STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

4.21 Resource Measure - Content

Clinical Quality Information Work GroupMaturity Level: 0Compartments: Not linked to any defined compartments

The Measure resource provides the definition of a quality measure.

4.21.1 Scope and Usage

This resource is a draft proposal for use as part of an approach to Clinical Quality within FHIR, and is documented as part of the Clinical Quality Improvement Framework Implementation Guide.

The Measure resource represents a structured computable definition of a clinical quality measure. A quality measure is a quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical quidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.

Note that the Measure itself does not contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as poulation criteria, reference named expressions within that library (or libraries). In addition, if the Measure references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression.

This resource is referenced by measurereport

4.21.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure ΣDomainResourceA quality measure
... moduleMetadata Σ0..1ModuleMetadataMetadata for the measure
... library Σ0..*Reference(Library)Logic used by the measure
... disclaimer Σ0..1markdownDisclaimer for the measure
... scoring Σ0..1codeproportion | ratio | continuous-variable | cohort
MeasureScoring (Required)
... type Σ0..*codeprocess | outcome
MeasureType (Required)
... riskAdjustment Σ0..1stringHow is risk adjustment applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownWhy does this measure exist
... clinicalRecommendationStatement Σ0..1markdownClinical recommendation
... improvementNotation Σ0..1stringImprovement notation for the measure, e.g. higher score indicates better quality
... definition Σ0..1markdownA natural language definition of the measure
... guidance Σ0..1markdownThe guidance for the measure
... set Σ0..1stringThe measure set, e.g. Preventive Care and Screening
... group Σ0..*BackboneElementPopulation criteria group
.... identifier Σ1..1IdentifierUnique identifier
.... name Σ0..1stringShort name
.... description Σ0..1stringSummary description
.... population Σ0..*BackboneElementPopulation criteria
..... type Σ1..1codeinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score
MeasurePopulationType (Required)
..... identifier Σ1..1IdentifierUnique identifier
..... name Σ0..1stringShort name
..... description Σ0..1stringThe human readable description of this population criteria
..... criteria Σ1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... stratifier Σ0..*BackboneElementStratifier criteria for the measure
..... identifier Σ1..1IdentifierThe identifier for the stratifier used to coordinate the reported data back to this stratifier
..... criteria Σ0..1stringStratifier criteria
..... path Σ0..1stringPath to the stratifier
... supplementalData Σ0..*BackboneElementSupplemental data
.... identifier Σ1..1IdentifierIdentifier, unique within the measure
.... usage Σ0..*codesupplemental-data | risk-adjustment-factor
MeasureDataUsage (Required)
.... criteria Σ0..1stringSupplemental data criteria
.... path Σ0..1stringPath to the supplemental data element

doco Documentation for this format

UML Diagram

Measure (DomainResource)The metadata for the measure, including publishing, life-cycle, version, documentation, and supporting evidencemoduleMetadata : ModuleMetadata [0..1]A reference to a Library resource containing the formal logic used by the measurelibrary : Reference [0..*] « Library »A disclaimer for the use of the measuredisclaimer : markdown [0..1]The measure scoring type, e.g. proportion, CVscoring : code [0..1] « The scoring type of the measure (Strength=Required)MeasureScoring! »The measure type, e.g. process, outcometype : code [0..*] « The type of measure (Strength=Required)MeasureType! »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 resultsriskAdjustment : string [0..1]A description of the rate aggregation for the measurerateAggregation : string [0..1]The rationale for the measurerationale : markdown [0..1]The clinical recommendation statement for the measureclinicalRecommendationStatement : markdown [0..1]Improvement notation for the measure, e.g. higher score indicates better qualityimprovementNotation : string [0..1]A narrative description of the complete measure calculationdefinition : markdown [0..1]Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measureguidance : markdown [0..1]The measure set, e.g. Preventive Care and Screeningset : string [0..1]GroupA unique identifier for the group. This identifier will used to report data for the group in the measure reportidentifier : Identifier [1..1]Optional name or short description of this groupname : string [0..1]The human readable description of this population groupdescription : string [0..1]PopulationThe type of population criteriatype : code [1..1] « The type of population (Strength=Required)MeasurePopulationType! »A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure reportidentifier : Identifier [1..1]Optional name or short description of this populationname : string [0..1]The human readable description of this population criteriadescription : string [0..1]The name of a valid referenced CQL expression (may be namespaced) that defines this population criteriacriteria : string [1..1]StratifierThe identifier for the stratifier used to coordinate the reported data back to this stratifieridentifier : Identifier [1..1]The criteria for the stratifier. This must be the name of an expression defined within a referenced librarycriteria : string [0..1]The path to an element that defines the stratifier, specified as a valid FHIR resource pathpath : string [0..1]SupplementalDataAn identifier for the supplemental dataidentifier : Identifier [1..1]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 calculationusage : code [0..*] « The intended usage for supplemental data elements in the measure (Strength=Required)MeasureDataUsage! »The criteria for the supplemental data. This must be the name of a valid expression defined within a referenced library, and defines the data to be returned for this elementcriteria : string [0..1]The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Pathpath : string [0..1]A population criteria for the measurepopulation[0..*]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 Pathstratifier[0..*]A group of population criteria for the measuregroup[0..*]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 PathsupplementalData[0..*]

XML Template

<Measure xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <moduleMetadata><!-- 0..1 ModuleMetadata Metadata for the measure --></moduleMetadata>
 <library><!-- 0..* Reference(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for the measure -->
 <scoring value="[code]"/><!-- 0..1 proportion | ratio | continuous-variable | cohort -->
 <type value="[code]"/><!-- 0..* process | outcome -->
 <riskAdjustment value="[string]"/><!-- 0..1 How is risk adjustment applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Why does this measure exist -->
 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Clinical recommendation -->
 <improvementNotation value="[string]"/><!-- 0..1 Improvement notation for the measure, e.g. higher score indicates better quality -->
 <definition value="[markdown]"/><!-- 0..1 A natural language definition of the measure -->
 <guidance value="[markdown]"/><!-- 0..1 The guidance for the measure -->
 <set value="[string]"/><!-- 0..1 The measure set, e.g. Preventive Care and Screening -->
 <group>  <!-- 0..* Population criteria group -->
  <identifier><!-- 1..1 Identifier Unique identifier --></identifier>
  <name value="[string]"/><!-- 0..1 Short name -->
  <description value="[string]"/><!-- 0..1 Summary description -->
  <population>  <!-- 0..* Population criteria -->
   <type value="[code]"/><!-- 1..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score -->
   <identifier><!-- 1..1 Identifier Unique identifier --></identifier>
   <name value="[string]"/><!-- 0..1 Short name -->
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria value="[string]"/><!-- 1..1 The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria -->
  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <identifier><!-- 1..1 Identifier The identifier for the stratifier used to coordinate the reported data back to this stratifier --></identifier>
   <criteria value="[string]"/><!-- 0..1 Stratifier criteria -->
   <path value="[string]"/><!-- 0..1 Path to the stratifier -->
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* Supplemental data -->
  <identifier><!-- 1..1 Identifier Identifier, unique within the measure --></identifier>
  <usage value="[code]"/><!-- 0..* supplemental-data | risk-adjustment-factor -->
  <criteria value="[string]"/><!-- 0..1 Supplemental data criteria -->
  <path value="[string]"/><!-- 0..1 Path to the supplemental data element -->
 </supplementalData>
</Measure>

JSON Template

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "moduleMetadata" : { ModuleMetadata }, // Metadata for the measure
  "library" : [{ Reference(Library) }], // Logic used by the measure
  "disclaimer" : "<markdown>", // Disclaimer for the measure
  "scoring" : "<code>", // proportion | ratio | continuous-variable | cohort
  "type" : ["<code>"], // process | outcome
  "riskAdjustment" : "<string>", // How is risk adjustment applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Why does this measure exist
  "clinicalRecommendationStatement" : "<markdown>", // Clinical recommendation
  "improvementNotation" : "<string>", // Improvement notation for the measure, e.g. higher score indicates better quality
  "definition" : "<markdown>", // A natural language definition of the measure
  "guidance" : "<markdown>", // The guidance for the measure
  "set" : "<string>", // The measure set, e.g. Preventive Care and Screening
  "group" : [{ // Population criteria group
    "identifier" : { Identifier }, // R!  Unique identifier
    "name" : "<string>", // Short name
    "description" : "<string>", // Summary description
    "population" : [{ // Population criteria
      "type" : "<code>", // R!  initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score
      "identifier" : { Identifier }, // R!  Unique identifier
      "name" : "<string>", // Short name
      "description" : "<string>", // The human readable description of this population criteria
      "criteria" : "<string>" // R!  The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "identifier" : { Identifier }, // R!  The identifier for the stratifier used to coordinate the reported data back to this stratifier
      "criteria" : "<string>", // Stratifier criteria
      "path" : "<string>" // Path to the stratifier
    }]
  }],
  "supplementalData" : [{ // Supplemental data
    "identifier" : { Identifier }, // R!  Identifier, unique within the measure
    "usage" : ["<code>"], // supplemental-data | risk-adjustment-factor
    "criteria" : "<string>", // Supplemental data criteria
    "path" : "<string>" // Path to the supplemental data element
  }]
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure ΣDomainResourceA quality measure
... moduleMetadata Σ0..1ModuleMetadataMetadata for the measure
... library Σ0..*Reference(Library)Logic used by the measure
... disclaimer Σ0..1markdownDisclaimer for the measure
... scoring Σ0..1codeproportion | ratio | continuous-variable | cohort
MeasureScoring (Required)
... type Σ0..*codeprocess | outcome
MeasureType (Required)
... riskAdjustment Σ0..1stringHow is risk adjustment applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownWhy does this measure exist
... clinicalRecommendationStatement Σ0..1markdownClinical recommendation
... improvementNotation Σ0..1stringImprovement notation for the measure, e.g. higher score indicates better quality
... definition Σ0..1markdownA natural language definition of the measure
... guidance Σ0..1markdownThe guidance for the measure
... set Σ0..1stringThe measure set, e.g. Preventive Care and Screening
... group Σ0..*BackboneElementPopulation criteria group
.... identifier Σ1..1IdentifierUnique identifier
.... name Σ0..1stringShort name
.... description Σ0..1stringSummary description
.... population Σ0..*BackboneElementPopulation criteria
..... type Σ1..1codeinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score
MeasurePopulationType (Required)
..... identifier Σ1..1IdentifierUnique identifier
..... name Σ0..1stringShort name
..... description Σ0..1stringThe human readable description of this population criteria
..... criteria Σ1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... stratifier Σ0..*BackboneElementStratifier criteria for the measure
..... identifier Σ1..1IdentifierThe identifier for the stratifier used to coordinate the reported data back to this stratifier
..... criteria Σ0..1stringStratifier criteria
..... path Σ0..1stringPath to the stratifier
... supplementalData Σ0..*BackboneElementSupplemental data
.... identifier Σ1..1IdentifierIdentifier, unique within the measure
.... usage Σ0..*codesupplemental-data | risk-adjustment-factor
MeasureDataUsage (Required)
.... criteria Σ0..1stringSupplemental data criteria
.... path Σ0..1stringPath to the supplemental data element

doco Documentation for this format

UML Diagram

Measure (DomainResource)The metadata for the measure, including publishing, life-cycle, version, documentation, and supporting evidencemoduleMetadata : ModuleMetadata [0..1]A reference to a Library resource containing the formal logic used by the measurelibrary : Reference [0..*] « Library »A disclaimer for the use of the measuredisclaimer : markdown [0..1]The measure scoring type, e.g. proportion, CVscoring : code [0..1] « The scoring type of the measure (Strength=Required)MeasureScoring! »The measure type, e.g. process, outcometype : code [0..*] « The type of measure (Strength=Required)MeasureType! »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 resultsriskAdjustment : string [0..1]A description of the rate aggregation for the measurerateAggregation : string [0..1]The rationale for the measurerationale : markdown [0..1]The clinical recommendation statement for the measureclinicalRecommendationStatement : markdown [0..1]Improvement notation for the measure, e.g. higher score indicates better qualityimprovementNotation : string [0..1]A narrative description of the complete measure calculationdefinition : markdown [0..1]Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measureguidance : markdown [0..1]The measure set, e.g. Preventive Care and Screeningset : string [0..1]GroupA unique identifier for the group. This identifier will used to report data for the group in the measure reportidentifier : Identifier [1..1]Optional name or short description of this groupname : string [0..1]The human readable description of this population groupdescription : string [0..1]PopulationThe type of population criteriatype : code [1..1] « The type of population (Strength=Required)MeasurePopulationType! »A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure reportidentifier : Identifier [1..1]Optional name or short description of this populationname : string [0..1]The human readable description of this population criteriadescription : string [0..1]The name of a valid referenced CQL expression (may be namespaced) that defines this population criteriacriteria : string [1..1]StratifierThe identifier for the stratifier used to coordinate the reported data back to this stratifieridentifier : Identifier [1..1]The criteria for the stratifier. This must be the name of an expression defined within a referenced librarycriteria : string [0..1]The path to an element that defines the stratifier, specified as a valid FHIR resource pathpath : string [0..1]SupplementalDataAn identifier for the supplemental dataidentifier : Identifier [1..1]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 calculationusage : code [0..*] « The intended usage for supplemental data elements in the measure (Strength=Required)MeasureDataUsage! »The criteria for the supplemental data. This must be the name of a valid expression defined within a referenced library, and defines the data to be returned for this elementcriteria : string [0..1]The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Pathpath : string [0..1]A population criteria for the measurepopulation[0..*]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 Pathstratifier[0..*]A group of population criteria for the measuregroup[0..*]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 PathsupplementalData[0..*]

XML Template

<Measure xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <moduleMetadata><!-- 0..1 ModuleMetadata Metadata for the measure --></moduleMetadata>
 <library><!-- 0..* Reference(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for the measure -->
 <scoring value="[code]"/><!-- 0..1 proportion | ratio | continuous-variable | cohort -->
 <type value="[code]"/><!-- 0..* process | outcome -->
 <riskAdjustment value="[string]"/><!-- 0..1 How is risk adjustment applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Why does this measure exist -->
 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Clinical recommendation -->
 <improvementNotation value="[string]"/><!-- 0..1 Improvement notation for the measure, e.g. higher score indicates better quality -->
 <definition value="[markdown]"/><!-- 0..1 A natural language definition of the measure -->
 <guidance value="[markdown]"/><!-- 0..1 The guidance for the measure -->
 <set value="[string]"/><!-- 0..1 The measure set, e.g. Preventive Care and Screening -->
 <group>  <!-- 0..* Population criteria group -->
  <identifier><!-- 1..1 Identifier Unique identifier --></identifier>
  <name value="[string]"/><!-- 0..1 Short name -->
  <description value="[string]"/><!-- 0..1 Summary description -->
  <population>  <!-- 0..* Population criteria -->
   <type value="[code]"/><!-- 1..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score -->
   <identifier><!-- 1..1 Identifier Unique identifier --></identifier>
   <name value="[string]"/><!-- 0..1 Short name -->
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria value="[string]"/><!-- 1..1 The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria -->
  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <identifier><!-- 1..1 Identifier The identifier for the stratifier used to coordinate the reported data back to this stratifier --></identifier>
   <criteria value="[string]"/><!-- 0..1 Stratifier criteria -->
   <path value="[string]"/><!-- 0..1 Path to the stratifier -->
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* Supplemental data -->
  <identifier><!-- 1..1 Identifier Identifier, unique within the measure --></identifier>
  <usage value="[code]"/><!-- 0..* supplemental-data | risk-adjustment-factor -->
  <criteria value="[string]"/><!-- 0..1 Supplemental data criteria -->
  <path value="[string]"/><!-- 0..1 Path to the supplemental data element -->
 </supplementalData>
</Measure>

JSON Template

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "moduleMetadata" : { ModuleMetadata }, // Metadata for the measure
  "library" : [{ Reference(Library) }], // Logic used by the measure
  "disclaimer" : "<markdown>", // Disclaimer for the measure
  "scoring" : "<code>", // proportion | ratio | continuous-variable | cohort
  "type" : ["<code>"], // process | outcome
  "riskAdjustment" : "<string>", // How is risk adjustment applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Why does this measure exist
  "clinicalRecommendationStatement" : "<markdown>", // Clinical recommendation
  "improvementNotation" : "<string>", // Improvement notation for the measure, e.g. higher score indicates better quality
  "definition" : "<markdown>", // A natural language definition of the measure
  "guidance" : "<markdown>", // The guidance for the measure
  "set" : "<string>", // The measure set, e.g. Preventive Care and Screening
  "group" : [{ // Population criteria group
    "identifier" : { Identifier }, // R!  Unique identifier
    "name" : "<string>", // Short name
    "description" : "<string>", // Summary description
    "population" : [{ // Population criteria
      "type" : "<code>", // R!  initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-score
      "identifier" : { Identifier }, // R!  Unique identifier
      "name" : "<string>", // Short name
      "description" : "<string>", // The human readable description of this population criteria
      "criteria" : "<string>" // R!  The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "identifier" : { Identifier }, // R!  The identifier for the stratifier used to coordinate the reported data back to this stratifier
      "criteria" : "<string>", // Stratifier criteria
      "path" : "<string>" // Path to the stratifier
    }]
  }],
  "supplementalData" : [{ // Supplemental data
    "identifier" : { Identifier }, // R!  Identifier, unique within the measure
    "usage" : ["<code>"], // supplemental-data | risk-adjustment-factor
    "criteria" : "<string>", // Supplemental data criteria
    "path" : "<string>" // Path to the supplemental data element
  }]
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.21.2.1 Terminology Bindings

PathDefinitionTypeReference
Measure.scoring The scoring type of the measureRequiredMeasureScoring
Measure.type The type of measureRequiredMeasureType
Measure.group.population.type The type of populationRequiredMeasurePopulationType
Measure.supplementalData.usage The intended usage for supplemental data elements in the measureRequiredMeasureDataUsage

4.21.3 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
descriptionstringText search against the descriptionMeasure.moduleMetadata.description
identifiertokenLogical identifier for the module (e.g. CMS-143)Measure.moduleMetadata.identifier
statustokenStatus of the moduleMeasure.moduleMetadata.status
titlestringText search against the titleMeasure.moduleMetadata.title
topictokenTopics associated with the moduleMeasure.moduleMetadata.topic
versionstringVersion of the module (e.g. 1.0.0)Measure.moduleMetadata.version