Quality Measure Implementation Guide
1.0.0 - STU 1 International 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 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-cqm/ and changes regularly. See the Directory of published versions

Resource Profile: CQMCompositeMeasure - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 4

Definitions for the cqm-compositemeasure resource profile.

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

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()))
comp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists()).allTrue())
comp-2: Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. ((scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())))
comp-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/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists())
comp-4: If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. (scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists())
comp-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/cqm/StructureDefinition/cqm-type').exists()).allFalse())
comp-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/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse())
comp-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/cqm/StructureDefinition/cqm-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. If the populationBasis is specified as a data requirement, the type SHALL be present, profile and codeFilter MAY be present, and no other elements are allowed. This usage allows population basis to be stated with more specificity, e.g. CT Scans, rather than just DiagnosticReport.

Control0..*
This element is affected by the following invariants: ele-1, comp-1
TypeExtension(CQM Population Basis) (Extension Type: Choice of: code, DataRequirement)
Is Modifierfalse
Must Supporttrue
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())
popBasis-1: If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. (value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()))
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, comp-3
TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supporttrue
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())
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
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())
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(CQM Scoring Precision) (Extension Type: positiveInt)
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())
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/cqm/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.usage
Definition

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

ShortDescribes the clinical usage of the measure
Comments

Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

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()))
20. 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
Must Supporttrue
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()))
SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ type
  • 22. Measure.relatedArtifact:component
    Slice Namecomponent
    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
    Must Supporttrue
    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()))
    24. Measure.relatedArtifact:component.extension:groupId
    Slice NamegroupId
    Definition

    Specifies the id of a particular group within the measure referenced by the related artifact resource.

    ShortWhat group
    Comments

    Note that a composite measure may reference component groups defined within itself.

    Control0..1
    TypeExtension(CQM Group Id) (Extension Type: string)
    Is Modifierfalse
    Must Supporttrue
    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())
    26. Measure.relatedArtifact:component.extension:weight
    Slice Nameweight
    Definition

    What is the weight of the contribution of this measure to the overall score.

    ShortContribution?
    Comments

    If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

    Control0..1
    TypeExtension(CQM Weight) (Extension Type: decimal)
    Is Modifierfalse
    Must Supporttrue
    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())
    28. Measure.relatedArtifact:component.type
    Definition

    A component of the composite measure.


    The type of relationship to the related artifact.

    ShortComponent measuredocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of
    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Fixed Valuecomposed-of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Measure.relatedArtifact:component.display
    Definition

    A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

    ShortBrief description of the related artifact
    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. Measure.relatedArtifact:component.resource
    Definition

    The related resource, such as a library, value set, profile, or other knowledge resource.

    ShortWhat resource is being referenced
    Comments

    If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

    Control10..1
    Typecanonical(Measure, Resource)
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. 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()))
    36. 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.

    Shortcompositeproportion | ratio | continuous-variable | cohort
    Control0..1
    This element is affected by the following invariants: comp-2, comp-3, comp-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
    Pattern Value{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "composite"
      }]
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    38. 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 CompositeMeasureScoringhttp://hl7.org/fhir/ValueSet/composite-measure-scoring
    (extensible to http://terminology.hl7.org/ValueSet/composite-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()))
    40. 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.

    ShortIndicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.process | outcome | structure | patient-reported-outcome | composite
    Control0..*
    This element is affected by the following invariants: comp-5
    BindingUnless not suitable, these codes SHALL be taken from ObservationMeasureTypehttp://hl7.org/fhir/ValueSet/measure-type
    (extensible to http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType)

    Indicates the type of quality measure based on the observation value.


    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()))
    42. 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: comp-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()))
    44. 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()))
    comp-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/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())
    comp-9: If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())
    cmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
    cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
    46. Measure.group.extension
    Definition

    An Extension


    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.

    ShortExtensionAdditional 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.

    Control10..*
    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())
    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
    • 48. Measure.group.extension:linkId
      Slice NamelinkId
      Definition

      Optional Extension Element - found in all resources.

      ShortOptional Extensions Element
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension Definition for Measure.group.linkId for Version 5.0) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      50. 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. If the populationBasis is specified as a data requirement, the type SHALL be present, profile and codeFilter MAY be present, and no other elements are allowed. This usage allows population basis to be stated with more specificity, e.g. CT Scans, rather than just DiagnosticReport.

      Control0..1
      This element is affected by the following invariants: ele-1, comp-1
      TypeExtension(CQM Population Basis) (Extension Type: Choice of: code, DataRequirement)
      Is Modifierfalse
      Must Supporttrue
      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())
      popBasis-1: If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. (value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      52. 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, comp-2, comp-8, comp-9, cmp-10, cmp-11
      TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      54. 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, comp-8
      TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      56. 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(CQM Scoring Precision) (Extension Type: positiveInt)
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      58. 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(CQM Composite Scoring) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. 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, cmp-11
      TypeExtension(CQM Component) (Extension Type: RelatedArtifact)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      62. Measure.group.extension:component.extension:groupId
      Slice NamegroupId
      Definition

      Specifies the id of a particular group within the measure referenced by the related artifact resource.

      ShortWhat group
      Comments

      Note that a composite measure may reference component groups defined within itself.

      Control0..1
      TypeExtension(CQM Group Id) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      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())
      64. Measure.group.extension:component.extension:weight
      Slice Nameweight
      Definition

      What is the weight of the contribution of this measure to the overall score.

      ShortContribution?
      Comments

      If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

      Control0..1
      TypeExtension(CQM Weight) (Extension Type: decimal)
      Is Modifierfalse
      Must Supporttrue
      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())
      66. Measure.group.extension:component.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      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.

      Control1..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
      68. Measure.group.extension:type
      Slice Nametype
      Definition

      Indicates the type of quality measure based on the observation value.

      ShortExtension
      Control0..*
      This element is affected by the following invariants: ele-1, comp-5
      TypeExtension(CQM Type) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      70. 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, comp-6
      TypeExtension(CQM Risk Adjustment) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      72. 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, comp-7
      TypeExtension(CQM Rate Aggregation) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      74. 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, comp-9
      TypeExtension(CQM Improvement Notation) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      76. 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())
      78. 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()))
      80. Measure.group.description
      Definition

      The human readable description of this population group.

      ShortSummary description
      Comments

      Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

      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()))
      82. Measure.group.population
      Definition

      A population criteria for the measure.

      ShortPopulation criteria
      Control0..*
      This element is affected by the following invariants: cmp-10
      TypeBackboneElement
      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.population.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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.

      Control10..*
      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())
      SlicingThis element introduces a set of slices on Measure.group.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 86. Measure.group.population.extension:linkId
        Slice NamelinkId
        Definition

        Optional Extension Element - found in all resources.

        ShortOptional Extensions Element
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Extension Definition for Measure.group.population.linkId for Version 5.0) (Extension Type: string)
        Is Modifierfalse
        Must Supporttrue
        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())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        88. 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())
        90. 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()))
        92. Measure.group.population.description
        Definition

        The human readable description of this population criteria.

        ShortThe human readable description of this population criteria
        Comments

        Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

        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()))
        94. 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()))
        96. 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()))
        98. Measure.group.stratifier.extension
        Definition

        An Extension


        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.

        ShortExtensionAdditional 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.

        Control10..*
        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())
        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
        • 100. 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(CQM Applies To) (Extension Type: CodeableConcept)
          Is Modifierfalse
          Must Supportfalse
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          102. Measure.group.stratifier.extension:linkId
          Slice NamelinkId
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control1..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Extension Definition for Measure.group.stratifier.linkId for Version 5.0) (Extension Type: string)
          Is Modifierfalse
          Must Supporttrue
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          104. Measure.group.stratifier.extension:valueSet
          Slice NamevalueSet
          Definition

          A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

          ShortWhat stratum values?
          Comments

          This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(CQM Value Set) (Extension Type: canonical)
          Is Modifierfalse
          Must Supportfalse
          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())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          106. 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())
          108. 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
          BindingThe codes SHOULD be taken from For codes, see Measure Stratifier Type
          (preferred to http://terminology.hl7.org/ValueSet/measure-stratifier-type)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          110. Measure.group.stratifier.description
          Definition

          The human readable description of this stratifier criteria.

          ShortThe human readable description of this stratifier
          Comments

          Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

          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()))
          112. 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()))
          114. Measure.group.stratifier.component.extension
          Definition

          An Extension


          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.

          ShortExtensionAdditional 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.

          Control10..*
          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())
          SlicingThis element introduces a set of slices on Measure.group.stratifier.component.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 116. Measure.group.stratifier.component.extension:linkId
            Slice NamelinkId
            Definition

            Optional Extension Element - found in all resources.

            ShortOptional Extensions Element
            Control1..1
            This element is affected by the following invariants: ele-1
            TypeExtension(Extension Definition for Measure.group.stratifier.component.linkId for Version 5.0) (Extension Type: string)
            Is Modifierfalse
            Must Supporttrue
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            118. Measure.group.stratifier.component.extension:valueSet
            Slice NamevalueSet
            Definition

            A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

            ShortWhat stratum values?
            Comments

            This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(CQM Value Set) (Extension Type: canonical)
            Is Modifierfalse
            Must Supportfalse
            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())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            120. 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())
            122. 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
            BindingThe codes SHOULD be taken from For codes, see Measure Stratifier Type
            (preferred to http://terminology.hl7.org/ValueSet/measure-stratifier-type)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. Measure.group.stratifier.component.description
            Definition

            The human readable description of this stratifier criteria component.

            ShortThe human readable description of this stratifier component
            Comments

            Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

            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()))
            126. 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()))
            128. 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()))
            130. Measure.supplementalData.extension
            Definition

            An Extension


            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.

            ShortExtensionAdditional 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.

            Control10..*
            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())
            SlicingThis element introduces a set of slices on Measure.supplementalData.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 132. Measure.supplementalData.extension:linkId
              Slice NamelinkId
              Definition

              Optional Extension Element - found in all resources.

              ShortOptional Extensions Element
              Control1..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Extension Definition for Measure.supplementalData.linkId for Version 5.0) (Extension Type: string)
              Is Modifierfalse
              Must Supporttrue
              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())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              134. Measure.supplementalData.extension:valueSet
              Slice NamevalueSet
              Definition

              A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

              ShortWhat stratum values?
              Comments

              This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(CQM Value Set) (Extension Type: canonical)
              Is Modifierfalse
              Must Supportfalse
              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())
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              136. 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())
              138. 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()))
              140. 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
              Comments

              Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

              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()))
              142. Measure.supplementalData.description
              Definition

              The human readable description of this supplemental data.

              ShortThe human readable description of this supplemental data
              Comments

              Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

              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()))
              144. 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 foundhere

              0. Measure
              2. Measure.extension:scoringUnit
              Slice NamescoringUnit
              Control0..1
              This element is affected by the following invariants: ele-1, comp-3
              TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
              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())
              4. Measure.relatedArtifact
              Control0..*
              Must Supporttrue
              SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ type
              • 6. Measure.relatedArtifact:component
                Slice Namecomponent
                Control0..*
                Must Supporttrue
                8. Measure.relatedArtifact:component.extension:groupId
                Slice NamegroupId
                Control0..1
                TypeExtension(CQM Group Id) (Extension Type: string)
                Must Supporttrue
                10. Measure.relatedArtifact:component.extension:weight
                Slice Nameweight
                Control0..1
                TypeExtension(CQM Weight) (Extension Type: decimal)
                Must Supporttrue
                12. Measure.relatedArtifact:component.type
                Definition

                A component of the composite measure.

                ShortComponent measure
                Control1..1
                Typecode
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Fixed Valuecomposed-of
                14. Measure.relatedArtifact:component.display
                Control0..1
                Must Supporttrue
                16. Measure.relatedArtifact:component.resource
                Control1..1
                Typecanonical(Measure)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                18. Measure.scoring
                Shortcomposite
                BindingUnless not suitable, these codes SHALL be taken from Measure Scoring
                (extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
                TypeCodeableConcept
                Must Supporttrue
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "composite"
                  }]
                }
                20. Measure.compositeScoring
                BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoring
                (extensible to http://terminology.hl7.org/ValueSet/composite-measure-scoring)
                Must Supporttrue
                22. Measure.group
                Is Modifierfalse
                Must Supporttrue
                Invariantscmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
                cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
                24. Measure.group.extension:scoring
                Slice Namescoring
                Control0..1
                This element is affected by the following invariants: cmp-10, cmp-11, ele-1, comp-2, comp-8, comp-9
                TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
                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())
                26. Measure.group.extension:scoringUnit
                Slice NamescoringUnit
                Control0..1
                This element is affected by the following invariants: ele-1, comp-8
                TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
                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())
                28. Measure.group.extension:compositeScoring
                Slice NamecompositeScoring
                Control0..1
                This element is affected by the following invariants: ele-1
                TypeExtension(CQM Composite Scoring) (Extension Type: CodeableConcept)
                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())
                30. 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, cmp-11
                TypeExtension(CQM 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())
                32. Measure.group.extension:component.extension:groupId
                Slice NamegroupId
                Control0..1
                TypeExtension(CQM Group Id) (Extension Type: string)
                Must Supporttrue
                34. Measure.group.extension:component.extension:weight
                Slice Nameweight
                Control0..1
                TypeExtension(CQM Weight) (Extension Type: decimal)
                Must Supporttrue
                36. Measure.group.population
                Must Supporttrue

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

                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()))
                comp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists()).allTrue())
                comp-2: Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. ((scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())))
                comp-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/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists())
                comp-4: If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. (scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists())
                comp-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/cqm/StructureDefinition/cqm-type').exists()).allFalse())
                comp-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/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse())
                comp-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/cqm/StructureDefinition/cqm-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. If the populationBasis is specified as a data requirement, the type SHALL be present, profile and codeFilter MAY be present, and no other elements are allowed. This usage allows population basis to be stated with more specificity, e.g. CT Scans, rather than just DiagnosticReport.

                  Control0..*
                  This element is affected by the following invariants: ele-1, comp-1
                  TypeExtension(CQM Population Basis) (Extension Type: Choice of: code, DataRequirement)
                  Is Modifierfalse
                  Must Supporttrue
                  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())
                  popBasis-1: If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. (value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()))
                  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, comp-3
                  TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Must Supporttrue
                  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())
                  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
                  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())
                  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(CQM Scoring Precision) (Extension Type: positiveInt)
                  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())
                  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/cqm/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
                  Comments

                  Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                  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()))
                  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
                  Must Supporttrue
                  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()))
                  SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ type
                  • 80. Measure.relatedArtifact:component
                    Slice Namecomponent
                    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
                    Must Supporttrue
                    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()))
                    82. Measure.relatedArtifact: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
                    84. Measure.relatedArtifact: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())
                    SlicingThis element introduces a set of slices on Measure.relatedArtifact.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 86. Measure.relatedArtifact:component.extension:groupId
                      Slice NamegroupId
                      Definition

                      Specifies the id of a particular group within the measure referenced by the related artifact resource.

                      ShortWhat group
                      Comments

                      Note that a composite measure may reference component groups defined within itself.

                      Control0..1
                      TypeExtension(CQM Group Id) (Extension Type: string)
                      Is Modifierfalse
                      Must Supporttrue
                      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())
                      88. Measure.relatedArtifact:component.extension:weight
                      Slice Nameweight
                      Definition

                      What is the weight of the contribution of this measure to the overall score.

                      ShortContribution?
                      Comments

                      If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

                      Control0..1
                      TypeExtension(CQM Weight) (Extension Type: decimal)
                      Is Modifierfalse
                      Must Supporttrue
                      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())
                      90. Measure.relatedArtifact:component.type
                      Definition

                      A component of the composite measure.

                      ShortComponent measure
                      Control1..1
                      BindingThe codes SHALL be taken from RelatedArtifactType
                      (required to http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1)

                      The type of relationship to the related artifact.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Fixed Valuecomposed-of
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      92. Measure.relatedArtifact:component.label
                      Definition

                      A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                      ShortShort label
                      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()))
                      94. Measure.relatedArtifact:component.display
                      Definition

                      A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                      ShortBrief description of the related artifact
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      96. Measure.relatedArtifact:component.citation
                      Definition

                      A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                      ShortBibliographic citation for the artifact
                      Comments

                      Additional structured information about citations should be captured as extensions.

                      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.relatedArtifact:component.url
                      Definition

                      A url for the artifact that can be followed to access the actual content.

                      ShortWhere the artifact can be accessed
                      Comments

                      If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).

                      Control0..1
                      Typeurl
                      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()))
                      100. Measure.relatedArtifact:component.document
                      Definition

                      The document being referenced, represented as an attachment. This is exclusive with the resource element.

                      ShortWhat document is being referenced
                      Control0..1
                      TypeAttachment
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      102. Measure.relatedArtifact:component.resource
                      Definition

                      The related resource, such as a library, value set, profile, or other knowledge resource.

                      ShortWhat resource is being referenced
                      Comments

                      If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                      Control1..1
                      Typecanonical(Measure)
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      104. 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()))
                      106. 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()))
                      108. 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.

                      Shortcomposite
                      Control0..1
                      This element is affected by the following invariants: comp-2, comp-3, comp-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
                      Pattern Value{
                        "coding" : [{
                          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                          "code" : "composite"
                        }]
                      }
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      110. 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://terminology.hl7.org/ValueSet/composite-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()))
                      112. 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.

                      ShortIndicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
                      Control0..*
                      This element is affected by the following invariants: comp-5
                      BindingUnless not suitable, these codes SHALL be taken from ObservationMeasureType
                      (extensible to http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType)

                      Indicates the type of quality measure based on the observation value.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      114. 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: comp-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()))
                      116. 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: comp-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()))
                      118. 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()))
                      120. 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()))
                      122. 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: comp-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()))
                      124. 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()))
                      126. 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()))
                      128. 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()))
                      comp-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/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())
                      comp-9: If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())
                      cmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
                      cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
                      130. 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
                      132. Measure.group.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control1..*
                      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
                      • 134. Measure.group.extension:linkId
                        Slice NamelinkId
                        Definition

                        Optional Extension Element - found in all resources.

                        ShortOptional Extensions Element
                        Control1..1
                        This element is affected by the following invariants: ele-1
                        TypeExtension(Extension Definition for Measure.group.linkId for Version 5.0) (Extension Type: string)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        136. 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. If the populationBasis is specified as a data requirement, the type SHALL be present, profile and codeFilter MAY be present, and no other elements are allowed. This usage allows population basis to be stated with more specificity, e.g. CT Scans, rather than just DiagnosticReport.

                        Control0..1
                        This element is affected by the following invariants: ele-1, comp-1
                        TypeExtension(CQM Population Basis) (Extension Type: Choice of: code, DataRequirement)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        popBasis-1: If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. (value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()))
                        138. 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, comp-2, comp-8, comp-9, cmp-10, cmp-11
                        TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        140. 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, comp-8
                        TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        142. 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(CQM Scoring Precision) (Extension Type: positiveInt)
                        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())
                        144. 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(CQM Composite Scoring) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        146. 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, cmp-11
                        TypeExtension(CQM Component) (Extension Type: RelatedArtifact)
                        Is Modifierfalse
                        Must Supporttrue
                        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())
                        148. Measure.group.extension: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
                        150. Measure.group.extension: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())
                        SlicingThis element introduces a set of slices on Measure.group.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 152. Measure.group.extension:component.extension:groupId
                          Slice NamegroupId
                          Definition

                          Specifies the id of a particular group within the measure referenced by the related artifact resource.

                          ShortWhat group
                          Comments

                          Note that a composite measure may reference component groups defined within itself.

                          Control0..1
                          TypeExtension(CQM Group Id) (Extension Type: string)
                          Is Modifierfalse
                          Must Supporttrue
                          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())
                          154. Measure.group.extension:component.extension:weight
                          Slice Nameweight
                          Definition

                          What is the weight of the contribution of this measure to the overall score.

                          ShortContribution?
                          Comments

                          If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

                          Control0..1
                          TypeExtension(CQM Weight) (Extension Type: decimal)
                          Is Modifierfalse
                          Must Supporttrue
                          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())
                          156. Measure.group.extension:component.url
                          Definition

                          Source of the definition for the extension code - a logical name or a URL.

                          Shortidentifies the meaning of the extension
                          Comments

                          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.

                          Control1..1
                          Typeuri
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Summaryfalse
                          Fixed Valuehttp://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
                          158. Measure.group.extension:component.value[x]
                          Definition

                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                          ShortValue of extension
                          Control0..1
                          TypeRelatedArtifact
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          160. Measure.group.extension:type
                          Slice Nametype
                          Definition

                          Indicates the type of quality measure based on the observation value.

                          ShortExtension
                          Control0..*
                          This element is affected by the following invariants: ele-1, comp-5
                          TypeExtension(CQM Type) (Extension Type: CodeableConcept)
                          Is Modifierfalse
                          Must Supportfalse
                          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())
                          162. 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, comp-6
                          TypeExtension(CQM Risk Adjustment) (Extension Type: string)
                          Is Modifierfalse
                          Must Supportfalse
                          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())
                          164. 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, comp-7
                          TypeExtension(CQM Rate Aggregation) (Extension Type: string)
                          Is Modifierfalse
                          Must Supportfalse
                          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())
                          166. 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, comp-9
                          TypeExtension(CQM Improvement Notation) (Extension Type: CodeableConcept)
                          Is Modifierfalse
                          Must Supporttrue
                          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())
                          168. 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())
                          170. 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()))
                          172. Measure.group.description
                          Definition

                          The human readable description of this population group.

                          ShortSummary description
                          Comments

                          Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                          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()))
                          174. Measure.group.population
                          Definition

                          A population criteria for the measure.

                          ShortPopulation criteria
                          Control0..*
                          This element is affected by the following invariants: cmp-10
                          TypeBackboneElement
                          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.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
                          178. Measure.group.population.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control1..*
                          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.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 180. Measure.group.population.extension:linkId
                            Slice NamelinkId
                            Definition

                            Optional Extension Element - found in all resources.

                            ShortOptional Extensions Element
                            Control1..1
                            This element is affected by the following invariants: ele-1
                            TypeExtension(Extension Definition for Measure.group.population.linkId for Version 5.0) (Extension Type: string)
                            Is Modifierfalse
                            Must Supporttrue
                            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())
                            182. 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())
                            184. 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()))
                            186. Measure.group.population.description
                            Definition

                            The human readable description of this population criteria.

                            ShortThe human readable description of this population criteria
                            Comments

                            Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                            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()))
                            188. 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()))
                            190. 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()))
                            192. 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
                            194. Measure.group.stratifier.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control1..*
                            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
                            • 196. 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(CQM Applies To) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Must Supportfalse
                              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())
                              198. Measure.group.stratifier.extension:linkId
                              Slice NamelinkId
                              Definition

                              Optional Extension Element - found in all resources.

                              ShortOptional Extensions Element
                              Control1..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(Extension Definition for Measure.group.stratifier.linkId for Version 5.0) (Extension Type: string)
                              Is Modifierfalse
                              Must Supporttrue
                              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())
                              200. Measure.group.stratifier.extension:valueSet
                              Slice NamevalueSet
                              Definition

                              A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

                              ShortWhat stratum values?
                              Comments

                              This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

                              Control0..1
                              This element is affected by the following invariants: ele-1
                              TypeExtension(CQM Value Set) (Extension Type: canonical)
                              Is Modifierfalse
                              Must Supportfalse
                              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())
                              202. 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())
                              204. 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
                              BindingThe codes SHOULD be taken from Measure Stratifier Type
                              (preferred to http://terminology.hl7.org/ValueSet/measure-stratifier-type)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              206. Measure.group.stratifier.description
                              Definition

                              The human readable description of this stratifier criteria.

                              ShortThe human readable description of this stratifier
                              Comments

                              Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                              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()))
                              208. 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()))
                              210. 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()))
                              212. 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
                              214. Measure.group.stratifier.component.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control1..*
                              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.component.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 216. Measure.group.stratifier.component.extension:linkId
                                Slice NamelinkId
                                Definition

                                Optional Extension Element - found in all resources.

                                ShortOptional Extensions Element
                                Control1..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(Extension Definition for Measure.group.stratifier.component.linkId for Version 5.0) (Extension Type: string)
                                Is Modifierfalse
                                Must Supporttrue
                                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())
                                218. Measure.group.stratifier.component.extension:valueSet
                                Slice NamevalueSet
                                Definition

                                A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

                                ShortWhat stratum values?
                                Comments

                                This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

                                Control0..1
                                This element is affected by the following invariants: ele-1
                                TypeExtension(CQM Value Set) (Extension Type: canonical)
                                Is Modifierfalse
                                Must Supportfalse
                                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())
                                220. 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())
                                222. 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
                                BindingThe codes SHOULD be taken from Measure Stratifier Type
                                (preferred to http://terminology.hl7.org/ValueSet/measure-stratifier-type)
                                TypeCodeableConcept
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                224. Measure.group.stratifier.component.description
                                Definition

                                The human readable description of this stratifier criteria component.

                                ShortThe human readable description of this stratifier component
                                Comments

                                Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                                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()))
                                226. 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()))
                                228. 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()))
                                230. 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
                                232. Measure.supplementalData.extension
                                Definition

                                An Extension

                                ShortExtension
                                Control1..*
                                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.supplementalData.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 234. Measure.supplementalData.extension:linkId
                                  Slice NamelinkId
                                  Definition

                                  Optional Extension Element - found in all resources.

                                  ShortOptional Extensions Element
                                  Control1..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(Extension Definition for Measure.supplementalData.linkId for Version 5.0) (Extension Type: string)
                                  Is Modifierfalse
                                  Must Supporttrue
                                  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())
                                  236. Measure.supplementalData.extension:valueSet
                                  Slice NamevalueSet
                                  Definition

                                  A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

                                  ShortWhat stratum values?
                                  Comments

                                  This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example. If present, the value set SHALL be consistent with the criteria (i.e., the criteria, when evaluated, will result in values from the value set).

                                  Control0..1
                                  This element is affected by the following invariants: ele-1
                                  TypeExtension(CQM Value Set) (Extension Type: canonical)
                                  Is Modifierfalse
                                  Must Supportfalse
                                  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())
                                  238. 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())
                                  240. 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()))
                                  242. 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
                                  Comments

                                  Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                                  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()))
                                  244. Measure.supplementalData.description
                                  Definition

                                  The human readable description of this supplemental data.

                                  ShortThe human readable description of this supplemental data
                                  Comments

                                  Although this element is string-valued, it will be markdown valued in future versions so systems should be able to render markdown content when it appears in this element

                                  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()))
                                  246. 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()))