The healthcare landscape is undergoing a significant transformation as we continue the shift from a fee-for-service model to value-based care and data interoperability. At the heart of this change is a revolution in quality measurement, moving from a backward-looking to a timelier and clinically aligned process. This second blog in our series expands on the two key components of NCQA's digital strategy that are driving this transformation: digital measure specifications and the Electronic Clinical Data Systems (ECDS) measure domain. If you missed the first blog, catch up on our discussion of the evolution of HEDIS and the significance of digital quality measures..
Digital Measures: A New Language for HEDIS
Digital measures, or Digital Quality Measures (dQMs), utilize data models prescribed by interoperability standards. NCQA has developed an implementation guide based on the FHIR (Fast Healthcare Interoperability Resources) standard[1]. FHIR provides a standardized framework for representing healthcare data, with each FHIR resource representing a data type, such as encounters, conditions, procedures, observations, medications or immunizations.
Digital measures are specified in a machine-readable format using FHIR CQL[2] (Clinical Quality Language). To utilize measures specified in CQL, a CQL Execution engine is required. NCQA is providing a reference CQL execution engine as part of their digital content services, but other CQL execution engines may be validated or certified for use in HEDIS measurement.
The combination of a standard data model and digital measure specification eliminates a source of variability in measurements and readies the industry for interoperable data quality measurement. This allows for automated, consistent interpretation of measure rules across different systems and platforms, supporting both transparency and scalability.
Another key aspect of digital quality measures is that they may rely on clinical data not typically captured in claims. This will allow NCQA to move from process measures to outcomes measures. This transition has been happening over the past several years, with the inclusion of new coding systems such as SNOMED, RxNorm, RadLex and CVX, which come from EHRs rather than claims sources.
ECDS: A New Pathway for Reporting
While digital measures define what is being measured, ECDS[3] defines how that measurement data is reported to NCQA. Introduced in 2015, ECDS is a HEDIS reporting method that uses clinical data from digital sources, rather than claims or manual medical record abstraction. Valid sources include Electronic Health Records (EHRs), Health Information Exchanges (HIEs), Clinical Registries, Immunization Registries, Electronic Lab and Pharmacy Systems, Case Management Systems and Public Health Agencies.
A subset of digital measures falls into the ECDS domain. All ECDS measures are digital measures, but only a subset of digital measures is prescribed in the ECDS format. ECDS measures are designed to leverage clinical data available at the point of care. ECDS is considered a data collection method, subject to proof of service and data validation standards, similar to supplemental data sources. Both administrative and non-administrative sources can be used to identify the initial population in ECDS reporting. Read our "Navigating Supplemental Data for HEDIS Measures" blog to learn more about supplemental data.
As of measurement year 2026, there are 25 measures specified under the ECDS domain. The long-term goal is to transition measures currently supported by the hybrid methodology to ECDS reporting over the next few years, ultimately streamlining the quality reporting process and improving the accuracy of measurement data.
Retirement of the Hybrid methodology
NCQA has provided a timeline for retiring the hybrid methodology measure-by-measure, with the ultimate goal of retiring the methodology by Measurement Year (MY) 2029[4]. The first measure to retire the hybrid methodology was Colorectal Cancer Screening, which was retired in MY 2024. Although the hybrid methodology is no longer available for this measure, the Colorectal Cancer Screening measure concept still exists in the Electronic Clinical Data Systems (ECDS) domain as COL-E.
For MY 2025, four additional measures will be retired from the hybrid methodology. These measures are specified using the ECDS methodology for MY 2025[5]:
- Cervical Cancer Screening
- Immunizations for Adolescents
- Childhood Immunization Status
In addition to the measures being retired from the hybrid methodology, there is another measure that will no longer have a hybrid reporting option in MY 2025: Eye Exam for Patients with Diabetes. However, this measure will not follow the ECDS reporting format. Instead, it has been revised to include new value sets for assessing eye exams, as well as eye enucleation and retinopathy severity individually for the left and right eye using LOINC codes. These assessments are not limited to eye care providers, allowing for a more comprehensive approach to measuring eye health in patients with diabetes.
Why This Matters for Your Organization
The transition to digital specifications and ECDS brings significant changes that directly impact your people, processes and systems. Consider these areas for organizational enhancement or new partnerships:
- Data Access: Do you have reliable pipelines to EHR, HIE or registry data? Will you be able to fill the gaps without relying on medical record review?
- Data Governance: Can you validate and audit those data flows for HEDIS purposes?
- People & Skills: Does your team understand FHIR, CQL and how they relate to quality reporting?
- System Capabilities: Can your tools ingest and process structured clinical data at scale?
If not, you're not alone鈥攂ut the time to start modernizing is now.
What's Next in Our Series
In our next post, we'll dive into early results from the digital transition. How are organizations performing under ECDS? What's improved, what's struggling, and what lessons can you take forward? Stay tuned as we break down the real-world performance data and explore what it means for the future of quality reporting. The journey to digital HEDIS and ECDS is just beginning, and it's essential to stay ahead of the curve. Missed the first blog? Catch up with our "Digital Quality Measures 鈥� The Future is Now" blog.
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