The measure developer uses the continuing evaluation process to make any changes to the specifications to demonstrate 

• The aspects of care included in the specifications continue to be highly important to measure and report because the measurement results can supply meaningful information to individuals and measured entities.
• The measurement results continue to drive significant improvements in health care quality and health outcomes where there is variation in and/or overall, less-than-optimal performance.
• The data elements, codes, and parameters included in the specifications are the best ones to use to quantify the specific measure because they most accurately and clearly target the aspects of the measure that are important to collect and report, and they do not place undue burden on resources in order to collect the data.
• The calculation methods included in the specifications remain valid because they reflect a clear and accurate representation of the variation in the quality or efficiency of the care delivered or the variation in the health outcome of interest.
• The measure continues to be either unique for its topic or it is the “best in class” when compared with competing measures.
• The measure is comparable with other measures in its clinical significance or difficulty.