Quality Measure Implementation Guide (STU5)
5.0.0-ballot - ballot United States of America flag

Quality Measure Implementation Guide (STU5), published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 5.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-measures/ and changes regularly. See the Directory of published versions

Resource Profile: CQFMMeasure - Detailed Descriptions

Active as of 2024-02-27

Definitions for the measure-cqfm resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Measure
Must Supportfalse
2. Measure.meta
Control1..1
Must Supporttrue
4. Measure.meta.profile
Control1..*
Must Supporttrue
Requirements

A measure must declare its profile.

6. Measure.extension:comment
Slice Namecomment
Control0..*
TypeExtension(CQFM Artifact Comment) (Complex Extension)
Must Supporttrue
8. Measure.extension:softwaresystem
Slice Namesoftwaresystem
Control0..*
TypeExtension(CQFM Software System) (Extension Type: Reference(CQFM Device))
Must Supporttrue
10. Measure.library
ShortCQFMMeasures are not required to use a Library, but if they do, it SHALL be a CQFMLibrary.
Control0..1
This element is affected by the following invariants: cqm-2
Typecanonical(CQFM Library)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Requirements

A computable measure MUST provide one primary library reference containing population criteria definitions for the measure.

Invariantscqm-2: Measures utilizing CQL SHALL reference one and only one CQL library (and that referenced library MUST be the primary library for the measure) (exists())
12. Measure.type
BindingUnless not suitable, these codes SHALL be taken from MeasureType
(extensible to http://terminology.hl7.org/ValueSet/measure-type
Must Supporttrue
Requirements

A measure must indicate the type of the measure.

14. Measure.group
Must Supporttrue
16. Measure.group.id
Must Supporttrue
Invariantscqm-3: Group identifiers SHOULD use the convention: "group-[group number]", where [group number] corresponds with the group naming convention for the criteria within the group (startsWith('group-'))
18. Measure.group.population
Control0..*
Must Supporttrue
Requirements

A measure must specify at least one population or composite calculation for each population group.

20. Measure.group.population.id
Control1..1
Must Supporttrue
Requirements

A measure must specify at least one population or composite calculation for each population group.

22. Measure.group.population.code
Control1..1
BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationType
(extensible to http://terminology.hl7.org/ValueSet/measure-population
Must Supporttrue
Requirements

A measure must specify the type of population criteria.

24. Measure.group.population.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.

ShortThe criteria that defines this population. The alternativeExpression extension may be used to provide alternative formulations of the expression
Control1..1
Must Supporttrue
Invariantscqm-4: Group population criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
26. Measure.group.stratifier
Must Supporttrue
Requirements

A measure should provide stratification information if appropriate for the measure content.

28. Measure.group.stratifier.id
Control1..1
Must Supporttrue
Requirements

A measure should provide stratification information if appropriate for the measure content.

30. Measure.group.stratifier.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.

ShortHow the measure should be stratified. The alternativeExpression extension may be used to provide alternative formulations of the expression
Control1..1
Must Supporttrue
Invariantscqm-5: Group stratifier criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
32. Measure.supplementalData
Must Supporttrue
Requirements

A measure should provide supplemental data appropriate for the measure content.

34. Measure.supplementalData.id
Control1..1
Must Supporttrue
Requirements

A measure should provide supplemental data appropriate for the measure content.

36. Measure.supplementalData.extension:includeInReportType
Slice NameincludeInReportType
Control0..*
TypeExtension(CQFM Include In Report Type) (Extension Type: code)
38. Measure.supplementalData.code
BindingThe codes SHOULD be taken from MeasureSupplementalData
(preferred to http://terminology.hl7.org/ValueSet/measure-supplemental-data
Must Supporttrue
40. Measure.supplementalData.usage
BindingThe codes SHOULD be taken from MeasureDataUsage
(preferred to http://terminology.hl7.org/ValueSet/measure-data-usage

Guidance on how to interpret the contents of this table can be found here

0. Measure
Definition

The Measure resource provides the definition of a quality measure.

ShortA quality measure definition
Control10..1*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
mea-1: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
mea-1: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
2. Measure.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control10..1
TypeMeta
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Measure.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles this resource claims to conform to
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control10..*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

A measure must declare its profile.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Measure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Measure.extension:comment
Slice Namecomment
Definition

A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.

ShortAdditional documentation, review, or usage guidance
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Artifact Comment) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. Measure.extension:softwaresystem
Slice Namesoftwaresystem
Definition

Specifies the software systems used in the packaging and testing of measure and library resources. Specifically to know which version of what software was used.

ShortExtension
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Software System) (Extension Type: Reference(CQFM Device))
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. Measure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. Measure.url
Definition

An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers.

ShortCanonical identifier for this measure, represented as a URI (globally unique)
Comments

Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.


Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the measure to be referenced by a single globally unique identifier.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Measure.identifier
Definition

A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.

ShortAdditional identifier for the measure
Comments

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Measure.version
Definition

The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.

ShortBusiness version of the measure
Comments

There may be different measure instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the measure with the format [url]|[version].

NoteThis is a business versionId, not a resource version id (see discussion)
Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Measure.name
Definition

A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.

ShortName for this measure (computer friendly)
Comments

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Control10..1
This element is affected by the following invariants: inv-0
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Support human navigation and code generation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Measure.title
Definition

A short, descriptive, user-friendly title for the measure.

ShortName for this measure (human friendly)
Comments

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Measure.status
Definition

The status of this measure. Enables tracking the life-cycle of the content.

Shortdraft | active | retired | unknown
Comments

Allows filtering of measures that are appropriate for use versus not.

Control1..1
BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1
(required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1
Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Measure.experimental
Definition

A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.

ShortFor testing purposes, not real usage
Comments

Allows filtering of measures that are appropriate for use versus not.

Control10..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Measure.date
Definition

The date (and optionally time) when the measure was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.

ShortDate last changed
Comments

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

Control0..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Alternate NamesRevision Date
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Measure.publisher
Definition

The name of the organization or individual that published the measure.

ShortName of the publisher (organization or individual)
Comments

Usually an organization but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Helps establish the "authority/credibility" of the measure. May also allow for contact.

Alternate Namessteward
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. Measure.contact
Definition

Contact details to assist a user in finding and communicating with the publisher.

ShortContact details for the publisher
Comments

May be a web site, an email address, a telephone number, etc.

Control0..*
TypeContactDetail
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. Measure.description
Definition

A free text natural language description of the measure from a consumer's perspective.

ShortNatural language description of the measure
Comments

This description can be used to capture details such as why the measure was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the measure is presumed to be the predominant language in the place the measure was created).

Control10..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate Namesscope
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Measure.useContext
Definition

The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.

ShortThe context that the content is intended to support
Comments

When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Control0..*
TypeUsageContext
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Assist in searching for appropriate content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Measure.jurisdiction
Definition

A legal or geographic region in which the measure is intended to be used.

ShortIntended jurisdiction for measure (if applicable)
Comments

It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.

Control0..*
BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSethttp://hl7.org/fhir/ValueSet/jurisdiction
(extensible to http://hl7.org/fhir/ValueSet/jurisdiction
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. Measure.library
Definition

A reference to a Library resource containing the formal logic used by the measure.

ShortCQFMMeasures are not required to use a Library, but if they do, it SHALL be a CQFMLibrary.Logic used by the measure
Control0..1*
This element is affected by the following invariants: cqm-2
Typecanonical(CQFM Library, Library)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summaryfalse
Requirements

A computable measure MUST provide one primary library reference containing population criteria definitions for the measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-2: Measures utilizing CQL SHALL reference one and only one CQL library (and that referenced library MUST be the primary library for the measure) (exists())
42. Measure.type
Definition

Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

Shortprocess | outcome | structure | patient-reported-outcome | composite
Control0..*
BindingUnless not suitable, these codes SHALL be taken from MeasureTypehttp://hl7.org/fhir/ValueSet/measure-type
(extensible to http://terminology.hl7.org/ValueSet/measure-type
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

A measure must indicate the type of the measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. Measure.group
Definition

A group of population criteria for the measure.

ShortPopulation criteria group
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. Measure.group.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
This element is affected by the following invariants: cqm-3
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Invariantscqm-3: Group identifiers SHOULD use the convention: "group-[group number]", where [group number] corresponds with the group naming convention for the criteria within the group (startsWith('group-'))
48. Measure.group.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
50. Measure.group.population
Definition

A population criteria for the measure.

ShortPopulation criteria
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure must specify at least one population or composite calculation for each population group.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. Measure.group.population.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control10..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure must specify at least one population or composite calculation for each population group.

54. Measure.group.population.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
56. Measure.group.population.code
Definition

The type of population criteria.

Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Control10..1
BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population
(extensible to http://terminology.hl7.org/ValueSet/measure-population
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure must specify the type of population criteria.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Measure.group.population.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.


An expression that specifies the criteria for the population, typically the name of an expression in a library.

ShortThe criteria that defines this population. The alternativeExpression extension may be used to provide alternative formulations of the expression
Comments

In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.

Control1..1
TypeExpression
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-4: Group population criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
60. Measure.group.stratifier
Definition

The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

ShortStratifier criteria for the measure
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure should provide stratification information if appropriate for the measure content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. Measure.group.stratifier.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control10..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure should provide stratification information if appropriate for the measure content.

64. Measure.group.stratifier.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
66. Measure.group.stratifier.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.


An expression that specifies the criteria for the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.

ShortHow the measure should be stratified. The alternativeExpression extension may be used to provide alternative formulations of the expression
Control10..1
TypeExpression
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-5: Group stratifier criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
68. Measure.supplementalData
Definition

The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

ShortWhat other data should be reported with the measure
Comments

Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.

Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure should provide supplemental data appropriate for the measure content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. Measure.supplementalData.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control10..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure should provide supplemental data appropriate for the measure content.

72. Measure.supplementalData.extension:includeInReportType
Slice NameincludeInReportType
Definition

Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types.

ShortThe type of report the element should be included in
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Include In Report Type) (Extension Type: code)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
74. Measure.supplementalData.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.


Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
76. Measure.supplementalData.code
Definition

Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.

ShortMeaning of the supplemental data
Control0..1
BindingThe codes SHOULD be taken from For codes, see MeasureSupplementalData
(preferred to http://terminology.hl7.org/ValueSet/measure-supplemental-data
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. Measure.supplementalData.usage
Definition

An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

Shortsupplemental-data | risk-adjustment-factor
Control0..*
BindingThe codes SHOULD be taken from Unless not suitable, these codes SHALL be taken from MeasureDataUsagehttp://hl7.org/fhir/ValueSet/measure-data-usage
(preferred to http://terminology.hl7.org/ValueSet/measure-data-usage
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. Measure.supplementalData.criteria
Definition

The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.

ShortExpression describing additional data to be reported
Control1..1
TypeExpression
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here

0. Measure
Definition

The Measure resource provides the definition of a quality measure.

ShortA quality measure definition
Control1..1
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
mea-1: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
2. Measure.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

ShortLogical id of this artifact
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

Control0..1
Typeid
Is Modifierfalse
Summarytrue
4. Measure.meta
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

ShortMetadata about the resource
Control1..1
TypeMeta
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. Measure.meta.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
8. Measure.meta.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Measure.meta.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
10. Measure.meta.versionId
Definition

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

ShortVersion specific identifier
Comments

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

Control0..1
Typeid
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Measure.meta.lastUpdated
Definition

When the resource last changed - e.g. when the version changed.

ShortWhen the resource version last changed
Comments

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

Control0..1
Typeinstant
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Measure.meta.source
Definition

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

ShortIdentifies where the resource comes from
Comments

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

Control0..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Measure.meta.profile
Definition

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

ShortProfiles this resource claims to conform to
Comments

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Control1..*
Typecanonical(StructureDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

A measure must declare its profile.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Measure.meta.security
Definition

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

ShortSecurity Labels applied to this resource
Comments

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Control0..*
BindingUnless not suitable, these codes SHALL be taken from All Security Labels
(extensible to http://hl7.org/fhir/ValueSet/security-labels
TypeCoding
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Measure.meta.tag
Definition

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

ShortTags applied to this resource
Comments

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Control0..*
BindingFor example codes, see CommonTags
(example to http://hl7.org/fhir/ValueSet/common-tags
TypeCoding
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Measure.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Measure.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages
(preferred to http://hl7.org/fhir/ValueSet/languages
Typecode
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Measure.text
Definition

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

ShortText summary of the resource, for human interpretation
Comments

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Control0..1
TypeNarrative
Is Modifierfalse
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Measure.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control0..*
TypeResource
Is Modifierfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
30. Measure.extension
Definition

An Extension

ShortExtension
Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Measure.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
32. Measure.extension:comment
Slice Namecomment
Definition

A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.

ShortAdditional documentation, review, or usage guidance
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Artifact Comment) (Complex Extension)
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
34. Measure.extension:softwaresystem
Slice Namesoftwaresystem
Definition

Specifies the software systems used in the packaging and testing of measure and library resources. Specifically to know which version of what software was used.

ShortExtension
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Software System) (Extension Type: Reference(CQFM Device))
Is Modifierfalse
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
36. Measure.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
38. Measure.url
Definition

An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers.

ShortCanonical identifier for this measure, represented as a URI (globally unique)
Comments

Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

Control1..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the measure to be referenced by a single globally unique identifier.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. Measure.identifier
Definition

A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.

ShortAdditional identifier for the measure
Comments

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. Measure.version
Definition

The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.

ShortBusiness version of the measure
Comments

There may be different measure instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the measure with the format [url]|[version].

NoteThis is a business versionId, not a resource version id (see discussion)
Control1..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. Measure.name
Definition

A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.

ShortName for this measure (computer friendly)
Comments

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Control1..1
This element is affected by the following invariants: inv-0
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Support human navigation and code generation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. Measure.title
Definition

A short, descriptive, user-friendly title for the measure.

ShortName for this measure (human friendly)
Comments

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. Measure.subtitle
Definition

An explanatory or alternate title for the measure giving additional information about its content.

ShortSubordinate title of the measure
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. Measure.status
Definition

The status of this measure. Enables tracking the life-cycle of the content.

Shortdraft | active | retired | unknown
Comments

Allows filtering of measures that are appropriate for use versus not.

Control1..1
BindingThe codes SHALL be taken from PublicationStatus
(required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1
Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. Measure.experimental
Definition

A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.

ShortFor testing purposes, not real usage
Comments

Allows filtering of measures that are appropriate for use versus not.

Control1..1
Typeboolean
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. Measure.subject[x]
Definition

The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anything.

ShortE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Comments

The subject of the measure is critical in interpreting the criteria definitions, as the logic in the measures is evaluated with respect to a particular subject. This corresponds roughly to the notion of a Compartment in that it limits what content is available based on its relationship to the subject. In CQL, this corresponds to the context declaration.

Control0..1
BindingUnless not suitable, these codes SHALL be taken from SubjectType
(extensible to http://hl7.org/fhir/ValueSet/subject-type
TypeChoice of: CodeableConcept, Reference(Group)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Meaning if MissingPatient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. Measure.date
Definition

The date (and optionally time) when the measure was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.

ShortDate last changed
Comments

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

Control0..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Alternate NamesRevision Date
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Measure.publisher
Definition

The name of the organization or individual that published the measure.

ShortName of the publisher (organization or individual)
Comments

Usually an organization but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.

Control1..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Helps establish the "authority/credibility" of the measure. May also allow for contact.

Alternate Namessteward
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. Measure.contact
Definition

Contact details to assist a user in finding and communicating with the publisher.

ShortContact details for the publisher
Comments

May be a web site, an email address, a telephone number, etc.

Control0..*
TypeContactDetail
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. Measure.description
Definition

A free text natural language description of the measure from a consumer's perspective.

ShortNatural language description of the measure
Comments

This description can be used to capture details such as why the measure was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the measure is presumed to be the predominant language in the place the measure was created).

Control1..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Alternate Namesscope
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. Measure.useContext
Definition

The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.

ShortThe context that the content is intended to support
Comments

When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Control0..*
TypeUsageContext
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Assist in searching for appropriate content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. Measure.jurisdiction
Definition

A legal or geographic region in which the measure is intended to be used.

ShortIntended jurisdiction for measure (if applicable)
Comments

It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.

Control0..*
BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSet
(extensible to http://hl7.org/fhir/ValueSet/jurisdiction
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. Measure.purpose
Definition

Explanation of why this measure is needed and why it has been designed as it has.

ShortWhy this measure is defined
Comments

This element does not describe the usage of the measure. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this measure.

Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. Measure.usage
Definition

A detailed description, from a clinical perspective, of how the measure is used.

ShortDescribes the clinical usage of the measure
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
72. Measure.copyright
Definition

A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.

ShortUse and/or publishing restrictions
Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Consumers must be able to determine any legal restrictions on the use of the measure and/or its content.

Alternate NamesLicense, Restrictions
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
74. Measure.approvalDate
Definition

The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

ShortWhen the measure was approved by publisher
Comments

The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

Control0..1
Typedate
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. Measure.lastReviewDate
Definition

The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

ShortWhen the measure was last reviewed
Comments

If specified, this date follows the original approval date.

Control0..1
Typedate
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. Measure.effectivePeriod
Definition

The period during which the measure content was or is planned to be in active use.

ShortWhen the measure is expected to be used
Comments

The effective period for a measure determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

Control0..1
TypePeriod
Is Modifierfalse
Summarytrue
Requirements

Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the measure are or are expected to be used instead.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. Measure.topic
Definition

Descriptive topics related to the content of the measure. Topics provide a high-level categorization grouping types of measures that can be useful for filtering and searching.

ShortThe category of the measure, such as Education, Treatment, Assessment, etc.
Control0..*
BindingFor example codes, see DefinitionTopic
(example to http://hl7.org/fhir/ValueSet/definition-topic
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Repositories must be able to determine how to categorize the measure so that it can be found by topical searches.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. Measure.author
Definition

An individiual or organization primarily involved in the creation and maintenance of the content.

ShortWho authored the content
Control0..*
TypeContactDetail
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. Measure.editor
Definition

An individual or organization primarily responsible for internal coherence of the content.

ShortWho edited the content
Control0..*
TypeContactDetail
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
86. Measure.reviewer
Definition

An individual or organization primarily responsible for review of some aspect of the content.

ShortWho reviewed the content
Control0..*
TypeContactDetail
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
88. Measure.endorser
Definition

An individual or organization responsible for officially endorsing the content for use in some setting.

ShortWho endorsed the content
Control0..*
TypeContactDetail
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. Measure.relatedArtifact
Definition

Related artifacts such as additional documentation, justification, or bibliographic references.

ShortAdditional documentation, citations, etc.
Comments

Each related artifact is either an attachment, or a reference to another resource, but not both.

Control0..*
TypeRelatedArtifact
Is Modifierfalse
Summaryfalse
Requirements

Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
92. Measure.library
Definition

A reference to a Library resource containing the formal logic used by the measure.

ShortCQFMMeasures are not required to use a Library, but if they do, it SHALL be a CQFMLibrary.
Control0..1
This element is affected by the following invariants: cqm-2
Typecanonical(CQFM Library)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summaryfalse
Requirements

A computable measure MUST provide one primary library reference containing population criteria definitions for the measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-2: Measures utilizing CQL SHALL reference one and only one CQL library (and that referenced library MUST be the primary library for the measure) (exists())
94. Measure.disclaimer
Definition

Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.

ShortDisclaimer for use of the measure or its referenced content
Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Some organizations require that notices and disclosures be included when publishing measures that reference their intellecutal property.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. Measure.scoring
Definition

Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

Shortproportion | ratio | continuous-variable | cohort
Control0..1
BindingUnless not suitable, these codes SHALL be taken from MeasureScoring
(extensible to http://hl7.org/fhir/ValueSet/measure-scoring
TypeCodeableConcept
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. Measure.compositeScoring
Definition

If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

Shortopportunity | all-or-nothing | linear | weighted
Control0..1
BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoring
(extensible to http://hl7.org/fhir/ValueSet/composite-measure-scoring
TypeCodeableConcept
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. Measure.type
Definition

Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

Shortprocess | outcome | structure | patient-reported-outcome | composite
Control0..*
BindingUnless not suitable, these codes SHALL be taken from MeasureType
(extensible to http://terminology.hl7.org/ValueSet/measure-type
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

A measure must indicate the type of the measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
102. Measure.riskAdjustment
Definition

A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

ShortHow risk adjustment is applied for this measure
Comments

Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
104. Measure.rateAggregation
Definition

Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

ShortHow is rate aggregation performed for this measure
Comments

The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. Measure.rationale
Definition

Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.

ShortDetailed description of why the measure exists
Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Measure developers need to be able to provide a detailed description of the purpose of the measure. This element provides detailed rationale, where the purpose element provides a summary of the rationale.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
108. Measure.clinicalRecommendationStatement
Definition

Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.

ShortSummary of clinical guidelines
Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
110. Measure.improvementNotation
Definition

Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

Shortincrease | decrease
Control0..1
BindingThe codes SHALL be taken from MeasureImprovementNotation
(required to http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Measure consumers and implementers must be able to determine how to interpret a measure score.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
112. Measure.definition
Definition

Provides a description of an individual term used within the measure.

ShortDefined terms used in the measure documentation
Control0..*
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
114. Measure.guidance
Definition

Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.

ShortAdditional guidance for implementers
Control0..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the population criteria of the measure. This element provides detailed guidance, where the usage element provides a summary of the guidance.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
116. Measure.group
Definition

A group of population criteria for the measure.

ShortPopulation criteria group
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. Measure.group.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
This element is affected by the following invariants: cqm-3
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Invariantscqm-3: Group identifiers SHOULD use the convention: "group-[group number]", where [group number] corresponds with the group naming convention for the criteria within the group (startsWith('group-'))
120. Measure.group.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
122. Measure.group.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
124. Measure.group.code
Definition

Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measures.

ShortMeaning of the group
Control0..1
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
126. Measure.group.description
Definition

The human readable description of this population group.

ShortSummary description
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
128. Measure.group.population
Definition

A population criteria for the measure.

ShortPopulation criteria
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure must specify at least one population or composite calculation for each population group.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
130. Measure.group.population.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control1..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure must specify at least one population or composite calculation for each population group.

132. Measure.group.population.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
134. Measure.group.population.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
136. Measure.group.population.code
Definition

The type of population criteria.

Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Control1..1
BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationType
(extensible to http://terminology.hl7.org/ValueSet/measure-population
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure must specify the type of population criteria.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
138. Measure.group.population.description
Definition

The human readable description of this population criteria.

ShortThe human readable description of this population criteria
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
140. Measure.group.population.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.

ShortThe criteria that defines this population. The alternativeExpression extension may be used to provide alternative formulations of the expression
Comments

In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.

Control1..1
TypeExpression
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-4: Group population criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
142. Measure.group.stratifier
Definition

The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

ShortStratifier criteria for the measure
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure should provide stratification information if appropriate for the measure content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
144. Measure.group.stratifier.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control1..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure should provide stratification information if appropriate for the measure content.

146. Measure.group.stratifier.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
148. Measure.group.stratifier.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
150. Measure.group.stratifier.code
Definition

Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

ShortMeaning of the stratifier
Control0..1
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
152. Measure.group.stratifier.description
Definition

The human readable description of this stratifier criteria.

ShortThe human readable description of this stratifier
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
154. Measure.group.stratifier.criteria
Definition

The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria. The alternativeExpression extension may be used to provide alternative formulations of the expression but the expressions must yield the same count for the population.

ShortHow the measure should be stratified. The alternativeExpression extension may be used to provide alternative formulations of the expression
Control1..1
TypeExpression
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
cqm-5: Group stratifier criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace. (expression.contains('.').not())
156. Measure.group.stratifier.component
Definition

A component of the stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

ShortStratifier criteria component for the measure
Comments

Stratifiers are defined either as a single criteria, or as a set of component criteria.

Control0..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
158. Measure.group.stratifier.component.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control0..1
Typestring
Is Modifierfalse
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
160. Measure.group.stratifier.component.extension
Definition

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
162. Measure.group.stratifier.component.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
164. Measure.group.stratifier.component.code
Definition

Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

ShortMeaning of the stratifier component
Control0..1
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
166. Measure.group.stratifier.component.description
Definition

The human readable description of this stratifier criteria component.

ShortThe human readable description of this stratifier component
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
168. Measure.group.stratifier.component.criteria
Definition

An expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.

ShortComponent of how the measure should be stratified
Control1..1
TypeExpression
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
170. Measure.supplementalData
Definition

The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

ShortWhat other data should be reported with the measure
Comments

Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.

Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

A measure should provide supplemental data appropriate for the measure content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
172. Measure.supplementalData.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

ShortUnique id for inter-element referencing
Control1..1
Typestring
Is Modifierfalse
Must Supporttrue
XML FormatIn the XML format, this property is represented as an attribute.
Summaryfalse
Requirements

A measure should provide supplemental data appropriate for the measure content.

174. Measure.supplementalData.extension
Definition

An Extension

ShortExtension
Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Measure.supplementalData.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
176. Measure.supplementalData.extension:includeInReportType
Slice NameincludeInReportType
Definition

Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types.

ShortThe type of report the element should be included in
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Include In Report Type) (Extension Type: code)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
178. Measure.supplementalData.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored even if unrecognized
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content, modifiers
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
180. Measure.supplementalData.code
Definition

Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.

ShortMeaning of the supplemental data
Control0..1
BindingThe codes SHOULD be taken from MeasureSupplementalData
(preferred to http://terminology.hl7.org/ValueSet/measure-supplemental-data
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
182. Measure.supplementalData.usage
Definition

An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

Shortsupplemental-data | risk-adjustment-factor
Control0..*
BindingThe codes SHOULD be taken from MeasureDataUsage
(preferred to http://terminology.hl7.org/ValueSet/measure-data-usage
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
184. Measure.supplementalData.description
Definition

The human readable description of this supplemental data.

ShortThe human readable description of this supplemental data
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
186. Measure.supplementalData.criteria
Definition

The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.

ShortExpression describing additional data to be reported
Control1..1
TypeExpression
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))