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Standards and Certification Regulations

Clinical Quality Measures

CMS uses clinical quality measures (CQMs) in a variety of quality initiatives that include quality improvement and public reporting. ONC certifies that electronic health record (EHR) technologies are capable of accurately calculating the CQM results for the meaningful use incentive program.

Quality Measure Code Sets

The Clinical Quality Measures used by the HHS EHR incentive program are comprised of definitions, measure logic, data elements, and value sets. Four federal agencies: the Agency for Healthcare Research and Quality (AHRQ), CMS, the National Library of Medicine (NLM), and ONC are providing these components in various formats in order to be understood by technical, non-technical, and clinical consumers. The Value Set Authority Center will provide downloadable access to all official versions of vocabulary Value Sets contained in CQMs that support Meaningful Use Stage 2.

Data Elements Catalog (DEC) – A data element is a representation of a clinical concept that represents a patient state or attribute. This may be a diagnosis, lab value, gender, etc. that is encoded using standardized terminologies. The DEC is maintained by NLM and available through the Value Set Authority Center (VSAC).

Value Sets – Value sets define clinical concepts unambiguously. They provide list of numerical values and the individual descriptions from standard vocabularies used to define the clinical concepts (e.g., diabetes, clinical visit) within the quality measures. NLM maintains the value sets with the Value Set Authority Center.

USHIKThe United States Health Information Knowledgebase (USHIK) is AHRQ's portal for Meaningful Use. The USHIK is intended as a one-stop shop for publically accessing the components of meaningful use quality measures, providing technical specifications including definitions, measure computation logic, data elements, context, version comparisons, and value (code) sets. Measures and value sets are available in Excel, PDF, XML, and SVS.

Note: Viewing and/or downloading Meaningful Use proprietary value sets, such as those including CPT codes or SNOMED CT codes from NLM-VSAC or AHRQ-USHIK, requires a free Unified Medical Language System® Metathesaurus License (UMLS). Authentication via an UMLS ID and password is obtainable through the National Library of Medicine.


The ONC Certification Program provides a defined process to ensure that EHR technologies meet the adopted standards and certification criteria to help providers and hospitals achieve Meaningful Use objectives and measures established by CMS. Eligible professionals and eligible hospitals that seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to demonstrate meaningful use of certified EHR technology. For more information on the ONC Certification Programs, please our section on Certification Programs & Policy

Certification of EHR technologies under the ONC certification program requires that EHR software products and EHR modules be tested, as applicable, for the capability to accurately and appropriately calculate the CQM results. ONC has commissioned the development of the Cypress certification tool. The process for submitting the Cypress tool for official approval to be used in the ONC Certification Program is currently under way.


Eligible Hospital and Provider Clinical Quality Measures 

Value Sets

Data Elements Catalogue

Clinical Quality Measure Certification Testing Decks

Clinical Quality Measure FAQs

USHIK – AHRQ’s Meaningful Use Quality Measure Portal

JIRA – Clinical Quality Measure Feedback System

JIRA – Clinical Quality Measure Feedback System Instructions [PDF - 2.15 MB]