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Clinical Quality Information Work GroupMaturity Level: 2 Trial Use Compartments: Not linked to any defined compartments

Detailed Descriptions for the elements in the Measure resource.

Measure
Definition

The Measure resource provides the definition of a quality measure.

Control1..1
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. This SHOULD be globally unique, and SHOULD be a literal address at which this measure is (or will be) published.

Control0..1
Typeuri
Requirements

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

Summarytrue
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 URL SHOULD include the major version of the measure. For more information see Technical and Business Versions.

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.

NoteThis is a business identifer, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Requirements

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

Summarytrue
Comments

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

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.

NoteThis is a business versionId, not a resource version id (see discussion)
Control0..1
Typestring
Summarytrue
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].

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.

Control0..1
Typestring
Requirements

Support human navigation and code generation.

Summarytrue
Comments

The name is not expected to be globally unique. The name should be a simple alpha-numeric type name to ensure that it is computable friendly.

Measure.title
Definition

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

Control0..1
Typestring
Summarytrue
Comments

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

Measure.status
Definition

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

Control1..1
Terminology BindingPublicationStatus (Required)
Typecode
Is Modifiertrue (Reason: null)
Summarytrue
Comments

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

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.

Control0..1
Typeboolean
Is Modifiertrue (Reason: null)
Requirements

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

Summarytrue
Comments

Allows filtering of measure that are appropriate for use vs. not.

Measure.date
Definition

The date (and optionally time) when the measure was published. The date must change if and 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.

Control0..1
TypedateTime
Alternate NamesRevision Date
Summarytrue
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.

Measure.publisher
Definition

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

Control0..1
Typestring
Requirements

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

Summarytrue
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.

Measure.description
Definition

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

Control0..1
Typemarkdown
Summarytrue
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 profile is presumed to be the predominant language in the place the profile was created).

Measure.purpose
Definition

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

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Typemarkdown
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.

Measure.usage
Definition

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

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Typestring
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.

Control0..1
Typedate
Comments

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

Measure.lastReviewDate
Definition

The date on which the resource content was last reviewed. Review happens periodically after approval, but doesn't change the original approval date.

Control0..1
Typedate
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.

Comments

If specified, this is usually after the approval date.

Measure.effectivePeriod
Definition

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

Control0..1
TypePeriod
Requirements

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

Summarytrue
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.

Measure.useContext
Definition

The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching for appropriate measure instances.

Control0..*
TypeUsageContext
Requirements

Assist in searching for appropriate content.

Summarytrue
Comments

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

Measure.jurisdiction
Definition

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

Control0..*
Terminology BindingJurisdiction ValueSet (Extensible)
TypeCodeableConcept
Summarytrue
Comments

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

Measure.subject
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.

Control0..1
Terminology BindingSubjectType (Extensible)
TypeCodeableConcept
Meaning if MissingPatient
Summarytrue
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.

Measure.topic
Definition

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

Control0..*
Terminology BindingDefinitionTopic (Example)
TypeCodeableConcept
Requirements

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

Measure.contributor
Definition

A contributor to the content of the measure, including authors, editors, reviewers, and endorsers.

Control0..*
TypeContributor
Requirements

Consumers of the content must be able to quickly determine who contributed to the content of the measure.

Measure.contact
Definition

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

Control0..*
TypeContactDetail
Summarytrue
Comments

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

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.

Control0..1
Typemarkdown
Requirements

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

Alternate NamesLicense; Restrictions
Measure.relatedArtifact
Definition

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

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TypeRelatedArtifact
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.

Comments

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

Measure.library
Definition

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

Control0..*
TypeReference(Library)
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.

Control0..1
Typemarkdown
Requirements

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

Summarytrue
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.

Control0..1
Terminology BindingMeasureScoring (Extensible)
TypeCodeableConcept
Summarytrue
Measure.compositeScoring
Definition

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

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Terminology BindingCompositeMeasureScoring (Extensible)
TypeCodeableConcept
Summarytrue
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.

Control0..*
Terminology BindingMeasureType (Extensible)
TypeCodeableConcept
Summarytrue
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.

Control0..1
Typestring
Summarytrue
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 an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.

Measure.rateAggregation
Definition

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

Control0..1
Typestring
Summarytrue
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).

Measure.rationale
Definition

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

Control0..1
Typemarkdown
Summarytrue
Measure.clinicalRecommendationStatement
Definition

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

Control0..1
Typemarkdown
Summarytrue
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 whthin a range).

Control0..1
Typestring
Requirements

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

Summarytrue
Measure.definition
Definition

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

Control0..*
Typemarkdown
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.

Summarytrue
Measure.guidance
Definition

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

Control0..1
Typemarkdown
Requirements

Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the logic of the measure.

Summarytrue
Measure.set
Definition

The measure set, e.g. Preventive Care and Screening.

Control0..1
Typestring
Summarytrue
Measure.group
Definition

A group of population criteria for the measure.

Control0..*
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.

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TypeCodeableConcept
Measure.group.description
Definition

The human readable description of this population group.

Control0..1
Typestring
Measure.group.population
Definition

A population criteria for the measure.

Control0..*
Measure.group.population.code
Definition

The type of population criteria.

Control0..1
Terminology BindingMeasurePopulationType (Extensible)
TypeCodeableConcept
Measure.group.population.description
Definition

The human readable description of this population criteria.

Control0..1
Typestring
Measure.group.population.criteria
Definition

The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria.

Control1..1
Typestring
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.

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.

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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.

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TypeCodeableConcept
Measure.group.stratifier.description
Definition

The human readable description of this stratifier criteria.

Control0..1
Typestring
Measure.group.stratifier.criteria
Definition

The criteria for the stratifier. This must be the name of an expression defined within a referenced library.

Control0..1
Typestring
Measure.group.stratifier.path
Definition

The path to an element that defines the stratifier, specified as a valid FHIR resource path.

Control0..1
Typestring
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.

Control0..*
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.

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.

Control0..1
TypeCodeableConcept
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.

Control0..*
Terminology BindingMeasureDataUsage (Extensible)
TypeCodeableConcept
Measure.supplementalData.description
Definition

The human readable description of this supplemental data.

Control0..1
Typestring
Measure.supplementalData.criteria
Definition

The criteria for the supplemental data. This must be the name of a valid expression defined within a referenced library, and defines the data to be returned for this element.

Control0..1
Typestring
Measure.supplementalData.path
Definition

The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Path.

Control0..1
Typestring