Quality Measure Implementation Guide
5.0.0 - STU5
Quality Measure Implementation Guide
5.0.0 - STU5
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 5.0.0 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
| Official URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation | Version: 4.0.0 | |||
| Active as of 2025-08-26 | Computable Name: CQFMImprovementNotation | |||
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).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.
Please provide comments on this additional code and if there are other codes needed in the improvement notation value set.
If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use? Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.
Purpose
Measure consumers and implementers must be able to determine how to interpret a measure score.
Context of Use
This extension may be used on the following element(s)
Measure.group
Usage info
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Extension |
0..1 | Extension | increase | decrease | |
  url |
1..1 | uri | "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation" | |
  value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| id |
0..1 | string | Unique id for inter-element referencing | |
 extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url |
1..1 | uri | "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Simple Extension with the type CodeableConcept: 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).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.
Please provide comments on this additional code and if there are other codes needed in the improvement notation value set.
If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use? Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| url |
1..1 | uri | "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url |
1..1 | uri | "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Simple Extension with the type CodeableConcept: 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).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.
Please provide comments on this additional code and if there are other codes needed in the improvement notation value set.
If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use? Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet | URI |
| Extension.value[x] | required | MeasureImprovementNotationhttp://terminology.hl7.org/ValueSet/measure-improvement-notation |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.cqfmeasures#5.0.0 based on FHIR 4.0.1. Generated 2025-08-26
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