How to Test your Quality Measures Calculations using Cypress

by Nadeem Nazeer

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In this blog, I have tried to walk you through testing your QRDA-I and QRDA-III files using Cypress. Before we start, a brief introduction about Cypress and some official documentations would help in understanding the concepts better.

What is Cypress?

  • Cypress is the rigorous and repeatable testing tool of Electronic Health Records (EHRs) and EHR modules in calculating Meaningful Use (MU) Stage 2 Clinical Quality Measures (CQMs).
  • The Cypress tool is open source and freely available.
  • ONC has commissioned the development of the open source Cypress certification tool.
  • Cypress has encoded the Eligible Professional (EP) and Eligible Hospital (EH) Clinical Quality Measure logic required for Meaningful Use Stage 2 in a software implementation.(1)

CQM certification

CQM certification criteria addressed by Cypress includes:

  • Capture and Export – the capability of EHR technology to create a data file that can be incorporated by another EHR technology which could be used to calculate CQMs.
  • Import and Calculate – the capability of EHR technology to incorporate data (from other EHR technology where necessary) and correctly calculate the result for CQMs.
  • Report – the capability of EHR technology to create a standard data file that can be electronically accepted by Centers for Medicaid & Medicare Services (CMS).

Cypress Test Data

The Cypress software includes a standard test data of synthetic patient records that exercises all of the MU Stage 2 CQMs, for Eligible Professionals (EP) and Eligible Hospitals (EH) to test the ability for EHR systems and EHR modules to accurately calculate and report CQM results. The Cypress test data is available in standard formats (XML and HTML) for both automated and manual input into an EHR system.

Here is the comprehensive Cypress Overview Presentation of the design, software, and use of the Cypress v2.0 software for Meaningful Use Stage 2 CQM testing program.

QRDA Category III and  Category I Testing

Before you start you need to register an account in Cypress and after logging in you will be presented with the dashboard. To start testing your EHR SUT (System Under Test) perform the following steps:

1. Add vendor


2. Enter vendor information and hit save


3. Add product 


4. Add product information and hit create


5. Click on the name of product


6. Add test



7. Name your test and hit next


8. Select measures you want to test and hit done


9. Click on the test name under CERTIFICATION DASHBOARD » <VENDOR NAME> » <PRODUCT NAME>


10.a QRDA Category III Testing:

  •  Patient test data for the selected CQMs of the specified test must be downloaded in the format required for the test.
  • Hover the mouse over the Test Data button below ‘1. Download Test Data’ to display the download menu.
  • Choose the format to download the data in (QRDA Cat 1, HTML) as required by the EHR. The downloaded patient record test data will be contained in a zip file.



10.b QRDA Category I Testing:

  • Category 1 tests can be generated by selecting the Generate button under ‘Generate Category 1 Tests’ on the Certification Dashboard.
  • The generated Category 1 test appears on the vendor product Certification Dashboard.
  • Select the generated test to download test data and perform the test.




Just as with Category III testing, Category 1 results from the EHR system can be uploaded from the Certification Dashboard.

  • Download Test Data
  • Load Test Data into your quality measure calculator
  • Upload Results

11. Uploading your Category III or Category I results

Once Test Results in the QRDA Category III or QRDA Category I format have been generated by the EHR system, they are uploaded from the Certification Dashboard.

  • The Test Proctor validates that the proper CQM artifacts in QRDA Category III or QRDA Category I file format for the test being performed are electronically generated by the EHR SUT(System Under Test).
  • Validation results are displayed in the Certification Dashboard.
  • Further detail of test results are available by selecting the various Test Results tabs.

In the next part we will go through what these various Test Results tabs are all about and how to identify what is wrong with your results.

Stay tuned for more stuff around Cypress. You can reach me at for any queries on Cypress.


References and resources:


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