NCQA and CareEvolution Expert Series Webinar

Myths and Misconceptions about the Digital HEDIS^® Transition

Digital HEDIS and dQMs are coming. That part is no longer up for debate.

What we see across the industry, though, is that many organizations are still operating from assumptions that do not line up with what the transition to Digital HEDIS will take.

In our recent Expert Series session with NCQA, this came up repeatedly. It is not that people do not want to move forward. It is that the journey to Digital HEDIS is widely misunderstood.

I hear versions of these all the time from health plans, provider organizations, and even vendors:

“The move to Digital HEDIS doesn’t really help my current quality program.”

“Once we turn on FHIR APIs, we are basically ready.”

“Our data warehouse or FHIR server can handle this already.”

“This is mainly an IT integration project.”

“We have clinical data feeds. We should be covered.”

“We will clean up the data after the dQM calculators are in place.”

“This is just a reporting update with a new HEDIS engine.”

Those statements point to three myths that are shaping expectations and will impact success for many.

Myth #1: Most source data for measures is already in FHIR

FHIR adoption is real and growing. The idea that most measure-ready data already lives in FHIR is not.

Clinical data still arrives through CCDs, PDFs, HL7, and a long tail of non-FHIR formats.

FHIR helps with access and exchange. It does not replace the upstream data supply chain that quality programs depend on.

Reality:
Digital HEDIS still starts with messy, non-standard inputs that must be ingested, reconciled, and refined before any dQM can run.

Myth #2: If it is FHIR, it is already normalized and standardized

There is an assumption that once data shows up in FHIR, it is standardized and ready to use.

Anyone who has worked with real-world EHR data knows that is not how it plays out.
FHIR coming out of an EHR still carries:

proprietary codes
Poorly coded terminology
Inconsistent, non-standard data placement
Data loss when converting to FHIR

FHIR gives structure. It does not guarantee semantic alignment.

Reality:
Terminology harmonization, normalization, loss prevention, and data refinement are still required. That work does not go away in a digital model. It becomes critical.

Myth #3: If we can access it via API, it is ready for measures

Access gets confused with readiness all the time.

Digital measures require:

Longitudinal patient coverage
Consistent attribution
Normalized coding
Standardized formatting

None of that is guaranteed just because a FHIR endpoint exists.

Reality:
Being able to ingest the data is step one. Refining the data to make it computable for measures is the hard part.

What this actually means

Digital HEDIS is not just interoperability.
It is not just a new reporting model.
It is not just an IT project.

It is a shift in how organizations think about sourcing, refining, and governing data for quality and their broader enterprise.

Organizations making real progress are focused on:

Knowing where their data actually comes from
Continuously normalizing and validating it
Building longitudinal views instead of episodic ones
Creating reusable, computable data assets

That is the work.

The path forward

Digital HEDIS will move the industry forward. It enables more timely measurement, more clinically grounded insight, and stronger provider and payer alignment.

Getting there requires confronting realities the industry has lived with for years. Manual workarounds, fragmented pipelines, and the assumption that this is simply how HEDIS operates. The intensive and wildly inefficient operations needed for a traditional quality program are also brittle and seem risky to change. Like, where do I even start?

FHIR alone will not fix it.
Automation alone will not fix it.
Digital measures alone will not remove operational complexity overnight.

Organizations that get ahead treat this as a data maturity journey rather than a reporting upgrade.

That is the difference between those that will be clear winners and accelerate from the pack.

Watch our previously recorded live session.

Join CareEvolution^® and NCQA for an engaging conversation about the real-world challenges healthcare organizations face when implementing HEDIS digital quality measures (dQMs), and what it really takes to move from digital measurement to meaningful quality improvement.

Watch the webinar