Cypress v3.0

Now Available: Cypress v3

Cypress v3 is now available to support 2015 certification for electronic clinical quality measures (eCQM). Cypress v3 supports testing for the June 2015 and April 2016 updates to the Meaningful Use (MU) Stage 2 Eligible Hospital eCQMs and the MU Stage 2 Eligible Professional eCQMs. The new v3 release and release notes are available on the Cypress website https://healthit.gov/cypress/.

New Features for Cypress v3 Release
  • Refreshed design providing a more responsive and accessible user interface
    • Cypress v3 complies with Section 508 and Web Content Accessibility Guidelines (WCAG) 2.0 AA conformance level requirements
  • A more flexible v3 Concept of Operations (ConOps) that evaluates certification testing criteria for accuracy of export of patient data (C1), computation of CQMs (C2) and submission requirements (C3), and data filtering (C4) independently of each other
    • Redesign of the Cypress workflow to allow for independent evaluation of electronic clinical quality measure (eCQM) testing criteria
    • User Interface updates to support updated C1, C2, C3, and C4 workflows
    • Testing and Integration
    • New eCQM Test Plan for 2015 Certification Program
  • New C4 CQM Filter Certification Criteria testing ability of electronic health records (EHR) systems to filter patients based on patient and provider information
  • Pre-Certification testing support
    • Certification Application Programming Interface (API) to automate and expedite pre-certification testing
    • Turn off document duplication and record randomization to use a stable set of test patients
  • Support for Health Quality Measure Format (HQMF) R2.1 and Quality Reporting Document Architecture (QRDA) R3.1
  • Cypress v3 certifies EHRs for accuracy of export of patient data C1, C2, C3, and C4 using automated import of QRDA Category 1 patient records
    • The ConOps will provide separate C1 testing without automated import that demonstrates the validation of well-formed QRDA Category 1 patient record required for interoperable exchange across systems
  • Support for the 2016 Annual Measure Update
    • Cypress v3 includes the updated specifications introduced for Eligible Hospital Measures and Eligible Professional Measures in April 2016 by the Centers for Medicare & Medicaid Services (CMS)
    • Validation of 2017 CMS Implementation Guide (IG) for Eligible Hospitals (informational)

Cypress is sponsored by the CMS and ONC and has been developed by MITRE.

Please send any feedback to project-cypress-talk@googlegroups.com. Thank you.


Cypress v2.7.0

Released July 23rd, 2015

Cypress v2.7: 2015 Measure Specs, Value Sets for 2015 Measure Specs, HL7 QRDA Category I Release 3, Cypress v2.7 Measure Bundle

Cypress 2.7.0 is no longer supported. Please use Cypress v3.0 to test the 2015 Measures


Features Added

  • Additional Validation checks to closer align with submission requirements
    • Performance Rates – Cypress will validate performance rates if they are provided in QRDA Cat III Files.
    • Measure Duplication – Cypress will validate that measures and populations are only reported once.
    • Measure Period – Cypress will validate that the correct measurement period is specified.
  • Standards Update
    • HL7 QRDA Category I Release 3
    • Health Quality Measures Format (eMeasure), DSTU Release 2.1
  • Cypress V2.7 Measure Bundle
    • Measure Bundle v2.7 includes updated patients
    • Patient Deck reviewed for clinical relevance
  • Support for the annual 2015 Eligible Hospital and Eligible Professional Clinical Quality Measure Update
    • Cypress v2.7 includes the updated specifications introduced for Eligible Hospital Measures and Eligible Professional Measure in May 2015 by the Centers for Medicare and Medicaid Services (CMS).
    • 2015 measures have been updated to use the HL7 Version 3 Standard: Representation of the Health Quality Measures Format (eMeasure), DSTU Release 2.1.
  • Minor User Interface updates
  • Updated installation procedure

Defects To Be Addressed

Jira Issues

  • Issue #524: CMS179 calculation includes calculation described by supplemental guidance.
  • Issue #530: Download Results feature fixed.
  • Issue #531: UI updated.
  • Issue #538: Extra data errors updated to allow multiple measure reporting.
  • Issue #541: Improved Supplemental Information validation.

Test Deck Issues

  • Issue #553: Measure update fixes calculation issues for CMS122, Diabetes Adult A and B updated to meet new Denominator and Numerator logic.
  • Issue #899: Heart Adult A updated to include valid INR intervals.

Cypress Patch Release v2.6.1

Released July 23rd, 2015

Cypress v2.6.1: 2014 Measure Specs, Value Sets for 2014 Measure Specs, HL7 QRDA Errata IG for 2014, Cypress v2.6 Measure Bundle

Available for use in certification for the 2014 Measures.


Features Added

  • Additional Validation checks to closer align with submission requirements
    • Performance Rates – Cypress will validate performance rates if they are provided in QRDA Cat III Files.
    • Measure Duplication – Cypress will validate that measures and populations are only reported once.
    • Measure Period – Cypress will validate that the correct measurement period is specified.
  • Minor User Interface updates
  • Updated installation procedure

Defects To Be Addressed

Jira Issues

  • Issue #530: Download Results feature fixed.
  • Issue #531: UI updated.
  • Issue #538: Extra data errors updated to allow multiple measure reporting.
  • Issue #541: Improved Supplemental Information validation.

Optional Cypress Validation Utility

Validates to CMS Program specific Implementation Guides for Reporting Years 2015 and 2016

Released July 23rd, 2015


The Cypress Validation Utility with support for the 2016 CMS QRDA Combined Implementation Guide is now available for use. This new utility is intended as a development tool for health IT vendors and others who are testing synthetic QRDA Category I and Category III documents for conformance to CMS submission requirements for the 2016 reporting period. While it is not required for certification and does not constitute a certification test, it is designed to help vendors reduce file submission errors when they submit reports to CMS. Note that files submitted for validation testing must not contain Protected Health Information (PHI) or Personally Identifiable Information (PII).

This new utility is a standalone capability and currently separate from the Cypress eCQM certification tool. You can access the Cypress QRDA utility from ONC’s SITE, the Standards Implementation and Testing Environment. QRDA Validators are found in the QRDA Sandbox at this link. Please send any questions or feedback about the validation utility to talk@projectcypress.org.

Features Added

  • Additional Validation checks to closer align with submission requirements
    • Performance Rates – Cypress will validate performance rates if they are provided in QRDA Cat III Files.
    • Measure Duplication – Cypress will validate that measures and populations are only reported once.
    • Measure Period – Cypress will validate that the correct measurement period is specified.
  • Support for the 2016 CMS Combined Implementation Guide and Schematron validations.
  • Cypress Validation Utility performs validations steps beyond the ones specified in the schematron. Cypress Validation Utility checks:
    • That provided Codes/ValueSets are included in the measures being reported
    • That encounter dates are valid for the measurement period being reported
    • That the measure ids are valid (version specific Ids and version neutral Ids)

Cypress Validation Utility for Reporting year 2015

Released April 30th, 2015

The Cypress Validation Utility with support for the 2015 CMS QRDA Combined Implementation Guide is now available for use. This new utility is intended as a development tool for health IT vendors and others who are testing synthetic QRDA Category I and Category III documents for conformance to CMS submission requirements for the 2015 reporting period. While it is not required for certification and does not constitute a certification test, it is designed to help vendors reduce file submission errors when they submit reports to CMS. Note that files submitted for validation testing must not contain Protected Health Information (PHI) or Personally Identifiable Information (PII).

This new utility is a standalone capability and currently separate from the Cypress eCQM certification tool. You can access the Cypress QRDA utility from ONC’s SITE, the Standards Implementation and Testing Environment. QRDA Validators are found in the QRDA Sandbox at this link. Please send any questions or feedback about the validation utility to talk@projectcypress.org.


Cypress v2.6.0

Released January 22th, 2015

Cypress v2.6: 2014 Measure Specs, Value Sets for 2014 Measure Specs, HL7 QRDA Errata IG for 2014, Cypress v2.6 Measure Bundle


Features Added

HL7 QRDA Errata IG for 2014

  • Support for the 2014 Errata Update to the HL7 Implementation Guide for CDA Release2: Quality Reporting Document Architecture - Category I and Category III.

Cypress V2.6 Measure Bundle

  • Measure Bundle v2.6 includes updated patients. Measure Bundle v2.6 will be the only option available to the Cypress user for testing

Defects To Be Addressed

Jira Issues

Test Deck Issues

  • Issue #487: Results added to Functional Status Assessments
  • Issue #231: Time precision caused calculation variation
  • Issue #196: Added necessary Cumulative Medication Duration information
  • Additional coverage added to CMS179

Cypress Enhancements

  • Increased level of detail in "Download Results" package
  • Fixed caching on Master Patient List
  • Descriptive error messages added to assist with file upload
  • Updated Ruby version 2.1.5 and Rails version 4.1.8
  • Added capability to regenerate cat I tests
  • Increased level of validation of supplemental information

Clean Install Recommended

  • Cypress 2.6 will require a fresh install of Cypress due to breaking changes in the QRDA Errata release. As a result of these QRDA changes, test results developed using Cypress 2.5.1 will no longer be valid in Cypress 2.6. Cypress 2.5.1 will be supported, and available for testing, for 90 days following the release of Cypress 2.6 to give vendors ample time to upgrade to the 2014 QRDA Errata IG and the v2.6 release of Cypress.

Cypress v2.5.1

Patch applied October 15th, 2014 to Build v2.5.0

Original Build v2.5.0 created 25th, 2014

Cypress v2.5.1: 2014 Measure Specs, Value Sets for 2014 Measure Specs, HL7 QRDA Errata IG for 2012, Cypress v2.5 Measure Bundle


Features Added

Support for the annual 2014 Eligible Hospital and Eligible Professional Clinical Quality Measure Update

  • Cypress v2.5 includes the updated specifications introduced for Eligible Hospital Measures in April 2014 and Eligible Professional Measures in July 2014 by the Centers for Medicare & Medicaid Services (CMS).

Cypress V2.5 Measure Bundle

  • Cypress v2.5 will provide support for the 2014 Annual Measure Updates only. Measure Bundle v2.5 includes the updated measures for both the Eligible Hospital CQMs and the Eligible Professional CQMs, along with an updated set of synthetic test patient records to test the updated measure set. Measure Bundle v2.5 will be the only option available to the Cypress user for testing.

Defects To Be Addressed

Jira Issues

Test Deck Issues

  • Issue #196: Additional information needed to perform cumulative medical duration calculation
  • Issue #231: Diagnosis of depression should be on a different date than depression screening
  • Issue #243: Change encounter in test deck from 1/1/12 to 1/2/12
  • Issue #248: Ensure units of measure are identical (mm3 vs. /mm3)
  • Issue #275: Change CMS146v1/NQF0002 from a patient based measure to an episode based measure
  • Issue #303: ICD10, ICD9 and SNOMED codes for pregnancy should be allowed
  • Issue #340: Fix use of inactive RxNorm code

Continued Support and Development

Support for Cypress V2.4.1 Continues for Certifying 2013 CQMs -

  • Vendors will continue to use Cypress v2.4.1, in order to provide them ample time to complete product certification for 2013 measures. Additional information will be provided in the future regarding the extension of that timeline. Authorized Testing Labs (ATLs) will continue to schedule certification testing for 2013 measures using Cypress v2.4.1 during this time. The MITRE Cypress team will continue to provide answers to questions about the operation and use of Cypress 2.4.1 through the Cypress Talk List and Cypress Jira Tracker. At this time, there are no plans to make bug fixes or enhancements to Cypress v2.4.1.

Cypress v2.4.1

Build created December 12th, 2013

Cypress v2.4.1: 2013 Measure Specs, Value Sets for 2013 Measure Specs, HL7 QRDA Errata IG for 2012, Cypress v2.4 Measure Bundle

Note: Demo Server for v2.4.1 will be retired on January 22, 2014.


Features Added

None identified at this time

Defects To Be Addressed

Jira Issues

  • Issue #178: Cypress reports error for family member value set OID in Diagnosis Family History Template
  • Issue #201: Risk Category Assessment Depression Screening Result Codes in QRDA Category 1
  • Issue #218: Cypress expects more data than we should provide
  • Issue #228: Cypress v2.4.0 is using outdated root IDs NQF 0338 CMS26 in QRDA Category 3 XML file
  • Issue #244: Problem status OID causes error in Cypress
  • Issue #259: Median calculation algorithm producing incorrect results
  • Issue #265: Cypress expects unnecessary ED encounter
  • Issue #272: Patient B, Eye_Adult missing attribute required to meet numerator for CMS167

Cypress v2.4.0

Build created September 5th, 2013


Features Added

  • Improved randomization of all Cypress patient records -

    • Cypress v2.4 will introduce the shifting of dates on patients added to the set of test data to improve randomization and further prevent gaming of the system.

Defects To Be Addressed

Jira Issues

Test Deck Issues

  • Diabetes_Peds B: Added new encounter to aid in code cross walk issue with NQF #0041 and if vendor is only using SNOMED codes (Cypress Jira Issue #143)
  • GP_Peds, A: Edited to reflect "Medication, Order" prior to "Medication, Active" (Talk List)
  • Stroke_Adult, B: "Decision to admit" concept moved to before end of ED visit (Cypress Jira Issue #187)
  • Cancer_Adult, B: PSA test units changed from ng/dL to ng/mL (Talk List and Cypress Jira Issue #192)
  • HIV_Peds A and HIV_Peds B: Added "mm3" units to lab result (Cypress Jira Issue #203)
  • CAP_Adult A and CAP_Adult B: Changed facility location from "ICU location" to "Non-ICU location" (Talk List)

Cypress v2.3.1

Build created July 19th, 2013


Features Added

Support the annual Eligible Professional clinical quality measure update -

  • Limiting HTML test files to clinical quality measure certifying data (aka "HTML Scoop and Filter") with the Cypress VM and Cypress AMI -

    • When testing with Cypress v2.3, the HTML view of the patient data will include data only for the clinical quality measures that are being tested and certified. No extraneous data will be present. There was an issue with the Cypress v2.3.0 release which included this feature in the software source code available from GitHub, but not in the Cypress virtual machine and the Amazon Machine Instance. This v2.3.1 release includes this feature in all distribution mechanisms for setting up Cypress (source code, VM, AMI).
    • 07-17-2013 Update: This feature was only incorporated in the software source code distribution of Cypress v2.3.0. The Cypress v2.3.0 VM and AMI did not include the integration of this feature. The Cypress v2.3.1 release is planned on July 19th to address this feature in both the Cypress VM and the Cypress AMI

Defects to be Addressed

None identified at this time

Cypress v2.3.0

Build created on July 11th, 2013


Features Added

Support the annual Eligible Professional clinical quality measure update -

  • Cypress v2.3 will include the updated specifications introduced in June by the Centers for Medicare & Medicaid Services. In addition, the Cypress test data was adjusted accordingly to meet basic testing and certification standards.

  • QRDA category I XML automated analysis -

    Cypress v2.3 will automate the content validation of the QRDA category I test (automatic structural validation will continue as normal in the Cypress software).

  • Additional clinical code validation -

    Cypress v2.3 will introduce the validation of code selection choices against clinical quality measure value sets.

  • Limiting HTML test files to clinical quality measure certifying data (aka "HTML Scoop and Filter") -

    • When testing with Cypress v2.3, the HTML view of the patient data will include data only for the clinical quality measures that are being tested and certified. No extraneous data will be present.
    • 07-17-2013 Update: This feature was only incorporated in the software source code distribution of Cypress v2.3.0. The Cypress v2.3.0 VM and AMI did not include the integration of this feature. A Cypress v2.3.1 release is planned on July 19th to address this feature in both the Cypress VM and the Cypress AMI
  • With the release of Cypress v2.3, users will be able to select the version of the measure that you want to use when you create tests in Cypress. You can do this if you install an older Cypress "bundle" for v2.1.1. You do not need to maintain older versions of the Cypress software to test January EP and EH measures. With the release of Cypress v2.3, the options to the Cypress user for testing, the January measures, the April EH updates, and the June EP updates is supported via:

    • Bundle v2.1.1 with the original versions of the EP and EH CQMs as of January 2013
    • Bundle v2.3.0 with the updated versions of BOTH the EH CQMs updates in April and EP CQM updates in July 2013

    As highlighted above, ATLs who need to testing EHR systems against older versions of the measures should download bundle v2.1.1 after setting up Cypress v2.3. Additionally, if users levering the Cypress virtual machine are testing both Cypress bundle v2.1.1 and Cypress bundle v2.3.0, we recommend increasing the memory allocated to your virtual machine, from the default of 1GB to 2GB.

    With the release of Cypress v2.3, the visual/manual checklist has been eliminated and has been replaced with automated software to fully grade the QRDA Category 1 XML to detect "false positives".

Defects Addressed

Cypress v2.2.0

Build created on April 26th, 2013


Features Added

Updated the Quality Measure Engine to support calculation of supplemental data elements

Updated the patient test data - see below

Updated the QRDA Category I language code

Updated the measure bundle with the annual release of Eligible Hospital measures on April 1, 2013

Updated the Value Sets based on requirements from latest measures

Updated the measure logic to latest implementation guidance for Denominator Exclusions, (are now left in the DENOM)

Removed the QRDA Cat I test patient generation and the ability to create QRDA Category I tests from the Add Test Wizard

Added the ability to Generate QRDA Category I tests from EP/EH calculations tests

Updated the generation of Category I tests based on individual measures

Updated QRDA Category I tests to accept a zip file of QRDA Cat I documents for testing

Added Multi File reporting views for QRDA Category I tests

Updated QRDA Cat I tests to test for patient names

Added initial check for too much data in Cat I tests

Removed QRDA Cat I measure specific schematron rules

Updated QRDA Category I schematron Rules to latest available from HL7 DSTU

Defects Addressed

Fixed issue related to start and end date processing of reporting period for exported Cat I documents

Updated Length of Stay calculations to fix bug related to LOS ≤ 24 hours

Fixed issue related to dates not being properly formatted in some portions of templates

  • 2.16.840.1.113883.10.20.24.3.40
  • 2.16.840.1.113883.10.20.24.3.46
  • 2.16.840.1.113883.10.20.24.3.62
  • Cypress Jira Issue 22 -

Fixed issue related to nullFlavored value elements not having an xsi:type, nullFlaovored values are now xsi:type="CD" in generic value template

Fixed issue with value element for values of string type being reported as xsi:type="INT", are now xsi:type="ST" in generic value template

Fixed issue related to stdc:dischargeCode being in the wrong location of template 2.16.840.1.113883.10.20.24.3.23

Fixed issue with routeCode having an invalid empty codeSystem attribute in generic _medication_details template

Fixed issue with targetSiteCode having an invalid empty codeSystem attribute for template 2.16.840.1.113883.10.20.24.3.7

Fixed issues related to effectiveTime being in the wrong location in template 2.16.840.1.113883.10.20.24.3.31

Removed extra text element from template 2.16.840.1.113883.10.20.24.3.46 Removed duplicated data entries from patient records

Fixed Episode of Care logic that incorrectly handled measures that had multiple potential episodes of care joined by a disjunction (effected measures 1365 and 0140)

Fixed alignment of the date/times in "Fields" column with "Time" column

Test Deck Updates

In Cypress 2.1 a bug was introduced in the processing order of Denominators and Exclusions, which has been resolved in this release. As a result of this modification the following changes have been observed in the measure population calculations.

NQF 0371:

  • A, CAP_ADULT - drops from the numerator and goes to the Exclusions

NQF 0372:

  • A, AMI_ADULT - drops from denominator and exclusions
  • B, AMI_ADULT - drops from denominator and exclusions
  • B, SCIP_ADULT - drops from denominator and exclusions
  • B, STROKE_ADULT - drops from denominator and exclusions
  • C, AMI_ADULT - drops from denominator and exclusions
  • C, VTE_ADULT - drops from denominator and exclusions
  • D, AMI_ADULT - drops from denominator and exclusions

Cholesterol Screening Risk (all populations):

  • B, Pregnancy_Adult - drops from denominator and exclusions

Fasting LDL Test (high risk and moderate risk):

  • B, Pregnancy_Adult - drops from denominator and exclusions

The following data element changes have been made to the EH patient test deck records:

  • AMI_ADULT A

    • Diagnostic Study, Result: Hospital Measures Ecg becomes Diagnostic Study, Result: Hospital Measures Ecg impression

    • Test result goes from "Hospital Measures-ST-segment elevation" to "Hospital Measures-Acute or Evolving Mi"
  • AMI_ADULT B

    • Diagnostic Study, Result: Hospital Measures Ecg becomes Diagnostic Study, Result: Hospital Measures Ecg impression

    • test result goes from "Hospital Measures-ST-segment elevation" to "Hospital Measures-Acute or Evolving Mi"

  • AMI_ADULT C

    • Diagnostic Study, Result: Hospital Measures Ecg becomes Diagnostic Study, Result: Hospital Measures Ecg impression

    • test result goes from "Hospital Measures-ST-segment elevation" to "Hospital Measures-Acute or Evolving Mi"

  • AMI_ADULT D

    • Diagnostic Study, Result: Hospital Measures Ecg becomes Diagnostic Study, Result: Hospital Measures Ecg impression

    • test result goes from "Hospital Measures-ST-segment elevation" to "Hospital Measures-Acute or Evolving Mi"

  • OB A

    • Diagnostic Study, Performed: Vte Diagnostic Test becomes Diagnostic Study, Result

  • OB B

    • Diagnostic Study, Performed: Vte Diagnostic Test becomes Diagnostic Study, Result

    • Diagnosis, Active: Normal Delivery And Other Indications For Care (Dropped from measure)

  • CAP_ADULT A

    • Encounter, Performed: ICU Admission or Transfer - end date shifted by 1 day to make length of stay > 1 day