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Many are based entirely on claims data; some are “clinically enriched” by incorporating laboratory or
pharmaceutical transactions. Organizations implementing measures typically abstract clinical
information from patient records manually and merge this information with administrative data to
evaluate their performance, compare outcomes, and report to external entities. This has been a
laborious and time-consuming process, generally requiring specially trained clinicians to abstract chart
information manually.
To allow providers to take advantage of their Electronic Health Records (EHRs) for performance
measurement, measure requirements need to be created in a format that clinical IT systems can read. In
2009, HHS, motivated by The Health Information Technology for Economic and Clinical Health (HITECH)
Act,
3
requested the retooling of 113 NQF-endorsed® measures from traditional paper-based measures
to electronic measures, or eMeasures, to be compatible with or readable by EHR systems.
Under contract with the National Quality Forum, a Beta version of the Measure Authoring Tool (MAT)
was initially developed and released in January 2011. The basic version of the tool was released in
September 2011, followed by the enhanced version in January 2012. Effective January 2013, the MAT
contract was transitioned from NQF to the CMS. This transition allows for greater coordination of efforts
to evolve eCQM standards. The MAT plays a key role in the future success of eCQMs.
In November 2013, the MAT integrated with the Value Set Authority Center (VSAC). The VSAC is
provided by the National Library of Medicine (NLM) in collaboration with the Office of the National
Coordinator for Health Information Technology (ONC) and CMS. The VSAC is the sole repository for
official versions of value sets. Rigorous review standards are implemented to ensure the validity and
accuracy of value sets used within eCQMs. With this integration, the functions of authoring,
maintenance, and storage of value sets were removed from the MAT. The MAT/VSAC integration
provides MAT users with a means for retrieval of value sets from VSAC for use in building measure logic.
Standardizing the measure format and content using eMeasures helps ensure that performance
measures are consistently defined, implemented, and compatible across EHRs and other clinical IT
systems. This standardization will make performance measurement more accurate and cost-effective
and less burdensome for providers, and will facilitate comparison across settings and conditions.
In the future, eMeasures will be essential to a more efficient electronic healthcare environment because
they enable:
• greater standardization and comparability across measures;
• more precision; and
• better care delivery through access to more comparable and accurate performance information.
The Measure Authoring Tool (MAT) is the first tool of its kind to offer the measurement community a
web-based, publicly available, and non-proprietary way to develop eMeasures. The MAT offers measure
developers a means to specify and develop quality measures in a streamlined, structured approach and
should significantly reduce the time required to create new eMeasures and convert existing paper-based
measures to eMeasures.
3
U.S. Congress, Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV
of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5 (Feb. 17, 2009). Washington,
DC: Government Printing Office (GPO); 2009.
Available at, http://www.gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf. Last accessed November 2011.
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III. THE QUALITY DATA MODEL (QDM) AND THE MEASURE
AUTHORING TOOL
The Quality Data Model (QDM) provides the grammar to express eMeasures. The QDM promotes a
shared understanding among stakeholders so they can communicate and interpret quality measures
consistently in electronic clinical applications. Measure developers using the QDM can consistently
describe a quality measure’s criteria, allowing for more accurate performance comparison.
The QDM allows eMeasures to specify a greater level of detail and in a more consistent and precise
manner than earlier methods of measure expression. The QDM will continue to be updated to support
the evolving needs of the measurement field. The MAT uses the QDM to enable measure developers to
create eMeasures precisely and consistently that can be used across EHRs and other clinical IT systems.
The MAT is software intended to develop an eMeasure based on measure specifications using the QDM.
For the purposes of the MAT and QDM, the following terms are used to describe various healthcare IT
concepts:
Value set: A list of specific codes derived from a code system to define an individual data
element within a measure; and
Code system: Used in the MAT and in the healthcare field, which is otherwise referred to as
Taxonomy in the output of an eMeasure. Examples of code systems are SNOMED-CT, LOINC,
and RxNorm.
Each QDM element is composed of a category of information, a datatype (or context of use), and a value
set. Each QDM element also may have related attributes (also known as metadata, information about
the data element). The category is the type of information addressed by the QDM element (e.g.,
medication, laboratory test, or condition). The category is the highest level of definition for a QDM
element. The data type allows the measure developer to assign a context in which the category of
information is expected to exist (e.g., “Medication, Order” vs. “Medication, Dispensed” vs. “Medication,
Administered”, vs. “Medication, Active”). The value set defines the specific instance of the category by
assigning a set of values (or codes). For example, the specific RxNorm codes that identify all aspirin-
containing compounds formulated for oral use constitute a value set. Adding the context by applying the
datatype “Medication, Active” allows the measure developer to specify the presence of aspirin on the
active medication list. An attribute provides additional information about a QDM element. All QDM
elements have timing (e.g., time of occurrence, start and/or stop times), and data flow attributes
(source or recorder). Other attributes include category-specific attributes. For example, medication
attributes include route and dose.
The structure of a QDM element is shown in more detail in Appendix A. This appendix illustrates the
relationships among QDM categories, datatypes, and value sets. The Quality Data Model Component
Matrix (Appendix B) provides a list of Health IT Standards Committee (HITSC) Clinical Quality Workgroup
and Vocabulary Task Force recommended code systems as well as allowable code systems in the MAT.
The QDM Component Matrix (Appendix C) also lists all possible combinations of QDM categories by
datatypes and attributes.
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The application of the QDM to eMeasures will become clearer as this User Guide steps through an
example measure, titled MAT User Guide Example: Proportion Measure, to guide users through all of
the steps to develop an eMeasure using the MAT tools and functionality. The example eMeasure assists
MAT users to create their eMeasure by reflecting the most recent QDM
(Quality Data Model v4.2.0 published August 31, 2015).
The human readable export of this measure is viewable in Appendix E. This is not a published measure,
nor is it intended to be a published measure.
IV. HOW TO USE THIS USER GUIDE
The user guide is designed for use by beginner-level measure developers and organizations interested in
creating measures to evaluate performance. Additionally, the user guide can be accessed from a link in
the footer of the MAT or in the footer of the MAT home page, https://www.emeasuretool.cms.gov. A
link to the user guide is also available at the MAT public website on the Training & Resources page.
The goal of the user guide is to:
• Provide a clear picture of the overall purpose of the MAT;
• Provide users with detailed guidelines and instructions on how to use the MAT to build an
eMeasure;
• Describe the MAT’s features and capabilities, its importance, and how it should be used; and
• Highlight key issues to consider before creating an eMeasure.
Examples of potential uses of the user guide include users seeking clarity on what the MAT is and what it
is used for. Questions may include:
• What are the system requirements?
• How do I request a new password?
• What is the relationship between the MAT and eMeasures?
• What is the relationship between the MAT and the VSAC?
Users move tab by tab through the user guide to build an eMeasure. The user guide is organized around
each page or tab in the MAT. The narrative, descriptions, and screen shots are intended to provide
clarity and detail.
The user guide leads a user through all functions of each tab and is divided by chapter. Below is a layout
of the chapters.
Chapter 5: MAT Account — describes the [MAT Account] page. Within the [MAT Account] page, users
update their personal information. Password maintenance features are accessed through this tab and
described in this chapter.
Chapter 6: Integrating with the VSAC — provides background information about the integration of the
Measure Authoring Tool and NLM’s Value Set Authority Center. Information and instruction about the
integration with the VSAC via the MAT are provided in this chapter.
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Chapter 7: Measure Library — describes the features available on the [Measure Library] page. The
[Measure Library] is the home page from which measures can be added, deleted, selected for editing or
updates, or viewing. The [Measure Composer] allows users to create all of the selected measure’s
components and logic. A chapter is designated for each sub-tab within [Measure Composer]. The sub-
tabs of [Measure Composer] are [Measure Details], [QDM Elements], [Clause Workspace], [Population
Workspace], [Measure Packager], and [Measure Notes].
Chapter 8: Measure Composer-Measure Details — describes the purpose and features within the
[Measure Details] page. [Measure Details] let users specify information about the measure (metadata)
that appears in the measure header section of the eMeasure.
Chapter 9: Measure Composer-QDM Elements — describes the features within the [QDM Elements]
page. Within the [QDM Elements] page, MAT users are able to create QDM elements and attributes.
QDM elements and attributes can be created with or without VSAC data. Once applied to a measure,
QDM elements and attributes can be modified, removed, copied, and updated with the most current
VSAC value set data.
Chapter 10: Measure Composer-Clause Workspace — describes the features within the [Clause
Workspace]. Within the [Clause Workspace], MAT users build logic statements called clauses. Here the
clauses may be created, edited, deleted, validated, and stored.
Chapter 11: Measure Composer-Population Workspace — describes the features and functions of the
[Population Workspace]. MAT users use the [Population Workspace] to define eMeasure populations
by adding and connecting clauses built and stored within the [Clause Workspace].
Chapter 12: Measure Composer-Measure Packager — describes how to use the [Measure Packager]
page to prepare an eMeasure for export. The populations to be included in a measure package are
compiled here. MAT users may also add an item count to a specific population, identify an association
between populations, or add supplemental data elements, if applicable. After a measure package is
completed, the measure is ready for export.
Chapter 13: Measure Composer-Measure Notes — describes how to use the [Measure Notes] page
features. Within the [Measure Notes] page, MAT users are able to create and export notes for a
selected measure draft or version.
The user guide draws on the sample eMeasure MAT User Guide Example: Proportion Measure to
illustrate how to create an eMeasure using the MAT. To view the sample measure in human readable
format, please refer to Appendix E.
Notes in the boxed text illustrated below provide navigation tips and walks users to the next step in
building a measure.
Navigation Tip: Information provided in these boxes provides tips and clues on next steps a user
should take to build an eMeasure.
The next chapter will address system requirements needed to access and use the MAT.
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Chapter 2: System Availability
and Requirements
Chapter Overview: This chapter lists the minimum hardware and software requirements to access the
MAT effectively.
I. HARDWARE
Processing speed: 2GHz (recommended). Less than the recommended processing speed will
affect the time it takes to load information or save data.
Memory: 2 GB RAM (minimum requirements).
Screen resolution: 1024 x 768 pixels.
II. SOFTWARE
Internet browsers: Microsoft® Internet Explorer Version 8.0 or 9.0, Firefox 36 or higher. Users
may open the MAT with other browsers, but they are not supported at this time.
Operating systems: Microsoft Windows 7. Users may open the MAT in other operating systems,
but they are not supported at this time.
III. INTERNET CONNECTION
The MAT is accessible via any high-speed Internet connection (minimum of a 56k modem).
IV. SYSTEM AVAILABILITY
The MAT is available 24 hours a day, 7 days a week at https://www.emeasuretool.cms.gov. MAT users
are notified by email about scheduled and unscheduled system maintenance. Scheduled maintenance
occurs on the second weekend of each month from 1:00 AM Eastern Time (ET) on Saturday through 7:00
PM ET on Sunday. The MAT may not be available during those times. A secondary maintenance window
is reserved to begin at 8:00 pm ET on Tuesday of each month.
Note: The Value Set Authority Center (VSAC) can operate using additional software (i.e. Google Chrome
and Mac OS). The MAT does not support this software, thus MAT software requirements must be met
when integrating with the VSAC via the MAT.
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Chapter 3: Account Registration
and Signing Into the MAT
Chapter Overview: This chapter outlines information a user must provide when setting up an account,
the process of setting up an account, the process of signing into the Measure Authoring Tool (MAT), and
how to retrieve a forgotten password/User ID. Additional information about system timeouts, help desk,
and system maintenance is also included.
There are several required steps to becoming a Measure Authoring Tool (MAT) user. All new MAT users
are required to submit a notarized New User Registration Form, obtain UMLS license credentials, and
register up to three Symantec™ VIP Access Credential IDs. Instructions for completing these steps are
provided next. Once these three steps are completed, MAT users may sign into the MAT. Instructions for
signing into the MAT are also provided in this chapter.
I. MAT REGISTRATION PROCESS
A. Submit New User Registration Form
To access the MAT, new MAT users must complete the New User Registration Form, which is located
on the Training & Resources tab of the MAT public website, http://www.emeasuretool.cms.gov. The
form should be completed according to the directions listed within the document. The form must be
notarized and the original mailed to the Help Desk at the following address:
Telligen
MAT Help Desk
1776 West Lakes Parkway
West Des Moines, IA 50266
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In addition to contact information, applicants will also need to provide the organization's object
identifier (OID). If the applicant’s organization has a registered OID, the applicant is to use that OID.
If the organization does not have an OID, the applicant may choose to register for an OID using the
HL7 OID Registry at, http://www.hl7.org/oid/index.cfm .
The organization name and OID used within the MAT must be consistent with other MAT users who
are using the same organization name. For example, if an organization is called Measure Developer,
Inc. and the OID for this organization is 1.2.3.4.5.6, all registration applicants who list Measure
Developer, Inc. as their organization must use the OID 1.2.3.4.5.6. Otherwise a different
organization name must be used.
If your organization does not have a registered OID, and a registered OID is not required for your
measure development purposes, you may submit a request to the MAT Help Desk to assign a
universally unique identifier (UUID) for your organization in lieu of an OID.
B. Apply for UMLS License
To integrate with the Value Set Authority Center (VSAC) through the MAT, users are required to
have a Unified Medical Language System© Metathesaurus License (UMLS).
To request a license and create a UMLS account, users must access
https://uts.nlm.nih.gov//license.html.
C. Set Up Symantec™ VIP Access
The MAT uses two-factor authentication. Two-factor authentication requires that two unique
identifiers be provided to access an application. When logging into the MAT, you are required to
enter a MAT User ID, password (unique identifier 1) and Symantec™ security code(unique identifier
2). The MAT uses an application produced Symantec™ Validation & ID Protection called Symantec™
VIP Access. The Symantec™ security code is generated from an installed application to your desktop,
smartphone, or tablet. Complete instructions for installing Symantec™ VIP Access and registering
the corresponding Symantec™ Credential ID are located on the Training & Resources page of the
public website in the document titled Symantec™ VIP Access Setup.
The MAT supports up to three installations of Symantec™ VIP Access. Symantec VIP Access
installation instructions for mobile devices and desktops can be accessed online at the
Symantec Validation & ID Protection Center. Once the Symantec™ VIP Access application is installed,
register the corresponding 12-digit alphanumeric Symantec™ Credential ID with the MAT Help Desk
by completing the Contact Us form on the public website or call 1-800-673-0655.
Note: The Symantec™ VIP Access application does not need to be installed on the same device or
computer being used to access the MAT. For example, a work-issued laptop or desktop can be used to
access the MAT, and the Symantec VIP Access application producing the Symantec™ Security Code may
be installed on a separate device such as a smartphone.
Documents you may be interested
Documents you may be interested
