Quality Measure Implementation Guide
1.0.0 - STU 1
Quality Measure Implementation Guide
1.0.0 - STU 1
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
| Official URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation | Version: 1.0.0 | |||
| Standards status: Trial-use | Maturity Level: 4 | Computable Name: CQMImprovementNotation | ||
| Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.42.16 | ||||
Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.
Purpose
Measure consumers and implementers must be able to determine how to interpret a measure score.
Context of Use
This extension may be used on the following element(s)
Measure.group
Usage info
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Extension |
0..1 | Extension | increase | decrease | |
  url |
1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation" | |
  value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| id |
0..1 | string | Unique id for inter-element referencing | |
 extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url |
1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Simple Extension with the type CodeableConcept: Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.
Maturity: 4
Differential View
This structure is derived from Extension
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| url |
1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Extension |
0..1 | Extension | increase | decrease | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |
| url |
1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation" | |
| value[x] |
0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure | |
| Documentation for this format | ||||
This structure is derived from Extension
Summary
Simple Extension with the type CodeableConcept: Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).
Additional Guidance: improvementNotation
Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.
Maturity: 4
Other representations of profile: CSV, Excel, Schematron
| Path | Conformance | ValueSet | URI |
| Extension.value[x] | required | MeasureImprovementNotationhttp://terminology.hl7.org/ValueSet/measure-improvement-notation |
| Id | Grade | Path(s) | Details | Requirements |
| ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
| ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.uv.cqm#1.0.0 based on FHIR 4.0.1. Generated 2025-08-27
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