Quality Measure Implementation Guide
6.0.0-ballot - ballot United States of America flag

Quality Measure Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 6.0.0-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: CQFMComputableMeasure - Detailed Descriptions

Active as of 2024-12-04

Definitions for the computable-measure-cqfm resource profile.

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

0. Measure
Must Supporttrue
Invariantscmp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue())
cmp-2: Scoring must either be specified at the root, or on each group (scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue()))
cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists())
cmp-4: Improvement notation must be specified for scoring types other than cohort ((scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort')))
cmp-5: If type is specified at the root, it may not be specified on any group (type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse())
cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group (riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse())
cmp-7: If rateAggregation is specified at the root, it may not be specified on any group (rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse())
2. Measure.extension:populationBasis
Slice NamepopulationBasis
Control0..1
This element is affected by the following invariants: cmp-1
TypeExtension(CQFM Population Basis) (Extension Type: code)
Must Supporttrue
4. Measure.extension:scoringUnit
Slice NamescoringUnit
Control0..1
This element is affected by the following invariants: cmp-3
TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
Must Supporttrue
6. Measure.extension:effectiveDataRequirements
Slice NameeffectiveDataRequirements
Control0..1
TypeExtension(CRMI Effective Data Requirements) (Extension Type: canonical(CRMI Module Definition Library))
Must Supporttrue
8. Measure.extension:scoringPrecision
Slice NamescoringPrecision
Control0..1
TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
10. 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 Subject Type Value Set
(extensible to http://hl7.org/fhir/uv/cqfmeasures/ValueSet/subject-type)
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Must Supporttrue
12. Measure.library
Control0..1
Typecanonical(CRMI Computable Library)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
14. Measure.scoring
BindingUnless not suitable, these codes SHALL be taken from Measure Scoring
(extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
Must Supporttrue
16. Measure.type
Must Supporttrue
18. Measure.riskAdjustment
Must Supportfalse
20. Measure.rateAggregation
Must Supportfalse
22. Measure.improvementNotation
BindingThe codes SHALL be taken from MeasureImprovementNotation
(required to http://terminology.hl7.org/ValueSet/measure-improvement-notation)
Must Supporttrue
24. Measure.group
Must Supporttrue
Invariantscmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists())
cmp-9: Improvement notation must be specified for scoring types other than cohort (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())
26. Measure.group.extension:populationBasis
Slice NamepopulationBasis
Control0..1
This element is affected by the following invariants: cmp-1
TypeExtension(CQFM Population Basis) (Extension Type: code)
Must Supporttrue
28. Measure.group.extension:scoring
Slice Namescoring
Control0..1
This element is affected by the following invariants: cmp-2, cmp-8, cmp-9
TypeExtension(CQFM Scoring) (Extension Type: CodeableConcept)
Must Supporttrue
30. Measure.group.extension:scoringUnit
Slice NamescoringUnit
Control0..1
This element is affected by the following invariants: cmp-8
TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
Must Supporttrue
32. Measure.group.extension:scoringPrecision
Slice NamescoringPrecision
Control0..1
TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
34. Measure.group.extension:compositeScoring
Slice NamecompositeScoring
Control0..1
TypeExtension(CQFM Composite Scoring) (Extension Type: CodeableConcept)
Must Supporttrue
36. Measure.group.extension:component
Slice Namecomponent
Control0..*
TypeExtension(CQFM Component) (Extension Type: RelatedArtifact)
Must Supporttrue
38. Measure.group.extension:type
Slice Nametype
Control0..*
This element is affected by the following invariants: cmp-5
TypeExtension(CQFM Type) (Extension Type: CodeableConcept)
Must Supportfalse
40. Measure.group.extension:riskAdjustment
Slice NameriskAdjustment
Control0..1
This element is affected by the following invariants: cmp-6
TypeExtension(CQFM Risk Adjustment) (Extension Type: string)
Must Supportfalse
42. Measure.group.extension:rateAggregation
Slice NamerateAggregation
Control0..1
This element is affected by the following invariants: cmp-7
TypeExtension(CQFM Rate Aggregation) (Extension Type: string)
Must Supportfalse
44. Measure.group.extension:improvementNotation
Slice NameimprovementNotation
Control0..1
This element is affected by the following invariants: cmp-9
TypeExtension(CQFM Improvement Notation) (Extension Type: CodeableConcept)
Must Supporttrue
46. Measure.group.code
Must Supporttrue
48. Measure.group.description
Must Supporttrue
50. Measure.group.population
Must Supporttrue
52. Measure.group.population.code
Must Supporttrue
54. Measure.group.population.description
Must Supporttrue
56. Measure.group.stratifier
Must Supporttrue
58. Measure.group.stratifier.extension:appliesTo
Slice NameappliesTo
Control0..*
TypeExtension(CQFM Applies To) (Extension Type: CodeableConcept)
Must Supportfalse
60. Measure.group.stratifier.code
Must Supporttrue
62. Measure.group.stratifier.description
Must Supporttrue
64. Measure.group.stratifier.component
Must Supporttrue
66. Measure.group.stratifier.component.code
Must Supporttrue
68. Measure.group.stratifier.component.description
Must Supporttrue
70. Measure.supplementalData
Must Supporttrue
72. Measure.supplementalData.code
Must Supporttrue
74. Measure.supplementalData.usage
Must Supporttrue
76. Measure.supplementalData.description
Must Supporttrue

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
Control0..*
Is Modifierfalse
Must Supporttrue
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()))
cmp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue())
cmp-2: Scoring must either be specified at the root, or on each group (scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue()))
cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists())
cmp-4: Improvement notation must be specified for scoring types other than cohort ((scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort')))
cmp-5: If type is specified at the root, it may not be specified on any group (type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse())
cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group (riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse())
cmp-7: If rateAggregation is specified at the root, it may not be specified on any group (rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse())
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.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()))
4. Measure.extension:populationBasis
Slice NamepopulationBasis
Definition

The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

ShortWhat type of population
Comments

In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

Control0..1
This element is affected by the following invariants: ele-1, cmp-1
TypeExtension(CQFM Population Basis) (Extension Type: code)
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())
6. Measure.extension:scoringUnit
Slice NamescoringUnit
Definition

Defines the expected units of measure for the measure score.

ShortWhat units?
Control0..1
This element is affected by the following invariants: ele-1, cmp-3
TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
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())
8. Measure.extension:effectiveDataRequirements
Slice NameeffectiveDataRequirements
Definition

A module definition library that contains the effective data requirements for the artifact (i.e. the calculated data requirements for the expressions referenced by the artifact structure).

ShortEffective required data for evaluation
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(CRMI Effective Data Requirements) (Extension Type: canonical(CRMI Module Definition Library))
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())
10. Measure.extension:scoringPrecision
Slice NamescoringPrecision
Definition

Defines the precision of the measure score when it is a decimal value.

ShortNumber of decimal places
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
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())
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.

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.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)

The lifecycle status of an artifact.

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()))
16. 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 Subject Type Value Sethttp://hl7.org/fhir/ValueSet/subject-type
(extensible to http://hl7.org/fhir/uv/cqfmeasures/ValueSet/subject-type)
TypeChoice of: CodeableConcept, Reference(Group)
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Meaning if MissingPatient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Measure.library
Definition

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

ShortLogic used by the measure
Control0..1*
Typecanonical(CRMI Computable Library, Library)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. 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
This element is affected by the following invariants: cmp-2, cmp-3, cmp-4
BindingUnless not suitable, these codes SHALL be taken from Measure Scoringhttp://hl7.org/fhir/ValueSet/measure-scoring
(extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. 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..*
This element is affected by the following invariants: cmp-5
BindingUnless not suitable, these codes SHALL be taken from MeasureTypehttp://hl7.org/fhir/ValueSet/measure-type
(extensible to http://hl7.org/fhir/ValueSet/measure-type)

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. 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
This element is affected by the following invariants: cmp-6
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. 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
This element is affected by the following invariants: cmp-7
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. 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
This element is affected by the following invariants: cmp-4
BindingThe codes SHALL be taken from MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
(required to http://terminology.hl7.org/ValueSet/measure-improvement-notation)
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
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()))
30. 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()))
cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists())
cmp-9: Improvement notation must be specified for scoring types other than cohort (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())
32. Measure.group.extension:populationBasis
Slice NamepopulationBasis
Definition

The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

ShortWhat type of population
Comments

In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

Control0..1
This element is affected by the following invariants: ele-1, cmp-1
TypeExtension(CQFM Population Basis) (Extension Type: code)
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())
34. Measure.group.extension:scoring
Slice Namescoring
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. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

Shortproportion | ratio | continuous-variable | cohort
Control0..1
This element is affected by the following invariants: ele-1, cmp-2, cmp-8, cmp-9
TypeExtension(CQFM Scoring) (Extension Type: CodeableConcept)
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())
36. Measure.group.extension:scoringUnit
Slice NamescoringUnit
Definition

Defines the expected units of measure for the measure score.

ShortWhat units?
Control0..1
This element is affected by the following invariants: ele-1, cmp-8
TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
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())
38. Measure.group.extension:scoringPrecision
Slice NamescoringPrecision
Definition

Defines the precision of the measure score when it is a decimal value.

ShortNumber of decimal places
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
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())
40. Measure.group.extension:compositeScoring
Slice NamecompositeScoring
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. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

Shortproportion | ratio | continuous-variable | cohort
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Composite Scoring) (Extension Type: CodeableConcept)
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())
42. Measure.group.extension:component
Slice Namecomponent
Definition

Specifies an artifact this is a component of a composite artifact.

ShortWhat artifact
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Component) (Extension Type: RelatedArtifact)
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())
44. Measure.group.extension:type
Slice Nametype
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
Control0..*
This element is affected by the following invariants: ele-1, cmp-5
TypeExtension(CQFM Type) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
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())
46. Measure.group.extension:riskAdjustment
Slice NameriskAdjustment
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
This element is affected by the following invariants: ele-1, cmp-6
TypeExtension(CQFM Risk Adjustment) (Extension Type: string)
Is Modifierfalse
Must Supportfalse
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())
48. Measure.group.extension:rateAggregation
Slice NamerateAggregation
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
This element is affected by the following invariants: ele-1, cmp-7
TypeExtension(CQFM Rate Aggregation) (Extension Type: string)
Is Modifierfalse
Must Supportfalse
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())
50. Measure.group.extension:improvementNotation
Slice NameimprovementNotation
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
This element is affected by the following invariants: ele-1, cmp-9
TypeExtension(CQFM Improvement Notation) (Extension Type: CodeableConcept)
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())
52. 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())
54. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
58. Measure.group.population
Definition

A population criteria for the measure.

ShortPopulation criteria
Control0..*
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
60. 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())
62. 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
Control0..1
BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population
(extensible to http://hl7.org/fhir/ValueSet/measure-population)

The type of population.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. Measure.group.population.criteria
Definition

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

ShortThe criteria that defines this population
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
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. 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
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
70. Measure.group.stratifier.extension:appliesTo
Slice NameappliesTo
Definition

Indicates the population that this stratifier should apply to. If no appliesTo extension is present, the stratifier is calculated based on the result of the population calculation (e.g. the calculated numerator for a proportion scoring).

ShortWhich population does this stratifier apply to?
Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(CQFM Applies To) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
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())
72. 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())
74. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. 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())
82. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
86. 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()))
88. 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
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. 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())
92. 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
TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. 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..*
BindingUnless not suitable, these codes SHALL be taken from MeasureDataUsagehttp://hl7.org/fhir/ValueSet/measure-data-usage
(extensible to http://hl7.org/fhir/ValueSet/measure-data-usage)

The intended usage for supplemental data elements in the measure.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. 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
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. 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
Control0..*
Is Modifierfalse
Must Supporttrue
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()))
cmp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue())
cmp-2: Scoring must either be specified at the root, or on each group (scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue()))
cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists())
cmp-4: Improvement notation must be specified for scoring types other than cohort ((scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort')))
cmp-5: If type is specified at the root, it may not be specified on any group (type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse())
cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group (riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse())
cmp-7: If rateAggregation is specified at the root, it may not be specified on any group (rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse())
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
Control0..1
TypeMeta
Is Modifierfalse
Summarytrue
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.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)

A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
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()))
10. 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()))
12. 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
14. 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 areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 16. Measure.extension:populationBasis
    Slice NamepopulationBasis
    Definition

    The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

    ShortWhat type of population
    Comments

    In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

    Control0..1
    This element is affected by the following invariants: ele-1, cmp-1
    TypeExtension(CQFM Population Basis) (Extension Type: code)
    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())
    18. Measure.extension:scoringUnit
    Slice NamescoringUnit
    Definition

    Defines the expected units of measure for the measure score.

    ShortWhat units?
    Control0..1
    This element is affected by the following invariants: ele-1, cmp-3
    TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
    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())
    20. Measure.extension:effectiveDataRequirements
    Slice NameeffectiveDataRequirements
    Definition

    A module definition library that contains the effective data requirements for the artifact (i.e. the calculated data requirements for the expressions referenced by the artifact structure).

    ShortEffective required data for evaluation
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(CRMI Effective Data Requirements) (Extension Type: canonical(CRMI Module Definition Library))
    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())
    22. Measure.extension:scoringPrecision
    Slice NamescoringPrecision
    Definition

    Defines the precision of the measure score when it is a decimal value.

    ShortNumber of decimal places
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
    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())
    24. 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())
    26. 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.

    Control0..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()))
    28. 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
    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()))
    30. 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 version Id, not a resource version Id (see discussion)
    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()))
    32. 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.

    Control0..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()))
    34. 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
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. 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()))
    38. 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)

    The lifecycle status of an artifact.

    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()))
    40. 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.

    Control0..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()))
    42. 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 Subject Type Value Set
    (extensible to http://hl7.org/fhir/uv/cqfmeasures/ValueSet/subject-type)
    TypeChoice of: CodeableConcept, Reference(Group)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summaryfalse
    Meaning if MissingPatient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. 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
    Summarytrue
    Alternate NamesRevision Date
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. 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.

    Control0..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.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. 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
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. 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).

    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()))
    52. 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
    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()))
    54. 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)

    Countries and regions within which this artifact is targeted for use.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. 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()))
    58. 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()))
    60. 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()))
    62. 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()))
    64. 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()))
    66. 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()))
    68. 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)

    High-level categorization of the definition, used for searching, sorting, and filtering.

    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()))
    70. 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()))
    72. 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()))
    74. 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()))
    76. 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()))
    78. 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()))
    80. Measure.library
    Definition

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

    ShortLogic used by the measure
    Control0..1
    Typecanonical(CRMI Computable Library)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    82. 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()))
    84. 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
    This element is affected by the following invariants: cmp-2, cmp-3, cmp-4
    BindingUnless not suitable, these codes SHALL be taken from Measure Scoring
    (extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    86. 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)

    The composite scoring method of the measure.

    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    88. 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..*
    This element is affected by the following invariants: cmp-5
    BindingUnless not suitable, these codes SHALL be taken from MeasureType
    (extensible to http://hl7.org/fhir/ValueSet/measure-type)

    The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    90. 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
    This element is affected by the following invariants: cmp-6
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    92. 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
    This element is affected by the following invariants: cmp-7
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    94. 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()))
    96. 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()))
    98. 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
    This element is affected by the following invariants: cmp-4
    BindingThe codes SHALL be taken from MeasureImprovementNotation
    (required to http://terminology.hl7.org/ValueSet/measure-improvement-notation)
    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    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()))
    100. 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()))
    102. 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()))
    104. 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()))
    cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists())
    cmp-9: Improvement notation must be specified for scoring types other than cohort (extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())
    106. 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
    Typestring
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    108. Measure.group.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.group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 110. Measure.group.extension:populationBasis
      Slice NamepopulationBasis
      Definition

      The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

      ShortWhat type of population
      Comments

      In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

      Control0..1
      This element is affected by the following invariants: ele-1, cmp-1
      TypeExtension(CQFM Population Basis) (Extension Type: code)
      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())
      112. Measure.group.extension:scoring
      Slice Namescoring
      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. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

      Shortproportion | ratio | continuous-variable | cohort
      Control0..1
      This element is affected by the following invariants: ele-1, cmp-2, cmp-8, cmp-9
      TypeExtension(CQFM Scoring) (Extension Type: CodeableConcept)
      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())
      114. Measure.group.extension:scoringUnit
      Slice NamescoringUnit
      Definition

      Defines the expected units of measure for the measure score.

      ShortWhat units?
      Control0..1
      This element is affected by the following invariants: ele-1, cmp-8
      TypeExtension(CQFM Scoring Unit) (Extension Type: CodeableConcept)
      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())
      116. Measure.group.extension:scoringPrecision
      Slice NamescoringPrecision
      Definition

      Defines the precision of the measure score when it is a decimal value.

      ShortNumber of decimal places
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CQFM Scoring Precision) (Extension Type: positiveInt)
      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())
      118. Measure.group.extension:compositeScoring
      Slice NamecompositeScoring
      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. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

      Shortproportion | ratio | continuous-variable | cohort
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CQFM Composite Scoring) (Extension Type: CodeableConcept)
      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())
      120. Measure.group.extension:component
      Slice Namecomponent
      Definition

      Specifies an artifact this is a component of a composite artifact.

      ShortWhat artifact
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(CQFM Component) (Extension Type: RelatedArtifact)
      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())
      122. Measure.group.extension:type
      Slice Nametype
      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
      Control0..*
      This element is affected by the following invariants: ele-1, cmp-5
      TypeExtension(CQFM Type) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      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.extension:riskAdjustment
      Slice NameriskAdjustment
      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
      This element is affected by the following invariants: ele-1, cmp-6
      TypeExtension(CQFM Risk Adjustment) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      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())
      126. Measure.group.extension:rateAggregation
      Slice NamerateAggregation
      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
      This element is affected by the following invariants: ele-1, cmp-7
      TypeExtension(CQFM Rate Aggregation) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      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())
      128. Measure.group.extension:improvementNotation
      Slice NameimprovementNotation
      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
      This element is affected by the following invariants: ele-1, cmp-9
      TypeExtension(CQFM Improvement Notation) (Extension Type: CodeableConcept)
      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())
      130. 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())
      132. 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
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      134. 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
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      136. Measure.group.population
      Definition

      A population criteria for the measure.

      ShortPopulation criteria
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      138. 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
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      140. 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())
      142. 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())
      144. 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
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationType
      (extensible to http://hl7.org/fhir/ValueSet/measure-population)

      The type of population.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      146. 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
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      148. Measure.group.population.criteria
      Definition

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

      ShortThe criteria that defines this population
      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
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      150. 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
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      152. 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
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      154. Measure.group.stratifier.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.group.stratifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 156. Measure.group.stratifier.extension:appliesTo
        Slice NameappliesTo
        Definition

        Indicates the population that this stratifier should apply to. If no appliesTo extension is present, the stratifier is calculated based on the result of the population calculation (e.g. the calculated numerator for a proportion scoring).

        ShortWhich population does this stratifier apply to?
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(CQFM Applies To) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supportfalse
        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())
        158. 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())
        160. 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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        162. 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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        164. Measure.group.stratifier.criteria
        Definition

        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
        Control0..1
        TypeExpression
        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
        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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        168. 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
        170. 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())
        172. 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())
        174. 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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        176. 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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        178. 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()))
        180. 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
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        182. 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
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        184. Measure.supplementalData.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())
        186. 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())
        188. 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
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        190. 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..*
        BindingUnless not suitable, these codes SHALL be taken from MeasureDataUsage
        (extensible to http://hl7.org/fhir/ValueSet/measure-data-usage)

        The intended usage for supplemental data elements in the measure.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        192. 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
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        194. 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()))