Healthcare payer executive guide
FHIR® 101 · NCQA Digital Quality Measures
Your dQM Readiness Roadmap to 2030
NCQA is moving HEDIS® to fully digital quality measures by 2030. Nine measures are required digitally now. Follow the roadmap to stay ahead of every deadline.
Required now
9
19 ECDS in MY25, 25 ECDS in MY26 (13 required)
Full deadline
2030
All HEDIS via ECDS
Know These Four Terms
FHIR (Fast Healthcare Interoperability Resources)
The HL7® FHIR® standard API that lets your systems share data with providers, electronic health records (EHRs), and NCQA.
dQM (digital quality measure)
Self-contained, machine-readable HEDIS files specified in FHIR and CQL. No more manual chart abstraction.
CQL (Clinical Quality Language)
The logic layer inside every dQM. NCQA publishes the code; your vendor runs it against your member data.
ECDS (Electronic Clinical Data Systems)
The NCQA submission standard, your plan’s pipeline for sending digital measure results to NCQA.
Phase 1 · Foundation
01. Assess Your Current Data Infrastructure
Most plans discover gaps between what their systems claim to support and what FHIR® actually requires. Those gaps slip deadlines.
- Audit EHR and claims data pipelines for FHIR API readiness.
- Identify which required HEDIS measures your plan is furthest from meeting digitally.
- Flag vendors still using QDM or QRDA instead of FHIR and CQL.
02. Build FHIR-Ready Data Pipelines
Pull member data from provider EHRs automatically. Not via fax, not via portal scrape, not via spreadsheet.
- Implement FHIR R4 APIs and Bulk FHIR across major provider partners.
- Align data standards to the US Core Implementation Guide.
- Set up governance for member data permissions and access agreements.
Phase 2 · Validation
03. Select a Validated dQM Engine
NCQA requires your calculation engine to pass formal Validation, not just legacy Certification.
- Confirm your vendor has achieved NCQA dQM Validation.
- Verify the engine runs NCQA’s FHIR and CQL measure logic against NCQA test data.
- Evaluate vendors with active DQIC (Digital Quality Implementers Community) participation.
04. One Year of Comparative Testing
NCQA recommends running dQM and traditional HEDIS side by side for a full measurement year to surface data and logic issues early.
- Run digital and traditional HEDIS on live members.
- Understand variance between traditional and digital results and trace root causes.
- Carry existing HEDIS workflows and dependencies forward.
- Use results to close care gaps before year end.
Phase 3 · Scale
05. Shift to Continuous Quality Monitoring
Plans that simply replicate old workflows digitally miss what dQMs unlock: near-real-time visibility. Use continuous scoring to act before deadlines hit.
- Move from annual chart review to continuous dQM calculation.
- Use near-real-time gap closure alerts to drive outreach and provider engagement.
- Connect quality scores to star ratings, value-based contracts, and risk score accuracy.
06. Scale Ahead of the 2030 Mandate
Nearly all HEDIS reporting is digital by 2030. Plans building now outperform plans scrambling in 2028.
- Map your multi-year vendor and IT roadmap to NCQA’s expansion schedule.
- Expand FHIR API connections beyond pilot partners to the full network.
- Invest in staff training on FHIR, CQL, and ECDS submission.
Three Questions to Ask in Your Next Leadership Meeting
Q · 01
Are we compliant now?
Confirm your plan is submitting the nine mandatory digital HEDIS measures via ECDS for measurement year 2025. Non-compliance carries accreditation risk.
Q · 02
Is our vendor validated?
Ask your quality technology partner directly: Do they hold NCQA dQM Validation? Legacy HEDIS certification does not satisfy digital reporting requirements.
Q · 03
Are we using the data?
FHIR-based dQMs allow continuous scoring. If your team only reviews results at submission time, you are leaving star rating improvements and care gap closures on the table.
