Table 2.

Burden reduction activities

Theme and Burden Reported	Recommendation	Solution or Innovation to Mitigate Reported Burden	Target Audience to Benefit from Recommendation	Goal
Alignment: eCQM quality reporting requirements are not aligned across CMS and federal agencies.	Improve intra- and inter-agency collaboration and align eCQM reporting requirements.	Expanded eCQM governance group membership	Federal partners across Department of Health and Human Services, Department of Defense, and Department of Veterans Affairs	Improved interagency collaboration by sharing quality measurement initiatives and experience across federal health agencies.
Alignment: Inconsistent measure specifications and value sets are burdensome to implement and report.	Align measure specifications, data elements, and value sets.	Established Value Set Workgroup	Clinicians, hospitals, health IT vendors, measure developers	Harmonization of value sets and providing guidelines to improve the usability and clarity of value sets across eCQMs and CDS.
Value: Lack of awareness of using clinical dashboards for eCQM tracking.	Increase awareness of best practices related to clinical dashboards.	Delivered a clinical dashboard best practices webinar4	Clinicians, hospitals, health IT vendors	Increase awareness of best practices and value of using clinical dashboards to support quality improvement initiatives.
Value: eCQMs are not meaningful and do not assist hospitals and clinicians in their quality improvement initiatives.	Include clinicians in the eCQM development process to help prioritize new eCQM development.	Developed Measure Collaboration (MC) Workspace eCQM concept module5	Clinicians, hospitals, health IT vendors, measure developers, CMS	Improves transparency of measure development process and provides capability to submit eCQM concept ideas to CMS.
Development Process: Lengthy eCQM development process.	Identify alternative approaches for accelerating critical measure development processes.	Identified opportunities to streamline the measure development life cycle	Clinicians, hospitals, health IT vendors, measure developers, CMS	Achieve time savings in the measure development process by using the CMS Measures Inventory Tool Environmental Scan and leveraging the MC Workspace.
Development Process: Decreased clinical participation in the eCQM development process at all points in the life cycle.	Create a collaborative workspace to increase engagement in CMS measure development.	Launched the MC Workspace, New eCQM Clinical Workflow, and eCQM Test Results modules	Clinicians, hospitals, health IT vendors, measure developers, CMS	Provides a collaborative portal to promote transparency and better interaction across stakeholder communities that develop, implement, and report eCQMs.
Implementation and Reporting Processes: Implementing eCQMs is time and resource intensive to map data and determine workflow requirements.	Provide a repository that provides easy-to-understand definitions of existing measures including data mapping for every data element.	Developed the MC Workspace eCQM Data Element Repository (DERep)6	Clinicians, hospitals, health IT vendors, measure developers	Provide data mapping support to improve accurate capture and calculation of eCQMs.
Implementation and Reporting Processes: Reconfiguring the same workflows across multiple organizations is not cost-effective or efficient.	Prepare a series of measure-level implementation webinars with best practices that includes review of data capture and consistent data mapping practices.	Delivered series of measure-level webinars	Clinicians, hospitals, health IT vendors	Help stakeholders understand data capture, data mapping, and common workflows.
Implementation and Reporting Processes: Stakeholders shared help desk concerns citing poor response times, contradictory responses, and cumbersome workflow.	Improve eCQM support websites and help desks.	Review and alignment of eCQM help desk processes across CMS quality programs	Clinicians, hospitals, health IT vendors	Improve customer experience with eCQM help desk support in the ONC Project Tracking System (Jira).7
Implementation and Reporting Processes: Multiple tools for submission are burdensome and some EHRs are not able to submit QRDAs.	Improve Tools, Standards, and Processes for eCQM reporting.	Launched CMS FHIR for Quality Reporting Initiative for Planning and Testing8	Clinicians, hospitals, health IT vendors	Explore a transition to FHIR-based quality reporting to simplify and align reporting specifications across CMS programs and with other nongovernment entities.
Implementation and Reporting Processes: Cumbersome quality reporting submission systems.	Streamline the login processes and improved error reports.	CMS Hospital Quality Reporting team launched the Next Generation System9	Clinicians, hospitals, health IT vendors	Reduce burden with testing and submitting quality reports for the Hospital Inpatient Quality Reporting program.
EHR Certification: The certification process does not ensure that a provider will be able to successfully report and submit its eCQM data from its Certified Electronic Health Record Technology to CMS.	Improve alignment between eCQM certification and eCQM reporting and submission requirements.	Partnered with ONC to achieve this alignment	ONC, health IT vendors	Reduce the number of errors with eCQM data submission to CMS by requiring health IT products conform to CMS submission requirements.10
EHR Certification: Stakeholders report errors with eCQM data submissions to CMS.	Provide instance of a tool replicating CMS submission requirements.	Developed the Cypress Validation Utility Plus (CVU+)11	Health IT vendors	Reduce the number of errors with eCQM data submission to CMS by allowing health IT vendors to test synthetic QRDA Category I and Category III documents for conformance to CMS submission requirements.
Communication, Education, Outreach: There is lack of awareness of available eCQM resources a lack of understanding of how and when to participate in measure development, testing, or troubleshooting technical issues throughout the eCQM life cycle.	Provide simplified resources and increase awareness of eCQM resources and participation opportunities.	Encouraged Use of Plain Language to Simplify eCQM-Related Materials Across CMS eCQM Contractors	Clinicians, hospitals, health IT vendors, measure developers	Improve readability and consistency of eCQM materials produced by CMS contractors, partners, and federal health agencies.
Communication, Education, Outreach: Hospital stakeholders shared challenges locating confusing or contradictory eCQM requirements on multiple program sites.	Improve CMS Quality Program resources through consistent formatting of eCQM sections of CMS program sites.	Aligned eCQM-Related References Across CMS Quality Reporting Program Sites	Clinicians, hospitals, health IT vendors, measure developers	Improve accuracy and consistency of eCQM references and eCQM related materials on CMS, federal health agency, and industry websites.