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Overview of the Specification Phase of Measure Development

Measure specification provides the technical instructions for how the measure is to be collected and implemented consistently, reliably, and effectively.

Both technical specification and harmonization define this phase; along with stakeholder engagement through public comment on the process. Final technical specifications provide the comprehensive details that allow the measure to be collected and implemented consistently, reliably, and effectively. The fields within the Measure Information Form (MIF) are completed and updated as the measure progresses from measure conceptualization to measure testing, and finalized when/if submitted for endorsement consideration. The MIF tracks very closely to the National Quality Forum’s online measure submission, Version 7.0, and references corresponding fields from that submission form.

In measure specification, precision is a key aspect that applies across the activities—including defining the population of interest and any exclusions, as well as specific data elements. The more precisely a measure can be specified at this initial stage, the more in-depth feedback can be provided.

Measure specification is an iterative process. Prior to drafting initial specifications, the measure developer should consider the data elements necessary for the proposed measure and conduct preliminary feasibility assessments. Throughout the process, stakeholder input is gathered in a variety of ways such as through use of a technical expert panel (TEP), public comment, and patient engagement.

During the development process, alpha (formative) testing of the measure occurs. For measures based on electronic administrative or claims-based data, the draft technical specifications may be provided to the programming staff responsible for data retrieval and for developing the programming logic necessary to produce the measure. The programmers will assess the feasibility of the technical specifications as written and may provide feedback. For measures based on chart abstraction, data collection tools are developed and tested. You can find more information about testing here.

 Specification Image


The following steps are performed to develop the full measure technical specifications:

  • Develop the candidate measure list
  • Develop precise technical specifications and update the MIF
  • Define the data source
  • Specify the code systems
  • Construct data protocol
  • Document the measures 

The key components of technical specifications are:

  • Measure name/title
  • Measure description
  • Initial population
  • Denominator statement
  • Numerator statement
  • Exclusion and exception
  • Data sources
  • Key terms, data elements, codes, and code systems
  • Unit of measurement or analysis
  • Sampling
  • Risk adjustment
  • Time intervals
  • Calculation algorithm

Electronic Clinical Quality Measures (eCQMs) must also have:


Develop candidate measure list:

CMS Blueprint (Section 3 – In-Depth Topics. 13.1 - Develop the Candidate Measure List)

Measures Management Up Close: Specification Phase

Develop precise technical specifications and update the measure information form:

CMS Blueprint (Section 3. In-Depth Topics – 13.2 Develop precise technical specifications and update the measure information form)

CMS Blueprint (Section 3. In-Depth Topics - 14 Measure Harmonization)

Define data source:

CMS Blueprint (Section 3. In-Depth Topics – 13.3 Define the data source)

Specify code sets:

CMS Blueprint (Section 3. In-Depth Topics – 13.4 Specify the Code Sets)

Construct data protocol

CMS Blueprint (Section 3. In-Depth Topics – 13.5 Construct Data Protocol)


Complete detailed technical specifications and document in the Measure Information and Measure Justification Forms:

CMS Blueprint (Section 3. In-Depth Topics – 13.6 Document the Measures)

CMS Blueprint (Measure Information Form Instructions)

CMS Blueprint (Blank Measure Justification Form Template)

eCQM Logic Quality Assurance Checklist

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