Generated Narrative: StructureDefinition cqm-publishablemeasure Name Flags Card. Type Description & Constraints Measure 1..1 CRMIPublishableMeasure A quality measure definition #xD; text S 1..1 Narrative Text summary of the resource, for human interpretation #xD; Slices for extension Content/Rules for all slices #xD; extension:limitations 0..1 markdown Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-limitations #xD; extension:trendingIssues 0..1 markdown Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-trendingIssues #xD; extension:supplementalDataGuidance S 0..* (Complex) Supplemental data guidance URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-supplementalDataGuidance #xD; extension:comment S 0..* (Complex) Additional documentation, review, or usage guidance URL: http://hl7.org/fhir/StructureDefinition/cqf-artifactComment #xD; extension:softwaresystem S 0..* Reference(CRMI Software System Device) Extension URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem #xD; extension:improvementNotationGuidance S 0..1 markdown Explanation of improvement notation URL: http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance #xD; Slices for identifier S 3..* Identifier Additional identifier for the measure Slice: Unordered, Open by value:type #xD; identifier:versionIndependentIdentifier S 1..1 Identifier Measure guid #xD; use S 1..1 code usual | official | temp | secondary | old (If known) Fixed Value: official #xD; type S 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/artifact-identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: version-independent #xD; system S 1..1 uri The namespace for the identifier value Fixed Value: urn:ietf:rfc:3986 #xD; value S 1..1 string The value that is unique #xD; identifier:versionSpecificIdentifier S 1..1 Identifier Measure version guid #xD; use S 1..1 code usual | official | temp | secondary | old (If known) Fixed Value: official #xD; type S 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/artifact-identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: version-specific #xD; system S 1..1 uri The namespace for the identifier value Fixed Value: urn:ietf:rfc:3986 #xD; value S 1..1 string The value that is unique #xD; identifier:shortName S 1..1 Identifier Short name #xD; use S 1..1 code usual | official | temp | secondary | old (If known) Fixed Value: usual #xD; type S 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/artifact-identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: short-name #xD; value S 1..1 string The value that is unique #xD; identifier:endorserIdentifier S 0..* Identifier Endorser identifier #xD; use S 1..1 code usual | official | temp | secondary | old (If known) Fixed Value: official #xD; type S 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/artifact-identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: endorser #xD; system S 0..1 uri The namespace for the identifier value #xD; value S 1..1 string The value that is unique #xD; assigner S 1..1 Reference(Organization) Organization that issued id (may be just text) #xD; display S 1..1 string Text alternative for the resource #xD; identifier:publisherIdentifier S 0..* Identifier Publisher identifier #xD; use S 1..1 code usual | official | temp | secondary | old (If known) Fixed Value: official #xD; type S 1..1 CodeableConcept Description of identifier Required Pattern: At least the following #xD; coding 1..* Coding Code defined by a terminology system Fixed Value: (Complex) #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/artifact-identifier-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: publisher #xD; system S 0..1 uri The namespace for the identifier value #xD; value S 1..1 string The value that is unique #xD; assigner S 1..1 Reference(Organization) Organization that issued id (may be just text) #xD; display S 1..1 string Text alternative for the resource #xD; title S 1..1 string Name for this measure (human friendly) #xD; status 1..1 code draft | active | retired | unknown #xD; date S 1..1 dateTime Date last changed #xD; publisher 1..1 string Name of the publisher (organization or individual) #xD; contact S 1..* ContactDetail Contact details for the publisher #xD; Slices for useContext S 0..* UsageContext The context that the content is intended to support Slice: Unordered, Open by value:code #xD; useContext:intendedVenue S 0..* UsageContext What venue? #xD; code S 1..1 Coding Type of context being specified Required Pattern: At least the following #xD; system 1..1 uri Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/usage-context-type #xD; code 1..1 code Symbol in syntax defined by the system Fixed Value: venue #xD; value[x] S 1..1 CodeableConcept Value that defines the context Binding: Intended Venue (extensible) #xD; purpose S 0..1 markdown Why this measure is defined #xD; usage S 0..1 string Allows measure developers to provide additional guidance so that implementers can more easily interpret and implement components of the measure. #xD; copyright S 0..1 markdown Use and/or publishing restrictions #xD; approvalDate S 0..1 date When the measure was approved by publisher #xD; lastReviewDate S 0..1 date When the measure was last reviewed #xD; effectivePeriod S 0..1 Period When the measure is expected to be used #xD; Slices for extension Content/Rules for all slices #xD; extension:anchor S 0..1 dateTime Date of first effective use URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodAnchor #xD; extension:duration S 0..1 Duration What reporting period is used URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodDuration #xD; topic S 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. #xD; author S 0..* ContactDetail Who authored the content #xD; editor S 0..* ContactDetail Who edited the content #xD; reviewer S 0..* ContactDetail Who reviewed the content #xD; endorser S 0..* ContactDetail Who endorsed the content #xD; Slices for relatedArtifact S 0..* RelatedArtifact Additional documentation, citations, etc. Slice: Unordered, Open by value:type #xD; relatedArtifact:predecessor S 0..1 RelatedArtifact Previous measure? #xD; type S 1..1 code documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of Fixed Value: predecessor #xD; resource S 1..1 canonical(Measure) What resource is being referenced #xD; relatedArtifact:citation S 0..* RelatedArtifact Reference/citation #xD; Slices for extension Content/Rules for all slices #xD; extension:isPrimaryCitation 0..1 boolean Primary reference URL: http://hl7.org/fhir/StructureDefinition/cqf-isPrimaryCitation #xD; extension:publicationStatus 0..1 code Publication status of referenced artifact URL: http://hl7.org/fhir/StructureDefinition/cqf-publicationStatus Binding: PublicationStatus (required): The lifecycle status of a reference artifact #xD; extension:publicationDate 0..1 date Publication date of referenced artifact URL: http://hl7.org/fhir/StructureDefinition/cqf-publicationDate #xD; type S 1..1 code documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of Fixed Value: citation #xD; relatedArtifact:derived-from S 0..* RelatedArtifact URL or canonical reference to other resources that a measure is derived from #xD; type S 1..1 code documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of Fixed Value: derived-from #xD; label 0..1 string Short label #xD; display 0..1 string Brief description of the related artifact #xD; url 0..1 url Should be permalink otherwise include an "accessed date" #xD; resource 0..1 canonical(Measure) Should be permalink otherwise include an "accessed date" #xD; disclaimer S 0..1 markdown Disclaimer for use of the measure or its referenced content #xD; type SΣ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite Binding: MeasureType (extensible) #xD; rationale S 0..1 markdown Justification for the measure in terms of impact, gap in care, and evidence. #xD; definition 0..* markdown Defined terms used in the measure documentation #xD; Slices for extension Content/Rules for all slices #xD; extension:definitionTerm 1..1 (Complex) Defined term URL: http://hl7.org/fhir/StructureDefinition/cqf-definitionTerm #xD; guidance 0..0 Additional guidance for implementers #xD; group #xD; Slices for extension Content/Rules for all slices #xD; extension:improvementNotationGuidance S 0..1 markdown Explanation of improvement notation URL: http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance #xD; supplementalData S 0..* BackboneElement What other data should be reported with the measure #xD; Slices for extension Content/Rules for all slices #xD; extension:includeInReportType S 0..* code The type of report the element should be included in URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-includeInReportType Binding: MeasureReportType (required): The type of report the element should be included in #xD; Documentation for this format
HL7 International / Clinical Quality Information
The CQM Publishable Measure profile defines the minimum expectations to enable appropriate content management, discovery, and utilization of published Quality Measures (QMs). For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.
The Measure resource provides the definition of a quality measure.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Name should be usable as an identifier for the module by machine processing applications such as code generation
not(exists(f:name/@value)) or matches(f:name/@value, '[A-Z]([A-Za-z0-9_]){0,254}')
Stratifier SHALL be either a single criteria or a set of criteria components
group.stratifier.all((code | description | criteria).exists() xor component.exists())
exists(f:group/stratifier/code) or exists(f:group/stratifier/component)
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
A published measure must provide human-readable narrative description of the measure contents.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved').
Defines the content expected to be rendered in all representations of the artifact. The (c) symbol should NOT be included in this string. It is expected to be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.
identifies what limitations should be noted, including potential selection biases and confounding factors when interpreting indicator results or comparing results across the country.
identifies what issues might affect the interpretation of trending results, including changes in geographic coverage, data quality, coding standards and classification changes (for example, a new ICD standard).
Specifies additional guidance related to the collection and reporting of supplemental data elements defined in the measure.
Additional documentation, review, or usage guidance
A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.
Specifies the software systems used in the packaging and testing of measure and library resources. Specifically to know which version of what software was used.
Additional guidance on how to interpret the improvement notation of the measure.
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).
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.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Canonical identifier for this measure, represented as a URI (globally unique)
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.
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](http://hl7.org/fhir/R4/resource.html#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](http://hl7.org/fhir/R4/resource.html#meta) element to indicate where the current master source of the resource can be found.
Allows the measure to be referenced by a single globally unique identifier.
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.
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.
A published measure must be able to specify additional identifiers such as endorser and publisher identifiers for the measure.
The version-independent globally unique identifier for the measure (GUID).
Allows externally provided and/or usable business identifiers to be easily associated with the module.
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
The version-specific globally unique identifier for the measure (GUID).
The short name for the measure (e.g. CMS104v4).
An identifier assigned by the measure endorser.
Literal reference, Relative, internal or absolute URL
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
An identifier assigned by the measure publisher.
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.
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].
Name for this measure (computer friendly)
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.
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.
Support human navigation and code generation.
A short, descriptive, user-friendly title for the measure.
This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.
A published measure must specify a human-friendly title.
An explanatory or alternate title for the measure giving additional information about its content.
The status of this measure. Enables tracking the life-cycle of the content.
Allows filtering of measures that are appropriate for use versus not.
A published measure must have a status of active.
This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
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.
Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.
E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
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.
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.
The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).
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.
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.
A published measure must specify the date the measure content was last changed.
Name of the publisher (organization or individual)
The name of the organization or individual that published the measure.
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.
A published measure must provide publisher information.
Contact details to assist a user in finding and communicating with the publisher.
May be a web site, an email address, a telephone number, etc.
A published measure must provide contact information for the publisher.
Natural language description of the measure
A free text natural language description of the measure from a consumer's perspective.
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).
The context that the content is intended to support
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.
When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.
A published measure must be able to specify intended contexts of use such as intended venue.
The intended venue for use for this measure.
Assist in searching for appropriate content.
A code that identifies the type of context being specified by this usage context.
A code that specifies a type of context being specified by a usage context.
A value that defines the context specified in this context of use. The interpretation of the value is defined by the code.
Intended jurisdiction for measure (if applicable)
A legal or geographic region in which the measure is intended to be used.
It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.
Countries and regions within which this artifact is targeted for use.
Explanation of why this measure is needed and why it has been designed as it has.
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.
A published measure should provide a clear description of the purpose of the measure.
Allows measure developers to provide additional guidance so that implementers can more easily interpret and implement components of the measure.
A detailed description, from a clinical perspective, of how the measure is used.
A published measure should provide clinical usage notes for the measure.
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.
A published measure should provide copyright information for the measure content.
When the measure was approved by publisher
The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.
The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.
A published measure must indicate the date the measure content was approved by the publisher.
The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.
If specified, this date follows the original approval date.
A published measure must indicate when the measure content was last reviewed.
The period during which the measure content was or is planned to be in active use.
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.
A published measure should provide an indication of the period during which the measure content can be effectively applied.
Specifies the anchor date for the effective period as defined by a starting date and a range.
Specifies the reporting period for the measure.
The start of the period. The boundary is inclusive.
If the low element is missing, the meaning is that the low boundary is not known.
End time with inclusive boundary, if not ongoing
The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
The category of the measure, such as Education, Treatment, Assessment, etc.
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.
A published measure should provide relevant topics for the measure content.
High-level categorization of the definition, used for searching, sorting, and filtering.
An individiual or organization primarily involved in the creation and maintenance of the content.
An individual or organization primarily responsible for internal coherence of the content.
An individual or organization primarily responsible for review of some aspect of the content.
.participation[typeCode=VRF] {not clear whether VRF best corresponds to reviewer or endorser}
An individual or organization responsible for officially endorsing the content for use in some setting.
Additional documentation, citations, etc.
Related artifacts such as additional documentation, justification, or bibliographic references.
Each related artifact is either an attachment, or a reference to another resource, but not both.
A published measure should provide related information such as supporting evidence, citations, and documentation.
documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of
The type of relationship to the related artifact.
A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.
Brief description of the related artifact
A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.
A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.
Additional structured information about citations should be captured as extensions.
A url for the artifact that can be followed to access the actual content.
If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).
The document being referenced, represented as an attachment. This is exclusive with the resource element.
The related resource, such as a library, value set, profile, or other knowledge resource.
If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.
Reference to a predecessor measure that this measure is replacing.
A published measure should indicate which measure it is replacing, if any.
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.
Specifies whether the related artifact is defining a primary citation for the artifact (i.e. one that should appear in the narrative for the artifact specification.
Publication status of referenced artifact
Specifies the publication status of the referenced artifacts.
Specifies the publication date of the referenced artifacts.
URL or canonical reference to other resources that a measure is derived from
Should be permalink otherwise include an "accessed date"
A reference to a Library resource containing the formal logic used by the measure.
Disclaimer for use of the measure or its referenced content
Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.
A published measure should provide legal disclaimer relating to the use of the measure content.
proportion | ratio | continuous-variable | cohort
Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.
opportunity | all-or-nothing | linear | weighted
If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.
The composite scoring method of the measure.
process | outcome | structure | patient-reported-outcome | composite
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.
A measure must indicate the type of the measure.
How risk adjustment is applied for this measure
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.
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.
How is rate aggregation performed for this measure
Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.
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).
Justification for the measure in terms of impact, gap in care, and evidence.
Provides a detailed justification of the need for the measure, including statements pertaining to importance criterion: impact, gap in care, and evidence.
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.
Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.
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).
Measure consumers and implementers must be able to determine how to interpret a measure score.
Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
Defined terms used in the measure documentation
Provides a description of an individual term used within the measure.
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.
unique id for the element within a resource (for internal references)
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Specifies a term and its associated definition.
Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.
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.
A group of population criteria for the measure.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
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.
The human readable description of this population group.
initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
The human readable description of this population criteria
The human readable description of this population criteria.
The criteria that defines this population
An expression that specifies the criteria for the population, typically the name of an expression in a library.
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.
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.
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.
The human readable description of this stratifier
The human readable description of this stratifier criteria.
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.
Stratifier criteria component for the measure
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.
Stratifiers are defined either as a single criteria, or as a set of component criteria.
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.
The human readable description of this stratifier component
The human readable description of this stratifier criteria component.
Component of how the measure should be stratified
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.
What other data should be reported with the measure
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.
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.
The type of report the element should be included in
Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types.
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.
supplemental-data | risk-adjustment-factor
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.
The intended usage for supplemental data elements in the measure.
The human readable description of this supplemental data
The human readable description of this supplemental data.
Expression describing additional data to be reported
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.