Situational Awareness for Novel Epidemic Response
1.0.1 - STU Release

Situational Awareness for Novel Epidemic Response, published by HL7 International Public Health Workgroup. This is not an authorized publication; it is the continuous build for version 1.0.1). This version is based on the current content of https://github.com/HL7/fhir-saner/ and changes regularly. See the Directory of published versions

Resource Profile: Public Health Measure

Defining URL:http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasure
Version:1.0.1
Name:PublicHealthMeasure
Title:Public Health Measure
Status:Draft as of 12/7/21, 8:30 PM
Definition:

Profile Public Health Measure The Public Health Measure Profile ensures that Measures are very well defined as an aid to automation of measures. These are developed for this guide to ensure that a measure is well understood and computation of it can be automated from systems that have the measure data.

Publisher:HL7 International Public Health Workgroup
Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasure

This Implementation Guide defines a profile for Measure to be used for Public Health reporting for Situational Awareness, rather than Quality Reporting. The measures using this profile are intended to support reporting about the health system capacity to provide adequate care for patients during a health system emergency, whether it is regional, national or global. In this, the purpose and function of situational awareness measures have a different focus and intent than those used for quality reporting.

Describing and Identifying a Measure

Each measure has a Title, the name by which it is commonly known by people, and by which it can be readily found in an information system. Titles should not be overly long (to enable recall by people), but should be descriptive enough to distinguish different measures published by the same organization. A subtitle may be present to provide additional descriptive detail.

  1. Measure.title should be less than 64 characters in length.
  2. Measure.subtitle may be present.

Software Component Name

Computer friendly names enable developers to create software tools that facilitate measure implementation and automation. This profile recommends transforming the title into a name by removing spaces and special characters (any character other than A-Z, a-z and 0-9), using PascalCase to seperate boundaries between words. This allows the name to be used in most computing languages and as the id for the resource in systems where user defined identifiers are supported for id values.

  1. Measure.name shall be present.
  2. Measure.name should match the pattern [A-Z][A-Za-z0-9]+.
  3. Measure.id should be equal to Measure.name.

Canonical URL

The canonical URL is a unique identifier which represents the Measure within MeasureReport resources defined by that Measure. Tooling for FHIR (e.g., the FHIR IG Publisher, SUSHI, Simplifier) follows a protocol for automatically constructing these URLs. This guide makes several recommendations for URLs used by a publisher. The example below is used to illustrate the recommendations

 https:\//example.com/saner/covid19/Measure/MyMeasureName
  1. All Measure URLs for measures published by the same organization should have the same base URL. The Base URL part should be memorable. In the example above, https:\//example.com/saner is the base URL.
  2. The base URL should be less than 40 characters in length.
  3. The penultimate path part of the URL may be used to categorize measures in some way, e.g., by topic (e.g., COVID-19, Hurricane) or type of facility (e.g., Hospital, Ambulatory, LTC) to which they apply. In the example above, covid19 is the category. This category should also be encoded in Measure.useContext (see Classifying Measures below).
  4. The last path part in the URL should be Measure. Following this recomendation simplifies the use of FHIR IG Development tools to generate Measure resources. In the example above, the last path part is Measure.
  5. The computable name given in the Measure should be the last part of the URL. Again, this simplifies measure development using existing FHIR IG Development tools. In the example above, MyMeasureName is the name of the measure.
  6. The URL should resolve to an HTML page that describes the measure, or provides access to it as a FHIR Resource and ideally, would return HTML, XML or JSON representations based on the requested mime type.

Versioning

Measures can change over time. This guide requires that the Measure version information recorded be performed as follows:

  1. A measure shall do one of the following:
    • be recorded in the form defined by Semantic Versioning, e.g.: version 1.2.3 is the third patch to the second minor update of the first major release, or
    • be recorded by date using ISO 8601 format with hyphens and no time component, e.g.: 2020-07-25 for the measure released on July 25, 2020.
  2. If versions can be updated more frequently than by day, a publisher shall use semantic versioning.

The use of semantic versioning is preferred because this is the form required in FHIR implementation guides, and it enables support for versioning of measures using FHIR Implementation Guide tools. This is also the format for versioning that has been the most widely adopted by the IT industry.

Meanings of Major, Minor and Patch with respect to Measures
Major
A major update adds one or more required elements to the Measure that shall be present in a MeasureReport to be considered valid by the receiving system. The definition of valid is defined by the measure developer, and need not be the same as that performed by FHIR validation tools. The FHIR Validator will fail a MeasureReport that does not include all the groups, populations and strata defined in the Measure, even though these components might otherwise be considered optional by the measure developer.
Minor
A minor update adds one or more recommended or optional elements to the Measure.
Patch
A patch can clarify or correct information that does not impact the interpretation of the measure.

Status of a Measure

This profile requires that the publication status of a measure be reported (this is a general requirement of all Measure resources), and furthermore, that it’s experimental status shall also be reported.

The usage of status values is described below:
draft
The measure is presently under development. Measures presently under development shall also be recorded as being experimental.
active
The measure is ready for, or being used, either in pilots or production. The experimental status for the measure shall be used to distinguish between measures that are being piloted (experimental=true) or in production (experimental=false).
retired
The measure should no longer be used in production. Measures which are retired before ever becoming active in production shall have experimental=true, while those which have been available for production use shall have experimental=false.

Measures which have been used in the past should remain available for access for use when data has been used in production to enable systems to interpret historical data recorded using the measure.

The Subject of Measurement

In quality measurement, the subject of a measure in FHIR describes to whom or what the measure applies. For situational awareness, this guide restricts the subject of measurement to locations, representing a specific facility, site within a facility, or a broader geographic region (which can be defined as a collection of facilities within that geographic region). These measures can also be used by an organization to manage sites and facilities based on other organizing criteria, but are generally intended to support geographic rather than organizational boundaries.

  1. Measure.subjectCodeableConcept shall have the value http://hl7.org/fhir/resource-types#Location

Classifying Measures

Measures can be classified in different ways, e.g., by clinical venue, program, type of healthcare provider, et cetera.

In the following: shall indicates a required binding for the vocabulary, and should indicates a preferred binding.

Measures Focused on a Particular Disease

  1. Measures focusing on a particular disease shall record that focus in Measure.useContext, where:
    Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#focus](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-focus)
    and
  2. Measure.useContext.valueCodableConcept is an appropriate code from a vocabulary identifying the disease of interest. It should come from SNOMED CT codes descending from 64572001 Disease (disorder).

Measures Focused on a Particular Kind of Event

  1. Measures focusing on a particular kind of event (e.g., Pandemic, Hurricane, Fire, Flood) shall record their focus in Measure.useContext, where:
    Measure.useContext.code = http://snomed.info/sct#272379006 Event
    and
  2. Measure.useContext.valueCodableConcept should come from SNOMED CT Codes descending from 276746005 Environmental Event to classify the type of event. See Event Context for the Value Set for this classification.

Measures Focused on a Particular Specialty

  1. Measures focusing on a particular specialty shall record the specialty in Measure.useContext, where:
    Measure.useContext.code = http://terminology.hl7.org/CodeSystem/usage-context-type#user
    and
  2. Measure.useContext.valueCodableConcept shall be an appropriate code from a vocabulary identifying the provider specialty.
  3. The value should come from SNOMED CT terms descending from 394658006 Clinical Specialty.

Measures Focused on a Clinical Venue (e.g., hospital, long-term care, ambulatory care)

  1. Measures focused on a particular clinical venue shall record the type of venue in Measure.useContext, where
    Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#venue](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-venue)
    and
  2. Measure.useContext.valueCodableConcept shall be an appropriate code from a vocabulary identifying the venue (e.g., hospitals, pharmacies, long term care facilities).
  3. These codes should come from:
    • http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType OR
    • Terms descending from SNOMED CT 43741000 Environment

Measures from a Given Program

  1. Measures developed to support a given program (e.g., the CDC National Healthcare Safety Network) shall identify the program in Measure.useContext, where
    Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#program](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-program)
    and
  2. Measure.useContext.valueCodableConcept.text is a string identifying the program of work (e.g., the CDC National Healthcare Safety Network).

Measure Publication

A measure is published by some appropriate authority, for example a governmental agency focused on public health or emergency response, or an organization working with such a governmental agency. Measures for situational awareness are not expected to endure a ballot process, but will instead be created by authorities using a well established governance process. The reason for this is that as the emergent situation progresses, new measures will be needed as the situation changes, or existing measures may need to be updated to address issues found during use.

Measures are published by organizations rather than individuals. This profile requires that the organization be identified in Measure.publisher, and furthermore, that there is at least one organizational e-mail address which can be used to contact that publisher about the Measure in Measure.contact

Use of Appropriate National Models

Many countries have developed national healthcare information models in various states of completion. This IG requires the use of national core standards or guides to localize the PublicHealthMeasure to ensure a consistent data model for automation.

  1. A conforming PublicHealthMeasure shall specify a jurisdiction to enable support for validation against national requirements.
  2. A measure defined for international use may specify an international juristiction, or multiple jurisdictions where that is feasible.

Setting the Measure jurisdiction ensures that resources referenced by the Measure or MeasureReport conform to appropriate national standards.

Measure Reporting Period

A measure shall suggest the approrpriate reporting frequency and period using the [ReportingPeriod](StructureDefinition-ReportingPeriod.html] extension.

Measure Requirements

A measure may indicate the requirements for sending the content of a measure group, population or stratum within a MeasureReport by using the MeasureExpection extension on the Measure.group, Measure.group.population or Measure.group.stratifier element. The MeasureExpectation extension works like the Expectation extension on CapabilityStatement resources, but applies to the requirements for the content of a MeasureReport.

Stratifiers

Stratifiers partition a measure so that it counts subsets of the measure population within the numerator or other measure population by some attribute that classifies the population. Common stratifications often used in healthcare settings include age, sex at birth1 and race and ethnicity. Constraints on the Measure.group.stratifier component of a Measure and further describes the elements of that component to support strata.

Each stratifier has the following features:

name
The human readable name for the stratifier. This can be found in stratifier.code.coding.display
code
A code that uniquely identifies the stratifier (e.g., age, sex at birth, race, ethnicity). This can be found in stratifier.code.coding.code and stratifier.code.coding.system
  1. Codes used in this attribute should descend from SNOMED CT 363787002 Observable Entity
description
A description of the purpose of the stratifier, explaining what function it serves. This can be found in stratifier.code.text
value set
A list of values that describe the different categories into which counted elements are classified for stratification. Individual values in this value set can be found in stratifier.component.code and an explaination of their function appears in stratifier.component.description.
  1. Codes used in this attribute should descend from SNOMED CT 404684003 Clinical Finding
  1. Also commonly referred to as gender, but is then confused with self-reported gender identity, so this guide uses the term sex at birth. 

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Measure

Summary

Mandatory: 14 elements (16 nested mandatory elements)
Must-Support: 29 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Measure.subject[x] is sliced based on the value of type:$this

This structure is derived from Measure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure 0..*MeasureA quality measure definition
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ReportingPeriod S1..1TimingEnables specification of proposed measure reporting
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
... url S1..1uriEach resource must have a url.
... name S1..1stringEach resource must have a name.
... status 1..1codedraft | active | retired
Binding: Measure Status Values (required)
... experimental S1..1booleanA resource must indicate its experimental status
... Slices for subject[x] 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Slice: Unordered, Open by type:$this
... subjectCodeableConcept 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/resource-types
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: Location
... publisher S1..1stringThe name of the organization publishing this resource
... contact S1..*ContactDetailThe contact information for whom to contact about this resource
... useContext S1..*UsageContextThe ISO 3166 code for use context
... author S1..1ContactDetailThe original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
.... name S1..1stringThe author must be identified by name. Can be the name of an individual or an organization.
.... telecom S1..*ContactPointThere must be contact information for the author.
... relatedArtifact S1..*RelatedArtifactThere must be at least one artifact describing the measure in human readable form.
... library S1..*canonical(Public Health Measure Library)Logic used by the measure
... group S0..*BackboneElementPopulation criteria group
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... MeasureGroupAttributes S1..1(Complex)Describes the attributes of one or more sections of the measure (form) being reported
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
..... extension:scoring 0..1ExtensionExtension
...... value[x] 1..1CodeableConceptValue of extension
...... valueCodeableConcept S1..1CodeableConceptMeasure must have a scoring
..... extension:type 0..1ExtensionExtension
...... value[x] 1..1CodeableConceptValue of extension
...... valueCodeableConcept S1..1CodeableConceptValue of extension
..... extension:rateAggregation 0..1ExtensionExtension
...... valueString 0..1stringcount | point-in-time | cumulative
Binding: Measure Rate Aggregation Value Set (required)
..... extension:improvementNotation 0..1ExtensionExtension
...... valueCodeableConcept S0..1CodeableConceptValue of extension
Binding: MeasureImprovementNotation (required)
..... extension:subject 1..1ExtensionExtension
...... valueCodeableConcept 0..1CodeableConceptConcept - reference to a terminology or just text
.... population S0..*BackboneElementPopulation criteria
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
...... coding S1..*CodingThe coding gives a 'name' for this population and must be supplied
...... text 0..1stringA human readable description of what this population is
..... description S1..1stringHuman readable instructions for counting or measuring this population
..... criteria 1..1MeasureCriteriaAn expression that can be used to generate a value
.... stratifier S0..*BackboneElementA group may have none, some or many strata
..... code S1..1CodeableConceptDescribes the purpose of this stratifier
...... coding S0..*CodingOptional code uniquely identifying the strata
....... display S1..1stringProvides a human readable name for the strata
...... text S1..1stringDescribes the function of the stratifier.
..... description S1..1stringDescribes the overall function of the strata.
..... criteria S1..1MeasureCriteriaAn expression that can be used to generate a value
..... component 0..0
... supplementalData
.... code 1..1CodeableConceptResource type included in the supplementalData
Binding: ResourceType (extensible)
.... description 1..1stringThe human readable description of this supplemental data
.... criteria 1..1MeasureCriteriaAn expression that can be used to generate a value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure I0..*MeasureA quality measure definition
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ReportingPeriod S1..1TimingEnables specification of proposed measure reporting
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... url SΣ1..1uriEach resource must have a url.
... identifier Σ0..*IdentifierAdditional identifier for the measure
... version SΣ1..1stringResources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
... name SΣI1..1stringEach resource must have a name.
... title Σ0..1stringName for this measure (human friendly)
... subtitle 0..1stringSubordinate title of the measure
... status ?!Σ1..1codedraft | active | retired
Binding: Measure Status Values (required)
... experimental SΣ1..1booleanA resource must indicate its experimental status
... Slices for subject[x] 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Slice: Unordered, Closed by type:$this
Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).

.... subject[x]:subjectCodeableConcept 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).


Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/resource-types
...... version0..1stringVersion of the system - if relevant
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: Location
...... display0..1stringRepresentation defined by the system
...... userSelected0..1booleanIf this coding was chosen directly by the user
..... text0..1stringPlain text representation of the concept
... date Σ0..1dateTimeDate last changed
... publisher SΣ1..1stringThe name of the organization publishing this resource
... contact SΣ1..*ContactDetailThe contact information for whom to contact about this resource
... description Σ0..1markdownNatural language description of the measure
... useContext SΣ1..*UsageContextThe ISO 3166 code for use context
... jurisdiction Σ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.


... purpose 0..1markdownWhy this measure is defined
... usage 0..1stringDescribes the clinical usage of the measure
... copyright 0..1markdownUse and/or publishing restrictions
... approvalDate 0..1dateWhen the measure was approved by publisher
... lastReviewDate 0..1dateWhen the measure was last reviewed
... effectivePeriod Σ0..1PeriodWhen the measure is expected to be used
... topic 0..*CodeableConceptThe category of the measure, such as Education, Treatment, Assessment, etc.
Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.


... author S1..1ContactDetailThe original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... name SΣ1..1stringThe author must be identified by name. Can be the name of an individual or an organization.
.... telecom SΣ1..*ContactPointThere must be contact information for the author.
... editor 0..*ContactDetailWho edited the content
... reviewer 0..*ContactDetailWho reviewed the content
... endorser 0..*ContactDetailWho endorsed the content
... relatedArtifact S1..*RelatedArtifactThere must be at least one artifact describing the measure in human readable form.
... library S1..*canonical(Public Health Measure Library)Logic used by the measure
... disclaimer Σ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring (extensible): The scoring type of the measure.

... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.

... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).


... riskAdjustment Σ0..1stringHow risk adjustment is applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownDetailed description of why the measure exists
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... definition Σ0..*markdownDefined terms used in the measure documentation
... guidance Σ0..1markdownAdditional guidance for implementers
... group S0..*BackboneElementPopulation criteria group
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... MeasureGroupAttributes S1..1(Complex)Describes the attributes of one or more sections of the measure (form) being reported
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... extension:scoring S0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"scoring"
...... Slices for value[x] 1..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S1..1CodeableConceptMeasure must have a scoring
Binding: MeasureScoring (required)
..... extension:compositeScoring 0..1ExtensionLike Measure.compositeScoring, but applies to group
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"compositeScoring"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept 0..1CodeableConceptValue of extension
Binding: CompositeMeasureScoring (extensible)
..... extension:type S0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"type"
...... Slices for value[x] 1..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S1..1CodeableConceptValue of extension
Binding: MeasureType (required)
..... extension:riskAdjustment 0..1ExtensionLike Measure.riskAdjustment, but applies to group
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"riskAdjustment"
...... value[x] 0..1stringValue of extension
..... extension:rateAggregation 0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"rateAggregation"
...... value[x] 0..1stringcount | point-in-time | cumulative
Binding: Measure Rate Aggregation Value Set (required)
..... extension:improvementNotation 0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"improvementNotation"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S0..1CodeableConceptValue of extension
Binding: MeasureImprovementNotation (required)
..... extension:subject S1..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"subject"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept 0..1CodeableConceptConcept - reference to a terminology or just text
Binding: ResourceType (extensible)
..... extension:subjectValueSet S0..1ExtensionIdentifies the ValueSet describing the subject elements to count based on a code.
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"subjectValueSet"
...... value[x] 0..1Reference(ValueSet)Value of extension
..... url 1..1uri"http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes"
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 0..1CodeableConceptMeaning of the group
.... description 0..1stringSummary description
.... population S0..*BackboneElementPopulation criteria
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population.

...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..*CodingThe coding gives a 'name' for this population and must be supplied
...... text Σ0..1stringA human readable description of what this population is
..... description S1..1stringHuman readable instructions for counting or measuring this population
..... criteria I1..1MeasureCriteriaAn expression that can be used to generate a value
.... stratifier S0..*BackboneElementA group may have none, some or many strata
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code S1..1CodeableConceptDescribes the purpose of this stratifier
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ0..*CodingOptional code uniquely identifying the strata
....... id 0..1stringUnique id for inter-element referencing
....... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ0..1codeSymbol in syntax defined by the system
....... display SΣ1..1stringProvides a human readable name for the strata
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text SΣ1..1stringDescribes the function of the stratifier.
..... description S1..1stringDescribes the overall function of the strata.
..... criteria SI1..1MeasureCriteriaAn expression that can be used to generate a value
... supplementalData 0..*BackboneElementWhat other data should be reported with the measure
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1CodeableConceptResource type included in the supplementalData
Binding: ResourceType (extensible)
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.


.... description 1..1stringThe human readable description of this supplemental data
.... criteria I1..1MeasureCriteriaAn expression that can be used to generate a value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure I0..*MeasureA quality measure definition
... ReportingPeriod 1..1TimingEnables specification of proposed measure reporting
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
... url Σ1..1uriEach resource must have a url.
... version Σ1..1stringResources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
... experimental Σ1..1booleanA resource must indicate its experimental status
... publisher Σ1..1stringThe name of the organization publishing this resource
... contact Σ1..*ContactDetailThe contact information for whom to contact about this resource
... useContext Σ1..*UsageContextThe ISO 3166 code for use context
... author 1..1ContactDetailThe original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
.... name Σ1..1stringThe author must be identified by name. Can be the name of an individual or an organization.
.... telecom Σ1..*ContactPointThere must be contact information for the author.
... relatedArtifact 1..*RelatedArtifactThere must be at least one artifact describing the measure in human readable form.
... library 1..*canonical(Public Health Measure Library)Logic used by the measure
... group 0..*BackboneElementPopulation criteria group
.... MeasureGroupAttributes 1..1(Complex)Describes the attributes of one or more sections of the measure (form) being reported
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
..... extension:scoring 0..1ExtensionExtension
...... value[x]:valueCodeableConcept 1..1CodeableConceptMeasure must have a scoring
Binding: MeasureScoring (required)
..... extension:type 0..1ExtensionExtension
...... value[x]:valueCodeableConcept 1..1CodeableConceptValue of extension
Binding: MeasureType (required)
..... extension:improvementNotation 0..1ExtensionExtension
...... value[x]:valueCodeableConcept 0..1CodeableConceptValue of extension
Binding: MeasureImprovementNotation (required)
..... extension:subject 1..1ExtensionExtension
..... extension:subjectValueSet 0..1ExtensionIdentifies the ValueSet describing the subject elements to count based on a code.
.... population 0..*BackboneElementPopulation criteria
..... code 1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population.

...... coding Σ1..*CodingThe coding gives a 'name' for this population and must be supplied
..... description 1..1stringHuman readable instructions for counting or measuring this population
.... stratifier 0..*BackboneElementA group may have none, some or many strata
..... code 1..1CodeableConceptDescribes the purpose of this stratifier
...... coding Σ0..*CodingOptional code uniquely identifying the strata
....... display Σ1..1stringProvides a human readable name for the strata
...... text Σ1..1stringDescribes the function of the stratifier.
..... description 1..1stringDescribes the overall function of the strata.
..... criteria I1..1MeasureCriteriaAn expression that can be used to generate a value

doco Documentation for this format

This structure is derived from Measure

Summary

Mandatory: 14 elements (16 nested mandatory elements)
Must-Support: 29 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Slices

This structure defines the following Slices:

  • The element Measure.subject[x] is sliced based on the value of type:$this

Differential View

This structure is derived from Measure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure 0..*MeasureA quality measure definition
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ReportingPeriod S1..1TimingEnables specification of proposed measure reporting
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
... url S1..1uriEach resource must have a url.
... name S1..1stringEach resource must have a name.
... status 1..1codedraft | active | retired
Binding: Measure Status Values (required)
... experimental S1..1booleanA resource must indicate its experimental status
... Slices for subject[x] 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Slice: Unordered, Open by type:$this
... subjectCodeableConcept 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Required Pattern: At least the following
.... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
..... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/resource-types
..... code1..1codeSymbol in syntax defined by the system
Fixed Value: Location
... publisher S1..1stringThe name of the organization publishing this resource
... contact S1..*ContactDetailThe contact information for whom to contact about this resource
... useContext S1..*UsageContextThe ISO 3166 code for use context
... author S1..1ContactDetailThe original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
.... name S1..1stringThe author must be identified by name. Can be the name of an individual or an organization.
.... telecom S1..*ContactPointThere must be contact information for the author.
... relatedArtifact S1..*RelatedArtifactThere must be at least one artifact describing the measure in human readable form.
... library S1..*canonical(Public Health Measure Library)Logic used by the measure
... group S0..*BackboneElementPopulation criteria group
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... MeasureGroupAttributes S1..1(Complex)Describes the attributes of one or more sections of the measure (form) being reported
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
..... extension:scoring 0..1ExtensionExtension
...... value[x] 1..1CodeableConceptValue of extension
...... valueCodeableConcept S1..1CodeableConceptMeasure must have a scoring
..... extension:type 0..1ExtensionExtension
...... value[x] 1..1CodeableConceptValue of extension
...... valueCodeableConcept S1..1CodeableConceptValue of extension
..... extension:rateAggregation 0..1ExtensionExtension
...... valueString 0..1stringcount | point-in-time | cumulative
Binding: Measure Rate Aggregation Value Set (required)
..... extension:improvementNotation 0..1ExtensionExtension
...... valueCodeableConcept S0..1CodeableConceptValue of extension
Binding: MeasureImprovementNotation (required)
..... extension:subject 1..1ExtensionExtension
...... valueCodeableConcept 0..1CodeableConceptConcept - reference to a terminology or just text
.... population S0..*BackboneElementPopulation criteria
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
...... coding S1..*CodingThe coding gives a 'name' for this population and must be supplied
...... text 0..1stringA human readable description of what this population is
..... description S1..1stringHuman readable instructions for counting or measuring this population
..... criteria 1..1MeasureCriteriaAn expression that can be used to generate a value
.... stratifier S0..*BackboneElementA group may have none, some or many strata
..... code S1..1CodeableConceptDescribes the purpose of this stratifier
...... coding S0..*CodingOptional code uniquely identifying the strata
....... display S1..1stringProvides a human readable name for the strata
...... text S1..1stringDescribes the function of the stratifier.
..... description S1..1stringDescribes the overall function of the strata.
..... criteria S1..1MeasureCriteriaAn expression that can be used to generate a value
..... component 0..0
... supplementalData
.... code 1..1CodeableConceptResource type included in the supplementalData
Binding: ResourceType (extensible)
.... description 1..1stringThe human readable description of this supplemental data
.... criteria 1..1MeasureCriteriaAn expression that can be used to generate a value

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure I0..*MeasureA quality measure definition
... id Σ0..1stringLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: CommonLanguages (preferred)
Max Binding: AllLanguages: A human language.

... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
... ReportingPeriod S1..1TimingEnables specification of proposed measure reporting
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... url SΣ1..1uriEach resource must have a url.
... identifier Σ0..*IdentifierAdditional identifier for the measure
... version SΣ1..1stringResources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
... name SΣI1..1stringEach resource must have a name.
... title Σ0..1stringName for this measure (human friendly)
... subtitle 0..1stringSubordinate title of the measure
... status ?!Σ1..1codedraft | active | retired
Binding: Measure Status Values (required)
... experimental SΣ1..1booleanA resource must indicate its experimental status
... Slices for subject[x] 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Slice: Unordered, Closed by type:$this
Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).

.... subject[x]:subjectCodeableConcept 0..1CodeableConceptE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).


Required Pattern: At least the following
..... id0..1stringUnique id for inter-element referencing
..... extension0..*ExtensionAdditional content defined by implementations
..... coding1..*CodingCode defined by a terminology system
Fixed Value: (complex)
...... id0..1stringUnique id for inter-element referencing
...... extension0..*ExtensionAdditional content defined by implementations
...... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/resource-types
...... version0..1stringVersion of the system - if relevant
...... code1..1codeSymbol in syntax defined by the system
Fixed Value: Location
...... display0..1stringRepresentation defined by the system
...... userSelected0..1booleanIf this coding was chosen directly by the user
..... text0..1stringPlain text representation of the concept
... date Σ0..1dateTimeDate last changed
... publisher SΣ1..1stringThe name of the organization publishing this resource
... contact SΣ1..*ContactDetailThe contact information for whom to contact about this resource
... description Σ0..1markdownNatural language description of the measure
... useContext SΣ1..*UsageContextThe ISO 3166 code for use context
... jurisdiction Σ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.


... purpose 0..1markdownWhy this measure is defined
... usage 0..1stringDescribes the clinical usage of the measure
... copyright 0..1markdownUse and/or publishing restrictions
... approvalDate 0..1dateWhen the measure was approved by publisher
... lastReviewDate 0..1dateWhen the measure was last reviewed
... effectivePeriod Σ0..1PeriodWhen the measure is expected to be used
... topic 0..*CodeableConceptThe category of the measure, such as Education, Treatment, Assessment, etc.
Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.


... author S1..1ContactDetailThe original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
.... name SΣ1..1stringThe author must be identified by name. Can be the name of an individual or an organization.
.... telecom SΣ1..*ContactPointThere must be contact information for the author.
... editor 0..*ContactDetailWho edited the content
... reviewer 0..*ContactDetailWho reviewed the content
... endorser 0..*ContactDetailWho endorsed the content
... relatedArtifact S1..*RelatedArtifactThere must be at least one artifact describing the measure in human readable form.
... library S1..*canonical(Public Health Measure Library)Logic used by the measure
... disclaimer Σ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring (extensible): The scoring type of the measure.

... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.

... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).


... riskAdjustment Σ0..1stringHow risk adjustment is applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownDetailed description of why the measure exists
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation Σ0..1CodeableConceptincrease | decrease
Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

... definition Σ0..*markdownDefined terms used in the measure documentation
... guidance Σ0..1markdownAdditional guidance for implementers
... group S0..*BackboneElementPopulation criteria group
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
.... MeasureGroupAttributes S1..1(Complex)Describes the attributes of one or more sections of the measure (form) being reported
URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
..... id 0..1stringUnique id for inter-element referencing
..... Slices for extension 1..*ExtensionExtension
Slice: Unordered, Open by value:url
..... extension:scoring S0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"scoring"
...... Slices for value[x] 1..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S1..1CodeableConceptMeasure must have a scoring
Binding: MeasureScoring (required)
..... extension:compositeScoring 0..1ExtensionLike Measure.compositeScoring, but applies to group
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"compositeScoring"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept 0..1CodeableConceptValue of extension
Binding: CompositeMeasureScoring (extensible)
..... extension:type S0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"type"
...... Slices for value[x] 1..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S1..1CodeableConceptValue of extension
Binding: MeasureType (required)
..... extension:riskAdjustment 0..1ExtensionLike Measure.riskAdjustment, but applies to group
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"riskAdjustment"
...... value[x] 0..1stringValue of extension
..... extension:rateAggregation 0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"rateAggregation"
...... value[x] 0..1stringcount | point-in-time | cumulative
Binding: Measure Rate Aggregation Value Set (required)
..... extension:improvementNotation 0..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"improvementNotation"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept S0..1CodeableConceptValue of extension
Binding: MeasureImprovementNotation (required)
..... extension:subject S1..1ExtensionExtension
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"subject"
...... Slices for value[x] 0..1CodeableConceptValue of extension
Slice: Unordered, Closed by type:$this
....... value[x]:valueCodeableConcept 0..1CodeableConceptConcept - reference to a terminology or just text
Binding: ResourceType (extensible)
..... extension:subjectValueSet S0..1ExtensionIdentifies the ValueSet describing the subject elements to count based on a code.
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..0
...... url 1..1uri"subjectValueSet"
...... value[x] 0..1Reference(ValueSet)Value of extension
..... url 1..1uri"http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes"
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 0..1CodeableConceptMeaning of the group
.... description 0..1stringSummary description
.... population S0..*BackboneElementPopulation criteria
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible): The type of population.

...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ1..*CodingThe coding gives a 'name' for this population and must be supplied
...... text Σ0..1stringA human readable description of what this population is
..... description S1..1stringHuman readable instructions for counting or measuring this population
..... criteria I1..1MeasureCriteriaAn expression that can be used to generate a value
.... stratifier S0..*BackboneElementA group may have none, some or many strata
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
..... code S1..1CodeableConceptDescribes the purpose of this stratifier
...... id 0..1stringUnique id for inter-element referencing
...... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
...... coding SΣ0..*CodingOptional code uniquely identifying the strata
....... id 0..1stringUnique id for inter-element referencing
....... Slices for extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ0..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ0..1codeSymbol in syntax defined by the system
....... display SΣ1..1stringProvides a human readable name for the strata
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text SΣ1..1stringDescribes the function of the stratifier.
..... description S1..1stringDescribes the overall function of the strata.
..... criteria SI1..1MeasureCriteriaAn expression that can be used to generate a value
... supplementalData 0..*BackboneElementWhat other data should be reported with the measure
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..*ExtensionAdditional content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored even if unrecognized
.... code 1..1CodeableConceptResource type included in the supplementalData
Binding: ResourceType (extensible)
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.


.... description 1..1stringThe human readable description of this supplemental data
.... criteria I1..1MeasureCriteriaAn expression that can be used to generate a value

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet / Code
Measure.languagepreferredCommonLanguages
Max Binding: AllLanguages
Measure.statusrequiredMeasureStatus
Measure.subject[x]extensibleSubjectType
Measure.subject[x]:subjectCodeableConceptextensiblePattern: Location
Measure.jurisdictionextensible