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 2.0.0 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

Changes

Changes for STU 2

Non-Compatible Changes

• FHIR-56819: Aligned operation parameters with CRMI operation profiles
• FHIR-53286: Composite measure elements should be at the group level
• FHIR-53140: Value-based stratifiers always and only use stratifier component elements

Compatible Substantive Changes

• FHIR-58060: Add a CQMLibrary profile
• FHIR-57727: Allow data requirements to be invoked on multiple measures
• FHIR-56009: Expand context of "limitations" and "trendingIssues" extensions
• FHIR-55982: Add MeasureReport.group to context of use for compositeScoring
• FHIR-53432: Consider the ability to return supporting evidence throughout a measure
• FHIR-51395: Subscription Approach

Non-substantive Changes

• FHIR-58297: Clarify the term "population group"
• FHIR-57879: Clarify the Group naming convention in Measures with Multiple Rates (3.4.8)
• FHIR-57861: Ensure topic search parameter is supported in publishable repository
• FHIR-57509: Additional clarity for calculation semantics
• FHIR-57499: Continuous variable semantics should use return all
• FHIR-57197: Measure Calculation Service Capability Statement Example has an very old published date
• FHIR-57196: Global profiles
• FHIR-57195: Quality Measurement and Data Model Standards Landscapes
• FHIR-57190: The reference to QI-Core in universal realm
• FHIR-57189: Package Procedure-Based Test Cases
• FHIR-57188: Explain Composite and Risk Scores
• FHIR-57187: Attribution Metadata Guardrails
• FHIR-57185: Terminology Inventory for Measures
• FHIR-57155: Diagram is a cycle, not a system
• FHIR-57090: Should we add US Quality Core in the Quality Measurement Landscape
• FHIR-57037: Expansion Parameters table is confusing
• FHIR-57012: Fix link to CRMI CI Build
• FHIR-57009: Using CQL: Consider Summarizing Differences w/ Using CQL IG
• FHIR-56929: Duplicate entries in QA "Filename" List
• FHIR-56928: QA report shows 568 validation errors
• FHIR-56889: Risk Adjustment example CQL definitions
• FHIR-56887: Update links to uv DEQM
• FHIR-56884: eCQI Link (Section 2.1)
• FHIR-56868: Alignment of terms
• FHIR-56867: Consider these revisions to correct the fragments, align tense and simplify wordiness-
• FHIR-56866: Change in how referenced
• FHIR-56864: Readability & Clarity
• FHIR-56863: Abbreviations and Acronyms
• FHIR-56862: Clarification of Alias
• FHIR-56818: Elaborate on Subscriptions use case for jurisdictional reporting
• FHIR-56817: Fix misc. typos, grammar
• FHIR-56816: Support Conformance verb tagging
• FHIR-56810: continuous variable measure example using outdated principal diagnosis modeling
• FHIR-56809: VTE example principal diagnosis modeling needs to be updated
• FHIR-56808: example using old modeling of principal diagnosis
• FHIR-56278: Clarify population counting semantics for non-subject-based measures
• FHIR-55969: Update quality improvement ecosystem diagram
• FHIR-55952: Add examples of risk-adjusted measures
• FHIR-52882: Mention CRMI operations on operations page
• FHIR-52881: Add note about CRMI on introduction page
• FHIR-52821: Restore the note about data requirements parameters
• FHIR-51841: Clarify cqf-criteriaReference with linkId

Changes for STU 2 Ballot

Non-Compatible Changes

• FHIR-53286: Composite measure elements should be at the group level
• FHIR-53140: Clarify expectations for value-based stratification expressions

Compatible, Substantive Changes

• FHIR-56009: Expand context of "limitations" and "trendingIssues" extensions
• FHIR-55982: Add MeasureReport.group to context of use for compositeScoring
• FHIR-53432: Consider the ability to return supporting evidence throughout a measure
• FHIR-51395: Subscription Approach

Non-Substantive Changes

• FHIR-55969: Update quality improvement ecosystem diagram
• FHIR-55952: Added risk-adjusted measure example
• FHIR-52882: Mention CRMI operations on operations page
• FHIR-52881: Add note about CRMI on introduction page
• FHIR-52821: Restore the note about data requirements parameters
• FHIR-51841: Clarify cqf-criteriaReference with linkId

Changes and Updates for STU 1 Publication (v1.0.0)

Non-Compatible Changes

• FHIR-51101: require Reference.display on publisher and endorser identifiers in publishable measure (Applied (here))
• FHIR-50265: Correct definitionTerm extension usage (Applied (here) and (here))
• FHIR-49245: Extension Issues Applied (here), (here), (here), (here), and (here)

Compatible, Substantive Changes

• FHIR-51242: Not all types of measures are represented in the current Measure Type ValueSet. (Applied (here)))
• FHIR-50925: Provide guidance regarding description elements (Applied (here), (here), and (here))
• FHIR-49978: Measures With Multiple Populations (Applied (here))
• FHIR-49859: align deqm-2/4 and cmp-4/9 (Applied (here))
• FHIR-49756: Allow specification of a ValueSet for stratifiers and supplemental data (Applied (here), (here), (here), (here), (here), and (here))
• FHIR-49669: Clarify guidance on linking support to MeasureReport (Applied (here))
• FHIR-48491: Surface population basis in human readable to ease implementer confusion (Applied (here), and (here))
• FHIR-43090: Allow for count as a quantity (Applied (here))

• FHIR-20699: Additional metadata for mesaure report

  quality statement (Applied (here), (here), (here), and (here))

Non-Substantive Changes

• FHIR-49938: Correct reference to data requirements in primary library (Applied (here))
• FHIR-49601: add grid to table display
• FHIR-49597: change cqm to uppercase CQM in measure profile descriptions (Applied (here), (here), (here), (here), and (here))
• FHIR-49593: Update introduction (Applied here)
• FHIR-49347: 1.3.1 Quality Improvement Ecosystem
• FHIR-49296: Please address spelling and grammar issues
• FHIR-49081: Example measures have populations out of order
• FHIR-51698: Conformance Requirement 3.9 and 3.16 have contradictory instructions
• FHIR-51572: Change patient-based to subject-based (Applied (here), (here), and (here) )
• FHIR-51380: Support different bases for ratio measures (Applied (here))
• FHIR-50666: Software system device profile was removed (Applied (here))
• FHIR-49921: Clarify calculation semantics (Applied (here))
• FHIR-49788: EXM 146 Library Example - Not Valid per UCWF
• FHIR-49598: ConceptMap Measure Type mapping needs an update (Applied here)
• FHIR-49595: Using CQL With FHIR IG version (Applied (here))
• FHIR-49580: Please add a "Plain Language Summary about this Guide" to the home page
• FHIR-49579: Update Change Log (Applied here)
• FHIR-49485: remove modelinfo FHIR Model Definition (STU2) (Applied (here))
• FHIR-49416: attestation measure population expression shouldn't indicate CQL (Applied here)
• FHIR-49346: 1.1 Summary Remove extra word
• FHIR-49228: Incorrect SNOMED Version Used in Example
• FHIR-49082: Typo: 2025-Jan-FHIR IG QM E1 STU 17.98.1 states 'Measure: Cervical Cancer EXM146 - Appropriate Testing for Children with Pharyngitis (Experimental)' but 'Cervical Cancer' should be removed.

STU 1 Ballot for FHIR R4 (v1.0.0-ballot)

• FHIR-45883: Consider universal realm (Applied (here))
• FHIR-48834: Fix improvementNotationGuidance extension (Applied (here))
• FHIR-49417: Added attestation to Table 3-1 (Applied (here))
• FHIR-49602: Glossary and Acronyms (Applied (here))
• FHIR-49763: Clarified Ratio Measure initial populations (Applied (here))

NOTE: This implementation guide is the Universal Realm successor of the US-based Quality Measure IG STU 5, and incorporates all the stakeholder feedback and implementation experience from that specification.