• Effective CY2025, The Joint Commission has added the following eCQMs as available optional measures towards meeting ORYX requirements:

  • eCQM: Hospital Harm - Pressure Injury (HH-PI)

  • IP-ExRad (eCQM) Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Inpatient) (REMOVED - additional information below)

  • eCQM: Excessive Radiation Dose or Inadequate Image Quality for Computed Tomography (CT) in Adults (Outpatient) (OP-ExRad)

• Effective CY2025, The Joint Commission has retired the following chart-abstracted measure:

  • VTE-6: Hospital Acquired Potentially-Preventable Venous Thromboembolism

• Effective CY2025, Small hospitals are required to submit a minimum of one (1) eCQM for the entire calendar year, plus two additional measures (Chart-abstracted, eCQM, or combination of both) applicable to their patient population and services offered.

• Effective CY2025, Critical Access Hospitals are required to submit a minimum of one (1) eCQM for the entire calendar year, plus two additional measures (Chart-abstracted, eCQM, or combination of both) applicable to their patient population and services offered.

The following two outpatient eCQMs are included as optional measures and are aligned with the US Centers for Medicare & Medicaid Services’ implementation approach, which allows for data submission of less than a full year for new outpatient eCQMs:

o    ST-Segment Elevation Myocardial Infarction (STEMI) (OP-40) – submit a minimum of two self-selected quarters; this will count as a complete measure / towards meeting the eCQM requirement 

o    Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (OP-ExRad) – submit a minimum of one self-selected quarter; this will count as a complete measure / towards meeting the eCQM requirement 

IP-ExRad (eCQM) Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Inpatient) has been removed.

The Joint Commission has removed from the 2025 ORYX^®; program an optional inpatient measure, the Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults, Hospital Level — Inpatient, (IP-ExRad). The IP-ExRad measure was on the list of optional measures organizations can select from to meet the ORYX requirement to report self-selected eCQMs. We are removing the measure due to a specification issue in the 2025 measure specifications (IP-ExRad version CMS1074v2). The issue is captured on the ONC Project Tracking System eCQM Known Issues Tracker [EKI-36] CMS1074v2 - Office of the National Coordinator for Health Information Technology.

The Joint Commission team will continue to work with the measure developer and stakeholders and consider implementing the measure once the specification is corrected. The Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computer Tomography (CT) in Adults (OP-ExRad) does not have this technical issue and will remain on the list of optional measures available for organizations to select to meet self-reported eCQMs.

Organizations that considered or selected this measure please reach out to our customer support team directly for additional assistance or with any questions at HCOOryx@jointcommission.org.  

Questions related to the ExRad eCQM specifications, logic, data elements, standards or resources can be submitted to the ONC JIRA CQM Issue Tracker.

Submit questions to the ONC JIRA CQM Issue Tracker.