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: CQMProportionMeasure - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 4

Definitions for the cqm-proportionmeasure 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.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()))
22. 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.

Shortproportionproportion | 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" : "proportion"
  }]
}
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. 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()))
26. 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()))
28. Measure.group
Definition

A group of population criteria for the measure.

ShortPopulation criteria group
Control10..*
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-14: Proportion measures may not have other than initial population, denominator, numerator, denominator-exclusion, denominator-exception, and numerator-exclusion 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 'proportion' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'denominator-exception' | 'numerator-exclusion')).allTrue())
30. 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
  • 32. 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())
    34. 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())
    36. 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
    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())
    38. 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())
    40. 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())
    42. 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())
    44. Measure.group.extension:component
    Slice Namecomponent
    Definition

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

    ShortWhat artifact
    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(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())
    46. 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())
    48. 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())
    50. 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())
    52. 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())
    54. 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())
    56. 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()))
    58. 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()))
    60. Measure.group.population
    Definition

    A population criteria for the measure.

    ShortPopulation criteria
    Control30..6*
    This element is affected by the following invariants: cmp-14
    TypeBackboneElement
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    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.group.population. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ code
    • 62. 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
      • 64. 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())
        66. 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())
        68. 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()))
        70. 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()))
        72. 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()))
        74. Measure.group.population:initialPopulation
        Slice NameinitialPopulation
        Definition

        A population criteria for the measure.

        ShortInitial PopulationPopulation criteria
        Control10..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. Measure.group.population:initialPopulation.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
        • 78. Measure.group.population:initialPopulation.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())
          80. Measure.group.population:initialPopulation.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          82. Measure.group.population:initialPopulation.code
          Definition

          The type of population criteria.

          Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
          Control10..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
          Pattern Value{
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
              "code" : "initial-population"
            }]
          }
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. Measure.group.population:initialPopulation.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()))
          86. Measure.group.population:initialPopulation.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()))
          88. Measure.group.population:denominator
          Slice Namedenominator
          Definition

          A population criteria for the measure.

          ShortDenominatorPopulation criteria
          Control10..1*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          90. Measure.group.population:denominator.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
          • 92. Measure.group.population:denominator.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())
            94. Measure.group.population:denominator.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())
            96. Measure.group.population:denominator.code
            Definition

            The type of population criteria.

            Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
            Control10..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
            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "denominator"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. Measure.group.population:denominator.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()))
            100. Measure.group.population:denominator.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()))
            102. Measure.group.population:denominatorExclusion
            Slice NamedenominatorExclusion
            Definition

            A population criteria for the measure.

            ShortDenominator ExclusionPopulation criteria
            Control0..1*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            104. Measure.group.population:denominatorExclusion.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
            • 106. Measure.group.population:denominatorExclusion.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())
              108. Measure.group.population:denominatorExclusion.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())
              110. Measure.group.population:denominatorExclusion.code
              Definition

              The type of population criteria.

              Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
              Control10..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
              Pattern Value{
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                  "code" : "denominator-exclusion"
                }]
              }
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              112. Measure.group.population:denominatorExclusion.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()))
              114. Measure.group.population:denominatorExclusion.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()))
              116. Measure.group.population:numerator
              Slice Namenumerator
              Definition

              A population criteria for the measure.

              ShortNumeratorPopulation criteria
              Control10..1*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Measure.group.population:numerator.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
              • 120. Measure.group.population:numerator.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())
                122. Measure.group.population:numerator.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())
                124. Measure.group.population:numerator.code
                Definition

                The type of population criteria.

                Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                Control10..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
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator"
                  }]
                }
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                126. Measure.group.population:numerator.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()))
                128. Measure.group.population:numerator.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()))
                130. Measure.group.population:numeratorExclusion
                Slice NamenumeratorExclusion
                Definition

                A population criteria for the measure.

                ShortNumerator ExclusionPopulation criteria
                Control0..1*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                132. Measure.group.population:numeratorExclusion.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
                • 134. Measure.group.population:numeratorExclusion.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())
                  136. Measure.group.population:numeratorExclusion.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.group.population:numeratorExclusion.code
                  Definition

                  The type of population criteria.

                  Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                  Control10..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
                  Pattern Value{
                    "coding" : [{
                      "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                      "code" : "numerator-exclusion"
                    }]
                  }
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  140. Measure.group.population:numeratorExclusion.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()))
                  142. Measure.group.population:numeratorExclusion.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()))
                  144. Measure.group.population:denominatorException
                  Slice NamedenominatorException
                  Definition

                  A population criteria for the measure.

                  ShortDenominator ExceptionPopulation criteria
                  Control0..1*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  146. Measure.group.population:denominatorException.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
                  • 148. Measure.group.population:denominatorException.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())
                    150. Measure.group.population:denominatorException.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())
                    152. Measure.group.population:denominatorException.code
                    Definition

                    The type of population criteria.

                    Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                    Control10..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
                    Pattern Value{
                      "coding" : [{
                        "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                        "code" : "denominator-exception"
                      }]
                    }
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    154. Measure.group.population:denominatorException.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()))
                    156. Measure.group.population:denominatorException.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()))
                    158. 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()))
                    160. 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
                    • 162. 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())
                      164. 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())
                      166. 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())
                      168. 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())
                      170. 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()))
                      172. 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()))
                      174. 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()))
                      176. 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
                      • 178. 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())
                        180. 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())
                        182. 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())
                        184. 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()))
                        186. 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()))
                        188. 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()))
                        190. 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()))
                        192. 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
                        • 194. 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())
                          196. 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())
                          198. 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())
                          200. 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()))
                          202. 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()))
                          204. 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()))
                          206. 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.scoring
                          Shortproportion
                          TypeCodeableConcept
                          Must Supporttrue
                          Pattern Value{
                            "coding" : [{
                              "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                              "code" : "proportion"
                            }]
                          }
                          4. Measure.group
                          Control1..*
                          Must Supporttrue
                          Invariantscmp-14: Proportion measures may not have other than initial population, denominator, numerator, denominator-exclusion, denominator-exception, and numerator-exclusion 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 'proportion' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'denominator-exception' | 'numerator-exclusion')).allTrue())
                          6. Measure.group.population
                          Control3..6
                          This element is affected by the following invariants: cmp-14
                          Must Supporttrue
                          SlicingThis element introduces a set of slices on Measure.group.population. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ code
                          • 8. Measure.group.population:initialPopulation
                            Slice NameinitialPopulation
                            ShortInitial Population
                            Control1..1
                            Must Supporttrue
                            10. Measure.group.population:initialPopulation.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "initial-population"
                              }]
                            }
                            12. Measure.group.population:denominator
                            Slice Namedenominator
                            ShortDenominator
                            Control1..1
                            Must Supporttrue
                            14. Measure.group.population:denominator.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "denominator"
                              }]
                            }
                            16. Measure.group.population:denominatorExclusion
                            Slice NamedenominatorExclusion
                            ShortDenominator Exclusion
                            Control0..1
                            Must Supporttrue
                            18. Measure.group.population:denominatorExclusion.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "denominator-exclusion"
                              }]
                            }
                            20. Measure.group.population:numerator
                            Slice Namenumerator
                            ShortNumerator
                            Control1..1
                            Must Supporttrue
                            22. Measure.group.population:numerator.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "numerator"
                              }]
                            }
                            24. Measure.group.population:numeratorExclusion
                            Slice NamenumeratorExclusion
                            ShortNumerator Exclusion
                            Control0..1
                            Must Supporttrue
                            26. Measure.group.population:numeratorExclusion.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "numerator-exclusion"
                              }]
                            }
                            28. Measure.group.population:denominatorException
                            Slice NamedenominatorException
                            ShortDenominator Exception
                            Control0..1
                            Must Supporttrue
                            30. Measure.group.population:denominatorException.code
                            Control1..1
                            TypeCodeableConcept
                            Must Supporttrue
                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                "code" : "denominator-exception"
                              }]
                            }

                            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
                              Summaryfalse
                              Requirements

                              Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              80. Measure.library
                              Definition

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

                              ShortLogic used by the measure
                              Control0..1
                              Typecanonical(CRMI Computable Library)
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              82. Measure.disclaimer
                              Definition

                              Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.

                              ShortDisclaimer for use of the measure or its referenced content
                              Control0..1
                              Typemarkdown
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Some organizations require that notices and disclosures be included when publishing measures that reference their intellecutal property.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              84. Measure.scoring
                              Definition

                              Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

                              Shortproportion
                              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" : "proportion"
                                }]
                              }
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              86. Measure.compositeScoring
                              Definition

                              If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

                              Shortopportunity | all-or-nothing | linear | weighted
                              Control0..1
                              BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoring
                              (extensible to http://hl7.org/fhir/ValueSet/composite-measure-scoring)

                              The composite scoring method of the measure.

                              TypeCodeableConcept
                              Is Modifierfalse
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              88. Measure.type
                              Definition

                              Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

                              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()))
                              90. Measure.riskAdjustment
                              Definition

                              A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

                              ShortHow risk adjustment is applied for this measure
                              Comments

                              Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

                              Control0..1
                              This element is affected by the following invariants: 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()))
                              92. Measure.rateAggregation
                              Definition

                              Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

                              ShortHow is rate aggregation performed for this measure
                              Comments

                              The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

                              Control0..1
                              This element is affected by the following invariants: 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()))
                              94. Measure.rationale
                              Definition

                              Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.

                              ShortDetailed description of why the measure exists
                              Control0..1
                              Typemarkdown
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Measure developers need to be able to provide a detailed description of the purpose of the measure. This element provides detailed rationale, where the purpose element provides a summary of the rationale.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              96. Measure.clinicalRecommendationStatement
                              Definition

                              Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.

                              ShortSummary of clinical guidelines
                              Control0..1
                              Typemarkdown
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              98. Measure.improvementNotation
                              Definition

                              Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

                              Shortincrease | decrease
                              Control0..1
                              This element is affected by the following invariants: 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()))
                              100. Measure.definition
                              Definition

                              Provides a description of an individual term used within the measure.

                              ShortDefined terms used in the measure documentation
                              Control0..*
                              Typemarkdown
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              102. Measure.guidance
                              Definition

                              Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.

                              ShortAdditional guidance for implementers
                              Control0..1
                              Typemarkdown
                              Is Modifierfalse
                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                              Summarytrue
                              Requirements

                              Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the population criteria of the measure. This element provides detailed guidance, where the usage element provides a summary of the guidance.

                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              104. Measure.group
                              Definition

                              A group of population criteria for the measure.

                              ShortPopulation criteria group
                              Control1..*
                              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-14: Proportion measures may not have other than initial population, denominator, numerator, denominator-exclusion, denominator-exception, and numerator-exclusion 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 'proportion' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'denominator-exception' | 'numerator-exclusion')).allTrue())
                              106. Measure.group.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              108. Measure.group.extension
                              Definition

                              An Extension

                              ShortExtension
                              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
                              • 110. 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())
                                112. 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()))
                                114. 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
                                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())
                                116. 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())
                                118. 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())
                                120. 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())
                                122. Measure.group.extension:component
                                Slice Namecomponent
                                Definition

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

                                ShortWhat artifact
                                Control0..*
                                This element is affected by the following invariants: ele-1
                                TypeExtension(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())
                                124. 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())
                                126. 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())
                                128. 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())
                                130. 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())
                                132. 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())
                                134. 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()))
                                136. 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()))
                                138. Measure.group.population
                                Definition

                                A population criteria for the measure.

                                ShortPopulation criteria
                                Control3..6
                                This element is affected by the following invariants: cmp-14
                                TypeBackboneElement
                                Is Modifierfalse
                                Must Supporttrue
                                Summaryfalse
                                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.group.population. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ code
                                • 140. 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
                                  142. 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
                                  • 144. 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())
                                    146. 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())
                                    148. 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()))
                                    150. 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()))
                                    152. 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()))
                                    154. Measure.group.population:initialPopulation
                                    Slice NameinitialPopulation
                                    Definition

                                    A population criteria for the measure.

                                    ShortInitial Population
                                    Control1..1
                                    TypeBackboneElement
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Summaryfalse
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    156. Measure.group.population:initialPopulation.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
                                    158. Measure.group.population:initialPopulation.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
                                    • 160. Measure.group.population:initialPopulation.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())
                                      162. Measure.group.population:initialPopulation.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())
                                      164. Measure.group.population:initialPopulation.code
                                      Definition

                                      The type of population criteria.

                                      Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                      Control1..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
                                      Pattern Value{
                                        "coding" : [{
                                          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                          "code" : "initial-population"
                                        }]
                                      }
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      166. Measure.group.population:initialPopulation.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()))
                                      168. Measure.group.population:initialPopulation.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()))
                                      170. Measure.group.population:denominator
                                      Slice Namedenominator
                                      Definition

                                      A population criteria for the measure.

                                      ShortDenominator
                                      Control1..1
                                      TypeBackboneElement
                                      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.population:denominator.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
                                      174. Measure.group.population:denominator.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
                                      • 176. Measure.group.population:denominator.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())
                                        178. Measure.group.population:denominator.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())
                                        180. Measure.group.population:denominator.code
                                        Definition

                                        The type of population criteria.

                                        Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                        Control1..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
                                        Pattern Value{
                                          "coding" : [{
                                            "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                            "code" : "denominator"
                                          }]
                                        }
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        182. Measure.group.population:denominator.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()))
                                        184. Measure.group.population:denominator.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()))
                                        186. Measure.group.population:denominatorExclusion
                                        Slice NamedenominatorExclusion
                                        Definition

                                        A population criteria for the measure.

                                        ShortDenominator Exclusion
                                        Control0..1
                                        TypeBackboneElement
                                        Is Modifierfalse
                                        Must Supporttrue
                                        Summaryfalse
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        188. Measure.group.population:denominatorExclusion.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
                                        190. Measure.group.population:denominatorExclusion.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
                                        • 192. Measure.group.population:denominatorExclusion.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())
                                          194. Measure.group.population:denominatorExclusion.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())
                                          196. Measure.group.population:denominatorExclusion.code
                                          Definition

                                          The type of population criteria.

                                          Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                          Control1..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
                                          Pattern Value{
                                            "coding" : [{
                                              "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                              "code" : "denominator-exclusion"
                                            }]
                                          }
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          198. Measure.group.population:denominatorExclusion.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()))
                                          200. Measure.group.population:denominatorExclusion.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()))
                                          202. Measure.group.population:numerator
                                          Slice Namenumerator
                                          Definition

                                          A population criteria for the measure.

                                          ShortNumerator
                                          Control1..1
                                          TypeBackboneElement
                                          Is Modifierfalse
                                          Must Supporttrue
                                          Summaryfalse
                                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          204. Measure.group.population:numerator.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
                                          206. Measure.group.population:numerator.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
                                          • 208. Measure.group.population:numerator.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())
                                            210. Measure.group.population:numerator.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())
                                            212. Measure.group.population:numerator.code
                                            Definition

                                            The type of population criteria.

                                            Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                            Control1..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
                                            Pattern Value{
                                              "coding" : [{
                                                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                                "code" : "numerator"
                                              }]
                                            }
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            214. Measure.group.population:numerator.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()))
                                            216. Measure.group.population:numerator.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()))
                                            218. Measure.group.population:numeratorExclusion
                                            Slice NamenumeratorExclusion
                                            Definition

                                            A population criteria for the measure.

                                            ShortNumerator Exclusion
                                            Control0..1
                                            TypeBackboneElement
                                            Is Modifierfalse
                                            Must Supporttrue
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            220. Measure.group.population:numeratorExclusion.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
                                            222. Measure.group.population:numeratorExclusion.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
                                            • 224. Measure.group.population:numeratorExclusion.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())
                                              226. Measure.group.population:numeratorExclusion.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())
                                              228. Measure.group.population:numeratorExclusion.code
                                              Definition

                                              The type of population criteria.

                                              Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                              Control1..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
                                              Pattern Value{
                                                "coding" : [{
                                                  "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                                  "code" : "numerator-exclusion"
                                                }]
                                              }
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              230. Measure.group.population:numeratorExclusion.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()))
                                              232. Measure.group.population:numeratorExclusion.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()))
                                              234. Measure.group.population:denominatorException
                                              Slice NamedenominatorException
                                              Definition

                                              A population criteria for the measure.

                                              ShortDenominator Exception
                                              Control0..1
                                              TypeBackboneElement
                                              Is Modifierfalse
                                              Must Supporttrue
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              236. Measure.group.population:denominatorException.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
                                              238. Measure.group.population:denominatorException.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
                                              • 240. Measure.group.population:denominatorException.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())
                                                242. Measure.group.population:denominatorException.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())
                                                244. Measure.group.population:denominatorException.code
                                                Definition

                                                The type of population criteria.

                                                Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                                Control1..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
                                                Pattern Value{
                                                  "coding" : [{
                                                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                                    "code" : "denominator-exception"
                                                  }]
                                                }
                                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                246. Measure.group.population:denominatorException.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()))
                                                248. Measure.group.population:denominatorException.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()))
                                                250. 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()))
                                                252. 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
                                                254. 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
                                                • 256. 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())
                                                  258. 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())
                                                  260. 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())
                                                  262. 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())
                                                  264. 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()))
                                                  266. 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()))
                                                  268. 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()))
                                                  270. 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()))
                                                  272. 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
                                                  274. 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
                                                  • 276. 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())
                                                    278. 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())
                                                    280. 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())
                                                    282. 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()))
                                                    284. 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()))
                                                    286. 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()))
                                                    288. 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()))
                                                    290. 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
                                                    292. 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
                                                    • 294. 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())
                                                      296. 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())
                                                      298. 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())
                                                      300. 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()))
                                                      302. 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()))
                                                      304. 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()))
                                                      306. 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()))