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One measure side by side
A measure still on hybrid run digitally next to its current result.
Healthcare / Digital HEDIS
Digital HEDIS software for the end of hybrid chart review
Every hybrid season, a plan's quality team chases charts for results that often already sit in a provider's EHR, an HIE or a registry. NCQA is moving HEDIS to electronic clinical data and digital measures. Agnotic Technologies builds the data feeds, measure logic and audit trail a health plan needs to report that way.
Feeds
EHR, HIE and registry data on FHIR
Logic
Measures in CQL on QI-Core
Audit
Evidence kept per data source
Trusted by global innovators
Industry Overview
What is digital HEDIS?
Digital HEDIS is the move from claims plus hybrid medical record review to HEDIS measures reported from electronic clinical data and written as computable FHIR and CQL specifications. Agnotic Technologies builds the software a health plan needs for it: clinical data feeds mapped to QI-Core, measure logic in CQL, ECDS reporting and the audit trail behind each result.
Industry Challenges
Why does hybrid reporting still take the quality team's spring?
The measures are moving to digital. The data plumbing in most plans has not moved with them.
Chart retrieval vendors, provider offices and abstractors work the same sample every year, by hand.
Lab results and screenings arrive as supplemental files in many layouts, each with its own validation history.
EHR data from provider APIs or an HIE lands in a data lake but never reaches the measure engine in a usable model.
Measure logic runs as a black box, so analysts cannot explain why a member counts as a numerator miss.
The auditor asks where each data element came from, and the answer is spread across email threads.
Nobody has compared ECDS results with hybrid results for the same measure before the hybrid option ends.
Data sources
Which data sources feed digital HEDIS, and what does each need?
The original element of this page: each source a digital measure can read, its NCQA ECDS category, how we map it, the checks before use and the evidence we keep for the audit.
| Data source | NCQA ECDS category | How we map it | Checks before use | Audit evidence kept |
|---|---|---|---|---|
| Claims and encounters | Administrative | Warehouse tables mapped to QI-Core Encounter, Condition and Procedure profiles | Totals reconciled to the claims system for the period | Claim identifiers, load dates and reconciliation reports |
| Eligibility and member rosters | Administrative | Member and coverage records keyed to the enterprise member ID | Enrollment segments checked against measure continuity rules | Roster versions by load date |
| Provider EHR data over FHIR | EHR or personal health record | US Core resources from provider APIs mapped to QI-Core | Codes checked against measure value sets; dates within the measurement period | Source organization, retrieval time and the original resource |
| HIE and immunization registry feeds | HIE or clinical registry | HL7 v2 or FHIR messages normalized to QI-Core | Duplicate and late record checks across feeds | Feed, message identifier and receipt time |
| Care and case management records | Case management system | Assessments and screenings mapped to QI-Core Observation | Who recorded it and whether the instrument is the one the measure names | System, recorder and timestamp |
Our Approach
How do we build for digital measures without risking this year's submission?
Three rules keep the transition safe while the current reporting cycle runs.
Run both methods side by side
Digital results run next to the hybrid and administrative results for the same members, so differences are explained before anything is retired.
Keep the source, not only the result
Every data element keeps its source, its original form and its load date, so the audit trail exists before the auditor asks.
Make the logic explainable
Measure logic runs in CQL on QI-Core data, and analysts can see for any member which data placed them in or out of each population.
Capabilities
What do we build for digital HEDIS?
The data and measure layers behind digital HEDIS. Stars dashboards, HCC gap detection and care gap analytics are covered on our payer analytics and AI page.
Clinical data intake
Provider FHIR APIs, HIE feeds, registries and files received, logged and queued for mapping.
QI-Core mapping layer
Source data normalized to QI-Core profiles, with the original record kept beside it.
Terminology checks
Codes validated against the value sets each measure uses, with unmapped codes sent for review.
CQL measure execution
Measure packages run in a CQL engine against QI-Core data, versioned by measurement year.
Member-level explorer
Why each member is in or out of the denominator, numerator and exclusions, with the evidence.
Supplemental data governance
Intake, validation and approval for each provider or aggregator source before its data counts.
Side-by-side run reports
Digital, hybrid and administrative results compared by measure and member.
Gaps in care exchange
Da Vinci DEQM Gaps in Care reports shared with provider groups over FHIR.
How It Works
How does a clinical record become a measure result?
The pipeline we build for digital HEDIS, with the evidence each stage leaves for the audit.
Intake
FHIR API pulls, HIE and registry feeds and supplemental files land with their source, receipt time and original payload.
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1
Normalize to QI-Core
Records are mapped to QI-Core profiles built on US Core, and the mapping version is stored with each record.
02
2
Check terminology
Codes are validated against the measure value sets; records with unknown codes are held for review instead of dropped.
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3
Run the measures
CQL measure logic runs for the measurement year, producing member-level results for each population.
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4
Compare and report
Digital results are compared with hybrid and administrative results, then shaped for the plan's HEDIS submission process.
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5
Share gaps
Open gaps go back to provider groups as DEQM Gaps in Care reports, so they can act before the year closes.
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6
Engineering Stack
Which standards does a digital HEDIS build use?
The standards we build on, chosen to match NCQA's digital measure direction.
Measure standards
HL7 FHIR R4QI-CoreClinical Quality Language (CQL)Da Vinci DEQM
Clinical data
US CoreHL7 v2 ORU and VXUBulk FHIR export where providers offer it
Terminology
LOINCSNOMED CTICD-10-CMCPT and CVX
Platform
FHIR serverData warehouseAudit storeRole-based access
Measured Impact
What should a quality team track during the transition?
Views we build for quality, data and compliance teams.
Ready
Measures with complete digital data
Measures whose digital results match or explain the hybrid results.
Sources
Contribution by category
Members met by each ECDS data source category.
Chart only
Hybrid-only hits
Numerator hits that only chart review found, traced to a missing feed.
Shared
Gaps sent to providers
Care gap reports delivered and acknowledged.
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Use Cases
Where do digital HEDIS projects usually start?
First releases we scope, each tied to the current measurement year.
02
Provider EHR feed
A FHIR feed from one high-volume provider group, mapped and validated.
03
Supplemental data intake
One governed path for provider and aggregator files, replacing many layouts.
04
Member-level explorer
Analysts see why a member is a numerator miss, with the evidence.
05
Gaps in care reports
DEQM reports to provider groups during the year.
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Digital HEDIS for smaller plans
A first digital pipeline sized for a regional or new plan.
Integrations
Which systems does digital HEDIS software connect to?
The systems a digital measure pipeline reads from and reports to.
FHIR APIs
Provider EHRs
Clinical feeds
Health information exchange
Registry data
Immunization information systems
Administrative data
Claims warehouse
Assessments
Case management system
CQL execution
Measure engine
Reporting
HEDIS submission process
Evidence
Audit workpapers
What we check
What should a side-by-side run of ECDS and hybrid results check?
Before a plan lets go of chart review for a measure, we run both methods and check these four areas. The gaps found here become the next data feeds to build.
Population
- Same eligible population in both runs
- Same exclusions applied
- Differences listed member by member
Numerator
- Members met by digital data only
- Members met by chart review only
- Each chart-only hit traced to its missing source
Data sources
- Contribution by ECDS category
- Feeds with late or missing data
- Supplemental files still needed
Readiness
- Measures ready to move first
- Provider groups to connect next
- Evidence ready for the auditor
Compliance-First Development Services Backed by Global Standards
We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, and strict access controls.
Fast Healthcare Interoperability Resources
Enabling standardized health data exchange through standards-based API mappings.
Health Level Seven International
Supporting enterprise-grade interoperability for clinical messaging and record workflows.
Our Edge
Why Global Leaders Choose Us
We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.
Enterprise-Grade Security
We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.
High-Performance Scaling
Our architectures are built to handle massive data loads and user bases, keeping performance steady whether you're serving ten or ten million.
Accelerated Time-to-Market
Using our suite of internal tools and proven frameworks, we cut setup work so your first release reaches users sooner.
Embedded AI Integration
Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.
Engagement Model
How does a digital HEDIS engagement run?
We start with one measure and the data the plan already holds. Timing follows the measurement year, and we agree a fixed first release on the scoping call.
01
Scoping call
Measures, current vendors, data sources and the reporting calendar.
02
Data source inventory
The data source table filled in for the plan, with gaps marked.
03
Fixed-scope first release
One measure running digitally next to its current result.
04
Add feeds and measures
New provider and HIE feeds, then more measures on the same pipeline.
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Support through each season
Measurement year updates and audit support under change control.
Facts and sources
Which standards and NCQA rules shape digital HEDIS?
Short facts we design around, each linked to its primary source. NCQA dates were read on ncqa.org on 22 October 2026.
NCQA reports that eight HEDIS measures still allowed hybrid reporting as of measurement year 2025, and that its planned transition removes the hybrid method by measurement year 2029, an endpoint it kept when it refined measure pathways in January 2026.
Source: NCQA, HEDIS Electronic Clinical Data Systems (ECDS) Reporting, Hybrid Transition (read 22 October 2026)NCQA groups data sources for HEDIS ECDS reporting into four categories: EHR or personal health record, HIE or clinical registry, case management system, and administrative data.
Source: NCQA, HEDIS Electronic Clinical Data Systems (ECDS) Reporting, Types of ECDS DataHL7 Clinical Quality Language (CQL) is a high-level, domain-specific language for clinical quality measure and decision support authors, with a machine-readable form called Expression Logical Model (ELM).
Source: HL7, Clinical Quality Language Specification v2.0.0The HL7 QI-Core Implementation Guide defines FHIR profiles that derive from base FHIR resources and US Core for quality improvement work; QI-Core STU 7 (version 7.0.2) aligns with US Core STU 7.
Source: HL7, QI-Core Implementation Guide v7.0.2The HL7 Da Vinci Data Exchange for Quality Measures (DEQM) Implementation Guide, version 5.0.0, gives guidance for exchanging individual, summary and subject list measure reports, and Gaps in Care reports, over FHIR.
Source: HL7, Da Vinci DEQM Implementation Guide v5.0.0 (STU5)
Voice of success
We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
“I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly.”
Aaron Phelan
Founder, Benchmark
“Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective.”
John Pasmore
Founder, Latimer
“Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together.”
Kim Smith
Founder, My Lauren
Related pages
Related payer, quality and interoperability pages
This page covers digital measure data and logic. These pages cover the work next to it.
Payer analytics and AI
Stars and HEDIS tracking, HCC gap detection and care gap outreach.
Software for health plans and payers
Core, member and provider systems, including CMS-0057-F APIs.
Medicare Advantage and Medicaid plan software
Software for government program health plans.
Health information exchange integration
Connecting to HIE feeds for clinical data.
What HL7 FHIR is
The resource model QI-Core and DEQM build on.
OMOP vs FHIR for analytics
When each data model fits an analytics build.
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Frequently Asked Questions
NCQA says it plans to remove the hybrid method by measurement year 2029, and kept that endpoint when it refined individual measure pathways in January 2026. Check NCQA's ECDS page for each measure's current path before planning your own.
NCQA describes ECDS as a HEDIS reporting standard for collecting and submitting measures from electronic clinical data, and a digital quality measure as computable, standards-based measure content in FHIR and CQL. A plan usually needs both: ECDS-ready data and a way to run digital logic on it.
No. NCQA owns the HEDIS specifications. We run the measure packages your plan licenses in a CQL engine, map your data to what they expect and build the tools to explain the results.
NCQA groups them into four categories: EHR or personal health record, HIE or clinical registry, case management system, and administrative data. Our data source table maps each of your feeds to one of them and lists the evidence to keep.
We run the digital measure for the same members and measurement year as the current result, then list every member where the two differ. Each chart-only hit is traced to the feed that would have carried it, which tells you what to build next.
The number of measures in scope, the provider groups and HIEs to connect, the state of your claims warehouse, how many supplemental file layouts exist and whether you need DEQM exchange with providers. We size these on the scoping call.
Yes. Open gaps can be sent to provider groups as Da Vinci DEQM Gaps in Care reports over FHIR, so they see the same gap the plan sees during the year.
Industries