Quality Measure Implementation Guide
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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 1.0.1-cibuild 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

Extension: CQM Improvement Notation

Official URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation Version: 1.0.0
Standards status: Trial-use Active as of 2026-03-03 Maturity Level: 4 Computable Name: CQMImprovementNotation
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.42.16

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

Additional Guidance: improvementNotation

Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Context of Use

    This extension may be used on the following element(s)

Usage info

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..1 Extension increase | decrease
... url 1..1 uri "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
... value[x] 0..1 CodeableConcept Value of extension
Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Extension.value[x] Base required MeasureImprovementNotation 📦1.0.1 THO v6.5
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..1 Extension increase | decrease
... id 0..1 string Unique id for inter-element referencing
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... url 1..1 uri "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Extension.value[x] Base required MeasureImprovementNotation 📦1.0.1 THO v6.5

Constraints

Id Grade Path(s) Description Expression
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Summary

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

Additional Guidance: improvementNotation

Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Maturity: 4

Differential ViewDifferential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..1 Extension increase | decrease
... url 1..1 uri "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
... value[x] 0..1 CodeableConcept Value of extension
Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Extension.value[x] Base required MeasureImprovementNotation 📦1.0.1 THO v6.5

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Extension 0..1 Extension increase | decrease
... id 0..1 string Unique id for inter-element referencing
... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
... url 1..1 uri "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Extension.value[x] Base required MeasureImprovementNotation 📦1.0.1 THO v6.5

Constraints

Id Grade Path(s) Description Expression
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Summary

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

Additional Guidance: improvementNotation

Reference range with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Maturity: 4

 

Other representations of profile: CSV, Excel, Schematron