eCQM Requirements Through 2030: The Move to Digital Quality Measures

eCQM requirements today

Electronic clinical quality measures (eCQMs) are calculated from certified EHR data using CMS specifications and reported across several programs. As of the 2026 performance year, the core eCQM requirements look like this:

• MIPS. Clinicians and groups report quality measures, including eCQMs, with annual updates to the measure list and scoring rules.
• Medicare ACOs. Under the APP Plus measure set, Shared Savings Program ACOs report eCQMs or Medicare CQMs across their entire patient population, aggregated across every EHR in the ACO. Our ACO eCQM Reporting Guide covers this in depth.
• Hospital IQR and Promoting Interoperability. Hospitals report a growing number of eCQMs each year from the available set, with progressive expansion of mandatory measures.
• HRSA UDS. Health center clinical tables are aligning with eCQM specifications, and UDS+ adds patient-level FHIR submission. See the UDS Reporting Guide.

Submissions today are largely QRDA based, and each year’s specifications are published in advance through the eCQI Resource Center with final details set in annual rulemaking. That annual update cycle is exactly why searching for a future year’s requirements rarely gives a definitive answer: the specifications for a given performance year are not final until CMS finalizes that year’s rule.

The direction of travel, year by year

While exact future-year specifications are set annually, the trajectory has been consistent across recent rulemaking and CMS’s digital quality measurement roadmap.

1. Now · 2026

   Annual eCQM updates continue

   Specifications refresh each year and QRDA remains the primary submission path. APP Plus eCQM reporting phases in for ACOs, and hospital mandatory eCQM counts keep growing.

2. Near term · 2027–2028

   Consolidation and FHIR pilots

   Measure sets consolidate around the Universal Foundation. FHIR-based reporting options and pilots expand, and more programs add patient-level, standards-based submission alongside aggregate reporting.

3. Target · 2030

   Fully digital quality measurement

   CMS’s stated goal is FHIR-based dQMs computed from interoperable data, with traditional QRDA-era mechanics phased down as dQM adoption matures.

Always confirm a specific performance year against that year’s final rule and the eCQI Resource Center. The timeline above describes the direction CMS has signaled, not final regulation for future years.

What a digital quality measure actually is

CMS defines digital quality measures (dQMs) as quality measures that use standardized, digital data from one or more sources of health information, exchanged via interoperable standards. In practice that means FHIR: measure logic that reads FHIR resources directly instead of depending on program-specific extract formats.

The practical difference from today’s eCQMs is where the data comes from and how automatically it flows. An eCQM is calculated from certified EHR data and submitted in a reporting format on a reporting schedule. A dQM is designed to be computed from interoperable FHIR data whenever it is needed. That last part matters more than it first appears: measure logic that can run whenever it is needed can run during the visit, not just at submission time. Real-time uses of quality logic, like identifying gaps in care at the point of care, are the same architecture arriving early.

How to prepare without rebuilding twice

The organizations that will absorb the dQM transition with the least disruption are the ones treating it as an infrastructure decision now rather than a compliance scramble later. Three moves matter most:

1. Consolidate measure calculation. If MIPS, ACO, and UDS numbers come from different calculation paths, they will drift. One engine, like CQMsolution, calculating every program from one data foundation removes that entire class of problem.
2. Stand up a FHIR data pipeline you actually use. A certified FHIR API that only exists for certification checkboxes will not carry you into dQMs. Ours, the Dynamic FHIR API, already carries production reporting workloads like UDS+ patient-level submission.
3. Put quality logic to work before submission day. Running measure logic in real time against FHIR data is the dQM operating model. Starting with point-of-care gap identification means the transition arrives as an upgrade, not a migration.