direct EHR integration · SMART on FHIR app · Bulk FHIR export · Data warehouse connector. Scoped to only the FHIR resources a measure requires.
Calculation Platform
Extracted from EQRS and generalized. A separation, not a rebuild — CMS already owns it and runs it at production scale.
- Declarative ingestion
- Data version control
- Transformation
- Calculation at scale
Provider-deployed open source or CMS-hosted shared service — one code base.
Actionable Results
Care Team
Rate plus the patient-level roster behind it — who is missing a test, in time to order it.
CMS / CCSQ
One reference implementation; every result reproducible and auditable.
Data-quality Feedback
Providers learn of their own coding gaps early.
Getting Consistent Data Out of Provider EHRs
The part that does not exist today
Direct Platform Integration
EHR-vendor supported extraction. Oracle/Cerner is supportive and recommends direct integration, the path already used with SSA and CMS CPI.
SMART on FHIR Application
Distributed through EHR vendor app galleries; a health system installs it without commissioning a custom integration project.
Bulk FHIR Export
Population-scale retrieval for a full measurement period.
Enterprise Data Warehouse Connector
Where an organization already consolidates clinical data.
Options are not mutually exclusive and can coexist per measure. Retrieval is scoped to only the FHIR resources a measure requires, and can be de-identified before calculation.
CMS Already Owns a Working Calculator — NGMC
Computes quality measures today for the End-Stage Renal Disease Quality Reporting System (EQRS). Architected as a decoupled measure calculation system from inception, so extraction is a separation rather than a rebuild.
Declarative Data Ingestion
Adding claims later is a configuration change, not a new system.
Data Version Control
Any disputed score reproduced against the exact inputs and logic version.
Data Transformation
Maps extracted resources to measure value sets; profiles coding gaps.
Measure Calculation at Scale
One published implementation per measure replaces many local interpretations.
A Clinic Does Not Receive a Score Alone — It Receives a Roster
First Measure: CMS951FHIR — Kidney Health Evaluation for Patients with Diabetes
Did an adult aged 18–85 with diabetes receive both an eGFR and a uACR test this year? A gap a clinic can close in a single encounter.
| Patient | eGFR | uACR | Status |
|---|---|---|---|
| J. Public | Mar 12 | — | Order uACR |
| S. Rivera | — | — | Order both |
| M. Chen | Jan 30 | Feb 4 | Met |
Illustrative roster. NGMC returns initial population, denominator, exclusions and numerator alongside it.
Why Kidney Health First
~37 million U.S. adults have chronic kidney disease; ~90% are unaware. Evaluation rates among Medicare patients with diabetes: 41.8%. CKD and ESRD spending exceeded $114B in 2016 — 23% of Medicare fee-for-service.
Which Measures This Fits
About half of converted dQMs compute in or near real time; another ~40% from longitudinal EHR data at episode end. Claims-risk-adjusted (CMS844, CMS529) and imaging-derived (CMS1074, 1206, 1056) measures come later.
Thin Vertical Slices — Scaled by Impact and Feasibility
Demonstrable Slice on Synthetic Data
CMS951FHIR end to end. Proves the decoupled NGMC, a targeted clinical schema and one complete calculation.
MVP at a Partner Provider
CMS951FHIR computed from live EHR data; rate and patient roster returned to that clinic. Demonstrable within weeks using a pilot clone of NGMC.
+5 Measures, Then Groups of ~10
Ordered by health impact of faster feedback against feasibility from data providers already capture. Re-prioritized after each group.
Later: Claims and Imaging
A claims source is a declarative ingestion change, bringing risk-adjusted measures into range. Imaging-derived values follow as translation matures.
Risks Surfaced Now, Not at Scale
Partial measure coverage · variable EHR coding quality · data-custody agreements · security authorization for a CMS-hosted path · adoption depends on returning something a clinic wants.
CCSQ Strategic Roadmap FY2025–2028
Prevention
The measures most amenable to rapid computation are predominantly screening measures.
Alignment
Aligning measures across settings and payers is easier when all parties compute from one reference implementation.
Interoperability
FHIR-based data flow and the transition to digital measures.
Less Redundant Reporting
One shared implementation of each dQM displaces the separate interpretation every vendor, registry and health system maintains today.
A result delivered two years late is a historical record; a result delivered this week is a chance to order the test.
Reusing a calculator CMS already owns is the fastest credible route to closing that interval.