Generated Narrative: StructureDefinition deqm-individualmeasurereport Name Flags Card. Type Description & Constraints MeasureReport <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( deqm-2, deqm-3, deqm-5 )">C 0..* MeasureReport Results of a measure evaluation Constraints: deqm-2, deqm-3, =1" class="constraint">deqm-5 #xD; Slices for extension Content/Rules for all slices #xD; extension:careGapRemark S 0..* (Complex) Condition Category remark URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-careGapRemark #xD; extension:message 0..1 Reference(OperationOutcome) Evaluation messages URL: http://hl7.org/fhir/StructureDefinition/cqf-messages #xD; extension:category S 0..1 CodeableConcept What category is this measure report URL: http://hl7.org/fhir/StructureDefinition/measurereport-category Binding: MeasureReportCategory (extensible) #xD; extension:reportingProgram 0..1 Identifier, canonical(CRMI Manifest Library) Reporting program URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-reportingProgram #xD; extension:inputParameters 0..1 Reference(Parameters) What parameters URL: http://hl7.org/fhir/StructureDefinition/cqf-inputParameters #xD; extension:supplementalData S 0..* (Complex) Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData #xD; value[x] #xD; Slices for extension Content/Rules for all slices #xD; extension:criteriaReference S 0..1 string Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference #xD; extension:description S 0..1 markdown Description of the supplemental data URL: http://hl7.org/fhir/StructureDefinition/measurereport-populationDescription #xD; extension:scoring S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( deqm-2, deqm-3, deqm-6 )">C 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite | attestation URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring Binding: Measure Scoring (extensible) #xD; extension:vendor 0..1 Reference(Organization) Vendor information URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-reportingVendor #xD; extension:cehrt 0..1 (Complex) CMS EHR Certification ID URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-certificationIdentifier #xD; valueIdentifier 1..1 Identifier Value of extension Required Pattern: At least the following #xD; system 1..1 uri The namespace for the identifier value Fixed Value: urn:oid:2.16.840.1.113883.3.2074.1 #xD; extension:software 0..* Reference(CRMI Software System Device) Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem #xD; extension:location 0..* Reference(Location) Location(s) from which reported data was gathered URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-dataLocation #xD; extension:limitations S 0..1 markdown identifies what limitations should be noted, including potential selection biases and confounding factors when interpreting indicator results or comparing results across the country. If the extension is present in the Measure, then it SHALL be in the MeasureReport (MustSupport) and SHALL at least contain a copy of the content from the Measure. It is permissible to add content to the extensions in the MeasureReport. URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-limitations #xD; extension:trendingIssues S 0..1 markdown identifies what issues might affect the interpretation of trending results, including changes in geographic coverage, data quality, coding standards and classification changes (for example, a new ICD standard). If the extension is present in the Measure, then it SHALL be in the MeasureReport (MustSupport) and SHALL at least contain a copy of the content from the Measure. It is permissible to add content to the extensions in the MeasureReport. URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-trendingIssues #xD; status S 1..1 code complete | pending | error #xD; type S 1..1 code individual | subject-list | summary | data-collection Fixed Value: individual #xD; measure SC 1..1 canonical(CRMI Shareable Measure) What measure was calculated Constraints: deqm-0 #xD; subject S 1..1 Reference(Patient | Practitioner | PractitionerRole | Location | Device | RelatedPerson) What individual(s) the report is for #xD; date S 1..1 dateTime When the report was generated. Note: The language in R5 was changed to calculated. We are clarifying that intent. #xD; reporter S 1..1 Reference(Organization | Practitioner | PractitionerRole) Who is reporting the data. The reporter is the entity fulfilling the reporting requirement. #xD; period SC 1..1 Period The period for which the report was calculated. For the gaps in care use case, this is referred to as the gaps through period. Constraints: deqm-1 #xD; start S 1..1 dateTime Starting time with inclusive boundary #xD; end S 1..1 dateTime End time with inclusive boundary, if not ongoing #xD; improvementNotation SC 0..1 CodeableConcept increase | decrease #xD; group S<a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( deqm-4, deqm-6 )">C 0..* BackboneElement Measure results for each group Constraints: deqm-4, deqm-6 #xD; id S 0..1 string Unique id for inter-element referencing #xD; Slices for extension Content/Rules for all slices #xD; extension:linkId S 1..1 string Unique id of the group from the measure. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.linkId #xD; extension:scoring SC 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite | attestation URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring Binding: Measure Scoring (extensible) #xD; extension:cqm-compositeScoring S 0..1 CodeableConcept How the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed #xD; extension:calculatedDate S 0..1 dateTime The date the score was calculated URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-calculatedDate #xD; extension:improvementNotation SC 0..1 CodeableConcept increase | decrease URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation Binding: MeasureImprovementNotation (extensible) #xD; extension:description S 0..1 markdown Description of the group URL: http://hl7.org/fhir/StructureDefinition/measurereport-populationDescription #xD; code S 0..1 CodeableConcept Meaning of the group #xD; population SC 0..* BackboneElement The populations in the group Constraints: deqm-8 #xD; Slices for extension Content/Rules for all slices #xD; extension:linkId S 1..1 string Unique id for group.population from the measure. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.population.linkId #xD; extension:countQuantity SC 0..1 Quantity Count as a Quantity URL: http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity #xD; extension:description S 0..1 markdown Description of the population URL: http://hl7.org/fhir/StructureDefinition/measurereport-populationDescription #xD; extension:supportingEvidence S 0..* ?gen-e1? [CanonicalType[http://hl7.org/fhir/StructureDefinition/cqf-supportingEvidence]] Specifies the result of a supporting evidence expression in the measure population. URL: http://hl7.org/fhir/StructureDefinition/cqf-supportingEvidence #xD; code S 1..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation #xD; count SC 0..1 integer Size of the population #xD; subjectResults 0..0 For subject-list reports, the subject results in this population #xD; measureScore SC 0..1 Quantity What score this group achieved #xD; Slices for extension Content/Rules for all slices #xD; extension:alternateScoreType S 0..1 dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio Possible additional measureScore value types URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-alternateScoreType #xD; stratifier SC 0..* BackboneElement Stratification results Constraints: deqm-7 #xD; Slices for extension Content/Rules for all slices #xD; extension:linkId S 1..1 string Unique id for group.stratifier from the measure. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.stratifier.linkId #xD; extension:description S 0..1 markdown Description of the stratifier URL: http://hl7.org/fhir/StructureDefinition/measurereport-populationDescription #xD; code S 0..1 CodeableConcept What stratifier of the group #xD; stratum S 0..* BackboneElement Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components #xD; component #xD; Slices for extension Content/Rules for all slices #xD; extension:linkId S 1..1 ?gen-e1? [CanonicalType[http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.stratifier.stratum.component.linkId]] Unique id for group.stratifier.component from the measure. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.stratifier.stratum.component.linkId #xD; population SC 0..* BackboneElement Population results in this stratum Constraints: deqm-9 #xD; Slices for extension Content/Rules for all slices #xD; extension:linkId S 1..1 string Unique id for group.stratifier.population from the measure. URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.group.stratifier.stratum.population.linkId #xD; extension:countQuantity SC 0..1 Quantity Size of the population as a quantity. URL: http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity #xD; code S 1..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation #xD; count SC 1..1 integer Size of the population #xD; measureScore S 0..1 Quantity What score this stratum achieved #xD; Slices for extension Content/Rules for all slices #xD; extension:alternateScoreType S 0..1 dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio Possible additional measureScore value types URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-alternateScoreType #xD; evaluatedResource S 0..* Reference(Resource) What data was used to calculate the measure score #xD; Slices for extension Content/Rules for all slices #xD; extension:criteriaReference S 0..* string Criteria reference URL: http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference #xD; Documentation for this format
HL7 International / Clinical Quality Information
[MeasureReport](http://hl7.org/fhir/R4/measurereport.html) is used as an organizer for both data exchange for measure and for measure reporting. Three profiles on the MeasureReport resource are defined in this guide to delineate these different uses. The **DEQM Individual MeasureReport Profile** defined here is used when a measure is reported to an aggregator for one specific subject. It contains all of the data that is relevant to generate the report including the measure outcome and is similar to a QRDA Category 1 report. In addition to the MeasureReport, the report would be collected in a Bundle with the reporter, subject, and any other resources that were used to calculate this measure.
The MeasureReport resource contains the results of the calculation of a measure; and optionally a reference to the resources involved in that calculation.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Measure Reports used for data collection SHALL NOT communicate group and score information
(type != 'data-collection') or group.exists().not()
not(f:kind/@value='data-collection') or not(exists(f:group))
Stratifiers SHALL be either a single criteria or a set of criteria components
group.stratifier.stratum.all(value.exists() xor component.exists())
If the measure scoring is specified at the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required
(extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').exists().anyTrue() and extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')).anyTrue() implies improvementNotation.exists()
Measure scoring is required. It must be specified on the root only, or on every group, and it cannot be on both.
(extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').exists() and group.extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').empty()) xor (extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').empty() and group.all(extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').exists()))
If the scoring, at either the root level or the group level, is other than composite then the group.population cardinality is >=1
(extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code contains ('composite')).not().anyTrue() or (group.extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code contains ('composite')).not().anyTrue() implies group.population.count()>=1
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
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.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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.
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
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
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.
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.
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.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
A remark shall include an author, an authorOrganization, or an authorSoftware
extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists()
An OperationOutcome resource with information, warning, or error messages that were generated as part of processing an operation.
Specifies the category of a measure report.
Reference the reporting program by referencing their unique id specified in a Library resource that conforms to the Quality Program profile.
Specifies the input parameters to the operation (such as a test case description or a data requirements or evaluate operation). This extension can be used as part of the result of an operation to indicate what the parameters were, but it can also be used as part of the definition of a test case to specify what the input parameters are expected to be for the test case.
Optional Extension Element - found in all resources.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).
Additional content defined by implementations
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.
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.
Reference a criteria by specifying that criteria's unique id
When used in a MeasureReport, this is a reference to the id of a criteria within the Measure referenced by the MeasureReport.
A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
proportion | ratio | continuous-variable | cohort | composite | attestation
A reference to the vendor who queried the data, calculated results and/or generated the report.
An identifier that represents the EHR certication number (CERHT). See [Certified EHR Technology](https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/certification.html) For more information.
Specifies the software systems used in the packaging and testing of knowledge artifacts. Specifically to support explicitly stating which versions of the various software components were used in the authoring, packaging, and testing.
Location(s) from which reported data was gathered
Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.
identifies what limitations should be noted, including potential selection biases and confounding factors when interpreting indicator results or comparing results across the country. If the extension is present in the Measure, then it SHALL be in the MeasureReport (MustSupport) and SHALL at least contain a copy of the content from the Measure. It is permissible to add content to the extensions in the MeasureReport.
identifies what limitations should be noted, including potential selection biases and confounding factors when interpreting indicator results or comparing results across the country.
identifies what issues might affect the interpretation of trending results, including changes in geographic coverage, data quality, coding standards and classification changes (for example, a new ICD standard). If the extension is present in the Measure, then it SHALL be in the MeasureReport (MustSupport) and SHALL at least contain a copy of the content from the Measure. It is permissible to add content to the extensions in the MeasureReport.
identifies what issues might affect the interpretation of trending results, including changes in geographic coverage, data quality, coding standards and classification changes (for example, a new ICD standard).
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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Additional identifier for the MeasureReport
A formal identifier that is used to identify this MeasureReport when it is represented in other formats or referenced in a specification, model, design or an instance.
Typically, this is used for identifiers that can go in an HL7 V3 II data type - e.g. to identify this {{title}} outside of FHIR, where the logical URL is not possible to use.
Allows externally provided and/or usable business identifiers to be easily associated with the module.
The MeasureReport status. No data will be available until the MeasureReport status is complete.
This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
individual | subject-list | summary | data-collection
The type of measure report. This may be an individual report, which provides the score for the measure for an individual member of the population; a subject-listing, which returns the list of members that meet the various criteria in the measure; a summary report, which returns a population count for each of the criteria in the measure; or a data-collection, which enables the MeasureReport to be used to exchange the data-of-interest for a quality measure.
Data-collection reports are used only to communicate data-of-interest for a measure. They do not necessarily include all the data for a particular subject or population, but they may.
For individual quality meaure reporting, this report is constrained to reporting on an individual.
A reference to the Measure that was calculated to produce this report.
This will indicate the measure and version being reported on. For example, the cannonical uri location for the MRP measure.
%resource.measure.toString().contains('|') and %resource.measure.substring(%resource.measure.toString().indexOf('|') + 1).length() > 0
Optional subject identifying the individual or individuals the report is for.
When the report was generated. Note: The language in R5 was changed to calculated. We are clarifying that intent.
The date this measure report was generated.
Who is reporting the data. The reporter is the entity fulfilling the reporting requirement.
The period for which the report was calculated. For the gaps in care use case, this is referred to as the gaps through period.
The reporting period for which the report was calculated.
Date precision SHALL be at least to day ( YYYY-MM-DD )
start.toString().length()>9 and end.toString().length()>9
The start of the period. The boundary is inclusive.
If the low element is missing, the meaning is that the low boundary is not known.
End time with inclusive boundary, if not ongoing
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
Whether improvement in the measure is noted by an increase or decrease in the measure score.
This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score.
Improvement notation determines how to interpret the measure score (i.e. whether an increase is an improvement)
Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
The results of the calculation, one for each population group in the measure.
If the measure scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the groupImprovementNotation element is required.
(extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').exists().anyTrue() and extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')).anyTrue() implies extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation').exists()
If the measure scoring type is 'proportion' then the measureScore SHALL be a numerical value between 0 and 1
((%resource.extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code contains 'proportion').anyTrue() or extension('http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-measureScoring').value.coding.code contains 'proportion').anyTrue() implies (measureScore.value >= 0.0 and measureScore.value <= 1.0)
Unique id of the group from the measure.
How the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort
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.
This applies to the date this metric was actually calculated. If your measure calculation draws on stored calculations and there are multiple calculation dates, this extension would not apply, as in the example of a composite measure where the individual measures were calculated on different dates. This would only cover the case where there is only one calculation date.
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The meaning of the population group as defined in the measure definition.
The populations that make up the population group, one for each type of population appropriate for the measure.
The population must either have a count (integer) or a countQuantity (quantity), but not both.
extension('http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity').exists() xor count.exists()
Unique id for group.population from the measure.
The count of the population represented as a Quantity. This is used in cases where the count may be a decimal value such as in a ratio measure.
Specifies the result of a supporting evidence expression in the measure population.
initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
The type of population (e.g. initial, numerator, denominator, etc.).
The number of members of the population.
For subject-list reports, the subject results in this population
This element refers to a List of subject level MeasureReport resources, one for each subject in this population.
The measure score for this population group, calculated as appropriate for the measure type and scoring method, and based on the contents of the populations defined in the group.
For individual reporting, the measure score is calculated for the individual. For a proportion measure, it would be 0.0 or 1.0 (indicating 0% or 100%).
Possible additional measureScore value types
Possible value types for the measureScore elements *in addition to* the standard [Quantity](http://hl7.org/fhir/R4/datatypes.html#Quantity) type. The alternate type is determined by the Quality Measure [Aggregate Method](http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod) extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation.
This extension corresponds to the additional MeasureScore type added to the R5 version of MeasureReport.
Numerical value (with implicit precision)
The value of the measured amount. The value includes an implicit precision in the presentation of the value.
The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).
Precision is handled implicitly in almost all cases of measurement.
PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
< | <= | >= | > - how to understand the value
How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.
Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.
If there is no comparator, then there is no modification of the value
This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
How the Quantity should be understood and represented.
There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.
The identification of the system that provides the coded form of the unit.
Need to know the system that defines the coded form of the unit.
CO.codeSystem, PQ.translation.codeSystem
A computer processable form of the unit in some unit representation system.
The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.
Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.
PQ.code, MO.currency, PQ.translation.code
When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.
If group.stratifier exists, then either group.stratifier.code or the group.stratifier.stratum.component.code is present, but not both
code.exists() xor stratum.component.exists()
Unique id for group.stratifier from the measure.
The meaning of this stratifier, as defined in the measure definition.
Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
This element contains the results for a single stratum within the stratifier. For example, when stratifying on administrative gender, there will be four strata, one for each possible gender value.
The value for this stratum, expressed as a CodeableConcept. When defining stratifiers on complex values, the value must be rendered such that the value for each stratum within the stratifier is unique.
Unique id for group.stratifier.component from the measure.
The code for the stratum component value.
The populations that make up the stratum, one for each type of population appropriate to the measure.
The stratum population must either have a count (integer) or a countQuantity (quantity), but not both.
Unique id for group.stratifier.population from the measure.
A Quantity representing the size of the population. This is important to support the case when a population value may result in a decimal when reporting composite measures.
The number of members of the population in this stratum.
This element refers to a List of subject level MeasureReport resources, one for each subject in this population in this stratum.
The measure score for this stratum, calculated as appropriate for the measure type and scoring method, and based on only the members of this stratum.
What data was used to calculate the measure score
A reference to a Bundle containing the Resources that were used in the calculation of this measure.
To support the reporting of supplemental data elements.