Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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

14.18 Resource Measure - Content

Clinical Quality Information Work GroupMaturity Level: 3 Trial UseSecurity Category: Anonymous Compartments: Not linked to any defined compartments

The Measure resource provides the definition of a quality measure.

14.18.1 Scope and Usage

The Measure resource represents a structured, computable definition of a health-related measure such as a clinical quality measure, public health indicator, or population analytics 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 guidelines 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 typically contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as population 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.

For a detailed discussion of how to use the Measure and MeasureReport resources, refer to the Quality Reporting topic.

14.18.2 Boundaries and Relationships

The Measure resource describes a specific quality measure, or population analytic, providing the structure of the measure in terms of the calculation elements (the populations involved). The Group resource is also capable of describing a population, however, the complexity involved in specifying the criteria in the general case requires the use of a high-level query language such as Clinical Quality Language (CQL). As such, the Measure resource defines only the top-level populations and references expressions for the actual criteria. These expressions are typically provided using a Library resource containing CQL or ELM expressions. In addition, the individual members of a population may be cases such as encounters or procedures and in these cases, the Group resource would be unable to represent the population characteristics accurately.

A Measure is also similar to an Observation resource, with the exception that the Measure is purely definitional, it contains no actual measurements, only a description of how to calculate a particular measurement or set of measurements.

A Measure is also similar to a clinical document, but as with the relationship to Observation, a Document is specific to a particular subject.

14.18.3 References to this Resource

14.18.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure TUDomainResourceA quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Interfaces Implemented: MetadataResource
... url ΣC0..1uriCanonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
... identifier Σ0..*IdentifierAdditional identifier for the measure

... version Σ0..1stringBusiness version of the measure
... name ΣC0..1stringName for this measure (computer friendly)
... title Σ0..1stringName for this measure (human friendly)
... subtitle 0..1stringSubordinate title of the measure
... status ?!Σ1..1codedraft | active | retired | unknown
PublicationStatus (Required)
... experimental Σ0..1booleanFor testing purposes, not real usage
... subject[x] 0..1E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Participant Resource Types (Extensible)
.... subjectCodeableConceptCodeableConcept
.... subjectReferenceReference(Group)
... basis Σ0..1codePopulation basis
All FHIR Types (Required)
... date Σ0..1dateTimeDate last changed
... publisher Σ0..1stringName of the publisher/steward (organization or individual)
... contact Σ0..*ContactDetailContact details for the publisher

... description Σ0..1markdownNatural language description of the measure
... useContext Σ0..*UsageContextThe context that the content is intended to support

... jurisdiction Σ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Jurisdiction (Extensible)

... purpose 0..1markdownWhy this measure is defined
... usage 0..1stringDescribes the clinical usage of the measure
... copyright 0..1markdownUse and/or publishing restrictions
... approvalDate 0..1dateWhen the measure was approved by publisher
... lastReviewDate 0..1dateWhen the measure was last reviewed
... effectivePeriod Σ0..1PeriodWhen the measure is expected to be used
... topic 0..*CodeableConceptThe category of the measure, such as Education, Treatment, Assessment, etc.
DefinitionTopic (Example)

... author 0..*ContactDetailWho authored the content

... editor 0..*ContactDetailWho edited the content

... reviewer 0..*ContactDetailWho reviewed the content

... endorser 0..*ContactDetailWho endorsed the content

... relatedArtifact 0..*RelatedArtifactAdditional documentation, citations, etc.

... library 0..*canonical(Library)Logic used by the measure

... disclaimer Σ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
MeasureScoring (Extensible)
... scoringUnit Σ0..1CodeableConceptWhat units?
Measure Scoring Unit (Example)
... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
CompositeMeasureScoring (Extensible)
... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
MeasureType (Extensible)

... riskAdjustment Σ0..1stringHow risk adjustment is applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownDetailed description of why the measure exists
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation Σ0..1CodeableConceptincrease | decrease
MeasureImprovementNotation (Required)
... term 0..*BackboneElementDefined terms used in the measure documentation

.... code 0..1CodeableConceptWhat term?
MeasureDefinitionExample (Example)
.... definition 0..1markdownMeaning of the term
... guidance Σ0..1markdownAdditional guidance for implementers
... group 0..*BackboneElementPopulation criteria group

.... code 0..1CodeableConceptMeaning of the group
MeasureGroupExample (Example)
.... description 0..1stringSummary description
.... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
MeasureType (Extensible)

.... basis Σ0..1codePopulation basis
All FHIR Types (Required)
.... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
MeasureScoring (Extensible)
.... scoringUnit Σ0..1CodeableConceptWhat units?
Measure Scoring Unit (Example)
.... improvementNotation Σ0..1CodeableConceptincrease | decrease
MeasureImprovementNotation (Required)
.... population 0..*BackboneElementPopulation criteria

..... code 0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
MeasurePopulationType (Extensible)
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1ExpressionThe criteria that defines this population
..... inputPopulationId 0..1stringWhich population
..... aggregateMethod 0..1CodeableConceptAggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Measure Aggregate Method (Extensible)
.... stratifier 0..*BackboneElementStratifier criteria for the measure

..... code 0..1CodeableConceptMeaning of the stratifier
MeasureStratifierExample (Example)
..... description 0..1stringThe human readable description of this stratifier
..... criteria 0..1ExpressionHow the measure should be stratified
..... component 0..*BackboneElementStratifier criteria component for the measure

...... code 0..1CodeableConceptMeaning of the stratifier component
MeasureStratifierExample (Example)
...... description 0..1stringThe human readable description of this stratifier component
...... criteria 1..1ExpressionComponent of how the measure should be stratified
... supplementalData 0..*BackboneElementWhat other data should be reported with the measure

.... code 0..1CodeableConceptMeaning of the supplemental data
MeasureSupplementalDataExample (Example)
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
MeasureDataUsage (Extensible)

.... description 0..1stringThe human readable description of this supplemental data
.... criteria 1..1ExpressionExpression describing additional data to be reported

doco Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

Measure (DomainResource) +MetadataResourceAn 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 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 serversurl : uri [0..1]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 instanceidentifier : Identifier [0..*]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 artifactsversion : string [0..1]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 generationname : string [0..1] « This element has or is affected by some invariantsC »A short, descriptive, user-friendly title for the measuretitle : string [0..1]An explanatory or alternate title for the measure giving additional information about its contentsubtitle : string [0..1]The status of this measure. Enables tracking the life-cycle of the content (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)PublicationStatus! »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 usageexperimental : boolean [0..1]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 anythingsubject[x] : DataType [0..1] « CodeableConcept|Reference(Group); null (Strength=Extensible) ParticipantResourceTypes+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »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 changesdate : dateTime [0..1]The name of the organization or individual responsible for the release and ongoing maintenance of the measurepublisher : string [0..1]Contact details to assist a user in finding and communicating with the publishercontact : ContactDetail [0..*]A free text natural language description of the measure from a consumer's perspectivedescription : markdown [0..1]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 instancesuseContext : UsageContext [0..*]A legal or geographic region in which the measure is intended to be usedjurisdiction : CodeableConcept [0..*] « null (Strength=Extensible)Jurisdiction ValueSet+ »Explanation of why this measure is needed and why it has been designed as it haspurpose : markdown [0..1]A detailed description, from a clinical perspective, of how the measure is usedusage : string [0..1]A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measurecopyright : markdown [0..1]The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usageapprovalDate : date [0..1]The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval datelastReviewDate : date [0..1]The period during which the measure content was or is planned to be in active useeffectivePeriod : Period [0..1]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 searchingtopic : CodeableConcept [0..*] « null (Strength=Example)DefinitionTopic?? »An individiual or organization primarily involved in the creation and maintenance of the contentauthor : ContactDetail [0..*]An individual or organization primarily responsible for internal coherence of the contenteditor : ContactDetail [0..*]An individual or organization primarily responsible for review of some aspect of the contentreviewer : ContactDetail [0..*]An individual or organization responsible for officially endorsing the content for use in some settingendorser : ContactDetail [0..*]Related artifacts such as additional documentation, justification, or bibliographic referencesrelatedArtifact : RelatedArtifact [0..*]A reference to a Library resource containing the formal logic used by the measurelibrary : canonical [0..*] « Library »Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measuredisclaimer : markdown [0..1]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 representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »If this is a composite measure, the scoring method used to combine the component measures to determine the composite scorecompositeScoring : CodeableConcept [0..1] « null (Strength=Extensible)CompositeMeasureScoring+ »Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)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]Describes how to combine the information calculated, based on logic in each of several populations, into one summarized resultrateAggregation : string [0..1]Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidencerationale : markdown [0..1]Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measureclinicalRecommendationStatement : markdown [0..1]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)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measureguidance : markdown [0..1]TermA codeable representation of the defined termcode : CodeableConcept [0..1] « null (Strength=Example)MeasureDefinitionExample?? »Provides a definition for the term as used within the measuredefinition : markdown [0..1]GroupIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureGroupExample?? »The human readable description of this population groupdescription : string [0..1]Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)MeasureType+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »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 representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »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)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »PopulationThe type of population criteriacode : CodeableConcept [0..1] « null (Strength=Extensible)MeasurePopulationType+ »The human readable description of this population criteriadescription : string [0..1]An expression that specifies the criteria for the population, typically the name of an expression in a librarycriteria : Expression [1..1]The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting pointinputPopulationId : string [0..1]Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculationaggregateMethod : CodeableConcept [0..1] « null (Strength=Extensible)MeasureAggregateMethod+ »StratifierIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? »The human readable description of this stratifier criteriadescription : string [0..1]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 elementcriteria : Expression [0..1]ComponentIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? »The human readable description of this stratifier criteria componentdescription : string [0..1]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 elementcriteria : Expression [1..1]SupplementalDataIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureSupplementalDataExample?? »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 : CodeableConcept [0..*] « null (Strength=Extensible)MeasureDataUsage+ »The human readable description of this supplemental datadescription : string [0..1]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 elementcriteria : Expression [1..1]Provides a description of an individual term used within the measureterm[0..*]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 -->
 <url value="[uri]"/><!-- 0..1 Canonical identifier for this measure, represented as a URI (globally unique) -->
 <identifier><!-- 0..* Identifier Additional identifier for the measure --></identifier>
 <version value="[string]"/><!-- 0..1 Business version of the measure -->
 <name value="[string]"/><!-- I 0..1 Name for this measure (computer friendly) -->
 <title value="[string]"/><!-- 0..1 Name for this measure (human friendly) -->
 <subtitle value="[string]"/><!-- 0..1 Subordinate title of the measure -->
 <status value="[code]"/><!-- 1..1 draft | active | retired | unknown -->
 <experimental value="[boolean]"/><!-- 0..1 For testing purposes, not real usage -->
 <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
 <basis value="[code]"/><!-- 0..1 Population basis -->
 <date value="[dateTime]"/><!-- 0..1 Date last changed -->
 <publisher value="[string]"/><!-- 0..1 Name of the publisher/steward (organization or individual) -->
 <contact><!-- 0..* ContactDetail Contact details for the publisher --></contact>
 <description value="[markdown]"/><!-- 0..1 Natural language description of the measure -->
 <useContext><!-- 0..* UsageContext The context that the content is intended to support --></useContext>
 <jurisdiction><!-- 0..* CodeableConcept Intended jurisdiction for measure (if applicable) --></jurisdiction>
 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <usage value="[string]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Use and/or publishing restrictions -->
 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed -->
 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. --></topic>
 <author><!-- 0..* ContactDetail Who authored the content --></author>
 <editor><!-- 0..* ContactDetail Who edited the content --></editor>
 <reviewer><!-- 0..* ContactDetail Who reviewed the content --></reviewer>
 <endorser><!-- 0..* ContactDetail Who endorsed the content --></endorser>
 <relatedArtifact><!-- 0..* RelatedArtifact Additional documentation, citations, etc. --></relatedArtifact>
 <library><!-- 0..* canonical(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for use of the measure or its referenced content -->
 <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
 <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
 <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted --></compositeScoring>
 <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
 <riskAdjustment value="[string]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Detailed description of why the measure exists -->
 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Summary of clinical guidelines -->
 <improvementNotation><!-- 0..1 CodeableConcept increase | decrease --></improvementNotation>
 <term>  <!-- 0..* Defined terms used in the measure documentation -->
  <code><!-- 0..1 CodeableConcept What term? --></code>
  <definition value="[markdown]"/><!-- 0..1 Meaning of the term -->
 </term>
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers -->
 <group>  <!-- 0..* Population criteria group -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[string]"/><!-- 0..1 Summary description -->
  <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
  <basis value="[code]"/><!-- 0..1 Population basis -->
  <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
  <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
  <improvementNotation><!-- 0..1 CodeableConcept increase | decrease --></improvementNotation>
  <population>  <!-- 0..* Population criteria -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria><!-- 1..1 Expression The criteria that defines this population --></criteria>
   <inputPopulationId value="[string]"/><!-- 0..1 Which population -->
   <aggregateMethod><!-- 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) --></aggregateMethod>
  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <code><!-- 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this stratifier -->
   <criteria><!-- 0..1 Expression How the measure should be stratified --></criteria>
   <component>  <!-- 0..* Stratifier criteria component for the measure -->
    <code><!-- 0..1 CodeableConcept Meaning of the stratifier component --></code>
    <description value="[string]"/><!-- 0..1 The human readable description of this stratifier component -->
    <criteria><!-- 1..1 Expression Component of how the measure should be stratified --></criteria>
   </component>
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor --></usage>
  <description value="[string]"/><!-- 0..1 The human readable description of this supplemental data -->
  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>
 </supplementalData>
</Measure>

JSON Template

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "url" : "<uri>", // Canonical identifier for this measure, represented as a URI (globally unique)
  "identifier" : [{ Identifier }], // Additional identifier for the measure
  "version" : "<string>", // Business version of the measure
  "name" : "<string>", // I Name for this measure (computer friendly)
  "title" : "<string>", // Name for this measure (human friendly)
  "subtitle" : "<string>", // Subordinate title of the measure
  "status" : "<code>", // R!  draft | active | retired | unknown
  "experimental" : <boolean>, // For testing purposes, not real usage
  // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:
  "subjectCodeableConcept" : { CodeableConcept },
  "subjectReference" : { Reference(Group) },
  "basis" : "<code>", // Population basis
  "date" : "<dateTime>", // Date last changed
  "publisher" : "<string>", // Name of the publisher/steward (organization or individual)
  "contact" : [{ ContactDetail }], // Contact details for the publisher
  "description" : "<markdown>", // Natural language description of the measure
  "useContext" : [{ UsageContext }], // The context that the content is intended to support
  "jurisdiction" : [{ CodeableConcept }], // Intended jurisdiction for measure (if applicable)
  "purpose" : "<markdown>", // Why this measure is defined
  "usage" : "<string>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Use and/or publishing restrictions
  "approvalDate" : "<date>", // When the measure was approved by publisher
  "lastReviewDate" : "<date>", // When the measure was last reviewed
  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "topic" : [{ CodeableConcept }], // The category of the measure, such as Education, Treatment, Assessment, etc.
  "author" : [{ ContactDetail }], // Who authored the content
  "editor" : [{ ContactDetail }], // Who edited the content
  "reviewer" : [{ ContactDetail }], // Who reviewed the content
  "endorser" : [{ ContactDetail }], // Who endorsed the content
  "relatedArtifact" : [{ RelatedArtifact }], // Additional documentation, citations, etc.
  "library" : ["<canonical(Library)>"], // Logic used by the measure
  "disclaimer" : "<markdown>", // Disclaimer for use of the measure or its referenced content
  "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
  "scoringUnit" : { CodeableConcept }, // What units?
  "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted
  "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
  "riskAdjustment" : "<string>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Detailed description of why the measure exists
  "clinicalRecommendationStatement" : "<markdown>", // Summary of clinical guidelines
  "improvementNotation" : { CodeableConcept }, // increase | decrease
  "term" : [{ // Defined terms used in the measure documentation
    "code" : { CodeableConcept }, // What term?
    "definition" : "<markdown>" // Meaning of the term
  }],
  "guidance" : "<markdown>", // Additional guidance for implementers
  "group" : [{ // Population criteria group
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<string>", // Summary description
    "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
    "basis" : "<code>", // Population basis
    "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
    "scoringUnit" : { CodeableConcept }, // What units?
    "improvementNotation" : { CodeableConcept }, // increase | decrease
    "population" : [{ // Population criteria
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      "description" : "<string>", // The human readable description of this population criteria
      "criteria" : { Expression }, // R!  The criteria that defines this population
      "inputPopulationId" : "<string>", // Which population
      "aggregateMethod" : { CodeableConcept } // Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "code" : { CodeableConcept }, // Meaning of the stratifier
      "description" : "<string>", // The human readable description of this stratifier
      "criteria" : { Expression }, // How the measure should be stratified
      "component" : [{ // Stratifier criteria component for the measure
        "code" : { CodeableConcept }, // Meaning of the stratifier component
        "description" : "<string>", // The human readable description of this stratifier component
        "criteria" : { Expression } // R!  Component of how the measure should be stratified
      }]
    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor
    "description" : "<string>", // The human readable description of this supplemental data
    "criteria" : { Expression } // R!  Expression describing additional data to be reported
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Measure;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Measure.url [ uri ]; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)
  fhir:Measure.identifier [ Identifier ], ... ; # 0..* Additional identifier for the measure
  fhir:Measure.version [ string ]; # 0..1 Business version of the measure
  fhir:Measure.name [ string ]; # 0..1 I Name for this measure (computer friendly)
  fhir:Measure.title [ string ]; # 0..1 Name for this measure (human friendly)
  fhir:Measure.subtitle [ string ]; # 0..1 Subordinate title of the measure
  fhir:Measure.status [ code ]; # 1..1 draft | active | retired | unknown
  fhir:Measure.experimental [ boolean ]; # 0..1 For testing purposes, not real usage
  # Measure.subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:Measure.subjectCodeableConcept [ CodeableConcept ]
    fhir:Measure.subjectReference [ Reference(Group) ]
  fhir:Measure.basis [ code ]; # 0..1 Population basis
  fhir:Measure.date [ dateTime ]; # 0..1 Date last changed
  fhir:Measure.publisher [ string ]; # 0..1 Name of the publisher/steward (organization or individual)
  fhir:Measure.contact [ ContactDetail ], ... ; # 0..* Contact details for the publisher
  fhir:Measure.description [ markdown ]; # 0..1 Natural language description of the measure
  fhir:Measure.useContext [ UsageContext ], ... ; # 0..* The context that the content is intended to support
  fhir:Measure.jurisdiction [ CodeableConcept ], ... ; # 0..* Intended jurisdiction for measure (if applicable)
  fhir:Measure.purpose [ markdown ]; # 0..1 Why this measure is defined
  fhir:Measure.usage [ string ]; # 0..1 Describes the clinical usage of the measure
  fhir:Measure.copyright [ markdown ]; # 0..1 Use and/or publishing restrictions
  fhir:Measure.approvalDate [ date ]; # 0..1 When the measure was approved by publisher
  fhir:Measure.lastReviewDate [ date ]; # 0..1 When the measure was last reviewed
  fhir:Measure.effectivePeriod [ Period ]; # 0..1 When the measure is expected to be used
  fhir:Measure.topic [ CodeableConcept ], ... ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc.
  fhir:Measure.author [ ContactDetail ], ... ; # 0..* Who authored the content
  fhir:Measure.editor [ ContactDetail ], ... ; # 0..* Who edited the content
  fhir:Measure.reviewer [ ContactDetail ], ... ; # 0..* Who reviewed the content
  fhir:Measure.endorser [ ContactDetail ], ... ; # 0..* Who endorsed the content
  fhir:Measure.relatedArtifact [ RelatedArtifact ], ... ; # 0..* Additional documentation, citations, etc.
  fhir:Measure.library [ canonical(Library) ], ... ; # 0..* Logic used by the measure
  fhir:Measure.disclaimer [ markdown ]; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:Measure.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
  fhir:Measure.scoringUnit [ CodeableConcept ]; # 0..1 What units?
  fhir:Measure.compositeScoring [ CodeableConcept ]; # 0..1 opportunity | all-or-nothing | linear | weighted
  fhir:Measure.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
  fhir:Measure.riskAdjustment [ string ]; # 0..1 How risk adjustment is applied for this measure
  fhir:Measure.rateAggregation [ string ]; # 0..1 How is rate aggregation performed for this measure
  fhir:Measure.rationale [ markdown ]; # 0..1 Detailed description of why the measure exists
  fhir:Measure.clinicalRecommendationStatement [ markdown ]; # 0..1 Summary of clinical guidelines
  fhir:Measure.improvementNotation [ CodeableConcept ]; # 0..1 increase | decrease
  fhir:Measure.term [ # 0..* Defined terms used in the measure documentation
    fhir:Measure.term.code [ CodeableConcept ]; # 0..1 What term?
    fhir:Measure.term.definition [ markdown ]; # 0..1 Meaning of the term
  ], ...;
  fhir:Measure.guidance [ markdown ]; # 0..1 Additional guidance for implementers
  fhir:Measure.group [ # 0..* Population criteria group
    fhir:Measure.group.code [ CodeableConcept ]; # 0..1 Meaning of the group
    fhir:Measure.group.description [ string ]; # 0..1 Summary description
    fhir:Measure.group.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
    fhir:Measure.group.basis [ code ]; # 0..1 Population basis
    fhir:Measure.group.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
    fhir:Measure.group.scoringUnit [ CodeableConcept ]; # 0..1 What units?
    fhir:Measure.group.improvementNotation [ CodeableConcept ]; # 0..1 increase | decrease
    fhir:Measure.group.population [ # 0..* Population criteria
      fhir:Measure.group.population.code [ CodeableConcept ]; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:Measure.group.population.description [ string ]; # 0..1 The human readable description of this population criteria
      fhir:Measure.group.population.criteria [ Expression ]; # 1..1 The criteria that defines this population
      fhir:Measure.group.population.inputPopulationId [ string ]; # 0..1 Which population
      fhir:Measure.group.population.aggregateMethod [ CodeableConcept ]; # 0..1 Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    ], ...;
    fhir:Measure.group.stratifier [ # 0..* Stratifier criteria for the measure
      fhir:Measure.group.stratifier.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier
      fhir:Measure.group.stratifier.description [ string ]; # 0..1 The human readable description of this stratifier
      fhir:Measure.group.stratifier.criteria [ Expression ]; # 0..1 How the measure should be stratified
      fhir:Measure.group.stratifier.component [ # 0..* Stratifier criteria component for the measure
        fhir:Measure.group.stratifier.component.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier component
        fhir:Measure.group.stratifier.component.description [ string ]; # 0..1 The human readable description of this stratifier component
        fhir:Measure.group.stratifier.component.criteria [ Expression ]; # 1..1 Component of how the measure should be stratified
      ], ...;
    ], ...;
  ], ...;
  fhir:Measure.supplementalData [ # 0..* What other data should be reported with the measure
    fhir:Measure.supplementalData.code [ CodeableConcept ]; # 0..1 Meaning of the supplemental data
    fhir:Measure.supplementalData.usage [ CodeableConcept ], ... ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:Measure.supplementalData.description [ string ]; # 0..1 The human readable description of this supplemental data
    fhir:Measure.supplementalData.criteria [ Expression ]; # 1..1 Expression describing additional data to be reported
  ], ...;
]

Changes since R4

Measure
Measure.subject[x]
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to http://hl7.org/fhir/ValueSet/participant-resource-types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/resource-types" to "http://hl7.org/fhir/fhir-types"
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to http://hl7.org/fhir/ValueSet/participant-resource-types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/resource-types" to "http://hl7.org/fhir/fhir-types"
Measure.basis
  • Added Element
Measure.scoringUnit
  • Added Element
Measure.term
  • Added Element
Measure.term.code
  • Added Element
Measure.term.definition
  • Added Element
Measure.group.type
  • Added Element
Measure.group.basis
  • Added Element
Measure.group.scoring
  • Added Element
Measure.group.scoringUnit
  • Added Element
Measure.group.improvementNotation
  • Added Element
Measure.group.population.inputPopulationId
  • Added Element
Measure.group.population.aggregateMethod
  • Added Element
Measure.definition
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 6 tests that all execute ok. All tests pass round-trip testing and 6 r3 resources are invalid (0 errors).)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure TUDomainResourceA quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Interfaces Implemented: MetadataResource
... url ΣC0..1uriCanonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
... identifier Σ0..*IdentifierAdditional identifier for the measure

... version Σ0..1stringBusiness version of the measure
... name ΣC0..1stringName for this measure (computer friendly)
... title Σ0..1stringName for this measure (human friendly)
... subtitle 0..1stringSubordinate title of the measure
... status ?!Σ1..1codedraft | active | retired | unknown
PublicationStatus (Required)
... experimental Σ0..1booleanFor testing purposes, not real usage
... subject[x] 0..1E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Participant Resource Types (Extensible)
.... subjectCodeableConceptCodeableConcept
.... subjectReferenceReference(Group)
... basis Σ0..1codePopulation basis
All FHIR Types (Required)
... date Σ0..1dateTimeDate last changed
... publisher Σ0..1stringName of the publisher/steward (organization or individual)
... contact Σ0..*ContactDetailContact details for the publisher

... description Σ0..1markdownNatural language description of the measure
... useContext Σ0..*UsageContextThe context that the content is intended to support

... jurisdiction Σ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Jurisdiction (Extensible)

... purpose 0..1markdownWhy this measure is defined
... usage 0..1stringDescribes the clinical usage of the measure
... copyright 0..1markdownUse and/or publishing restrictions
... approvalDate 0..1dateWhen the measure was approved by publisher
... lastReviewDate 0..1dateWhen the measure was last reviewed
... effectivePeriod Σ0..1PeriodWhen the measure is expected to be used
... topic 0..*CodeableConceptThe category of the measure, such as Education, Treatment, Assessment, etc.
DefinitionTopic (Example)

... author 0..*ContactDetailWho authored the content

... editor 0..*ContactDetailWho edited the content

... reviewer 0..*ContactDetailWho reviewed the content

... endorser 0..*ContactDetailWho endorsed the content

... relatedArtifact 0..*RelatedArtifactAdditional documentation, citations, etc.

... library 0..*canonical(Library)Logic used by the measure

... disclaimer Σ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
MeasureScoring (Extensible)
... scoringUnit Σ0..1CodeableConceptWhat units?
Measure Scoring Unit (Example)
... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
CompositeMeasureScoring (Extensible)
... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
MeasureType (Extensible)

... riskAdjustment Σ0..1stringHow risk adjustment is applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownDetailed description of why the measure exists
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation Σ0..1CodeableConceptincrease | decrease
MeasureImprovementNotation (Required)
... term 0..*BackboneElementDefined terms used in the measure documentation

.... code 0..1CodeableConceptWhat term?
MeasureDefinitionExample (Example)
.... definition 0..1markdownMeaning of the term
... guidance Σ0..1markdownAdditional guidance for implementers
... group 0..*BackboneElementPopulation criteria group

.... code 0..1CodeableConceptMeaning of the group
MeasureGroupExample (Example)
.... description 0..1stringSummary description
.... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
MeasureType (Extensible)

.... basis Σ0..1codePopulation basis
All FHIR Types (Required)
.... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
MeasureScoring (Extensible)
.... scoringUnit Σ0..1CodeableConceptWhat units?
Measure Scoring Unit (Example)
.... improvementNotation Σ0..1CodeableConceptincrease | decrease
MeasureImprovementNotation (Required)
.... population 0..*BackboneElementPopulation criteria

..... code 0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
MeasurePopulationType (Extensible)
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1ExpressionThe criteria that defines this population
..... inputPopulationId 0..1stringWhich population
..... aggregateMethod 0..1CodeableConceptAggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Measure Aggregate Method (Extensible)
.... stratifier 0..*BackboneElementStratifier criteria for the measure

..... code 0..1CodeableConceptMeaning of the stratifier
MeasureStratifierExample (Example)
..... description 0..1stringThe human readable description of this stratifier
..... criteria 0..1ExpressionHow the measure should be stratified
..... component 0..*BackboneElementStratifier criteria component for the measure

...... code 0..1CodeableConceptMeaning of the stratifier component
MeasureStratifierExample (Example)
...... description 0..1stringThe human readable description of this stratifier component
...... criteria 1..1ExpressionComponent of how the measure should be stratified
... supplementalData 0..*BackboneElementWhat other data should be reported with the measure

.... code 0..1CodeableConceptMeaning of the supplemental data
MeasureSupplementalDataExample (Example)
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
MeasureDataUsage (Extensible)

.... description 0..1stringThe human readable description of this supplemental data
.... criteria 1..1ExpressionExpression describing additional data to be reported

doco Documentation for this format

See the Extensions for this resource

UML Diagram (Legend)

Measure (DomainResource) +MetadataResourceAn 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 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 serversurl : uri [0..1]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 instanceidentifier : Identifier [0..*]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 artifactsversion : string [0..1]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 generationname : string [0..1] « This element has or is affected by some invariantsC »A short, descriptive, user-friendly title for the measuretitle : string [0..1]An explanatory or alternate title for the measure giving additional information about its contentsubtitle : string [0..1]The status of this measure. Enables tracking the life-cycle of the content (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)PublicationStatus! »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 usageexperimental : boolean [0..1]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 anythingsubject[x] : DataType [0..1] « CodeableConcept|Reference(Group); null (Strength=Extensible) ParticipantResourceTypes+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »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 changesdate : dateTime [0..1]The name of the organization or individual responsible for the release and ongoing maintenance of the measurepublisher : string [0..1]Contact details to assist a user in finding and communicating with the publishercontact : ContactDetail [0..*]A free text natural language description of the measure from a consumer's perspectivedescription : markdown [0..1]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 instancesuseContext : UsageContext [0..*]A legal or geographic region in which the measure is intended to be usedjurisdiction : CodeableConcept [0..*] « null (Strength=Extensible)Jurisdiction ValueSet+ »Explanation of why this measure is needed and why it has been designed as it haspurpose : markdown [0..1]A detailed description, from a clinical perspective, of how the measure is usedusage : string [0..1]A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measurecopyright : markdown [0..1]The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usageapprovalDate : date [0..1]The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval datelastReviewDate : date [0..1]The period during which the measure content was or is planned to be in active useeffectivePeriod : Period [0..1]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 searchingtopic : CodeableConcept [0..*] « null (Strength=Example)DefinitionTopic?? »An individiual or organization primarily involved in the creation and maintenance of the contentauthor : ContactDetail [0..*]An individual or organization primarily responsible for internal coherence of the contenteditor : ContactDetail [0..*]An individual or organization primarily responsible for review of some aspect of the contentreviewer : ContactDetail [0..*]An individual or organization responsible for officially endorsing the content for use in some settingendorser : ContactDetail [0..*]Related artifacts such as additional documentation, justification, or bibliographic referencesrelatedArtifact : RelatedArtifact [0..*]A reference to a Library resource containing the formal logic used by the measurelibrary : canonical [0..*] « Library »Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measuredisclaimer : markdown [0..1]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 representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »If this is a composite measure, the scoring method used to combine the component measures to determine the composite scorecompositeScoring : CodeableConcept [0..1] « null (Strength=Extensible)CompositeMeasureScoring+ »Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)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]Describes how to combine the information calculated, based on logic in each of several populations, into one summarized resultrateAggregation : string [0..1]Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidencerationale : markdown [0..1]Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measureclinicalRecommendationStatement : markdown [0..1]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)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measureguidance : markdown [0..1]TermA codeable representation of the defined termcode : CodeableConcept [0..1] « null (Strength=Example)MeasureDefinitionExample?? »Provides a definition for the term as used within the measuredefinition : markdown [0..1]GroupIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureGroupExample?? »The human readable description of this population groupdescription : string [0..1]Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)MeasureType+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »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 representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »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)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »PopulationThe type of population criteriacode : CodeableConcept [0..1] « null (Strength=Extensible)MeasurePopulationType+ »The human readable description of this population criteriadescription : string [0..1]An expression that specifies the criteria for the population, typically the name of an expression in a librarycriteria : Expression [1..1]The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting pointinputPopulationId : string [0..1]Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculationaggregateMethod : CodeableConcept [0..1] « null (Strength=Extensible)MeasureAggregateMethod+ »StratifierIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? »The human readable description of this stratifier criteriadescription : string [0..1]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 elementcriteria : Expression [0..1]ComponentIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? »The human readable description of this stratifier criteria componentdescription : string [0..1]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 elementcriteria : Expression [1..1]SupplementalDataIndicates 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 measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureSupplementalDataExample?? »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 : CodeableConcept [0..*] « null (Strength=Extensible)MeasureDataUsage+ »The human readable description of this supplemental datadescription : string [0..1]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 elementcriteria : Expression [1..1]Provides a description of an individual term used within the measureterm[0..*]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 -->
 <url value="[uri]"/><!-- 0..1 Canonical identifier for this measure, represented as a URI (globally unique) -->
 <identifier><!-- 0..* Identifier Additional identifier for the measure --></identifier>
 <version value="[string]"/><!-- 0..1 Business version of the measure -->
 <name value="[string]"/><!-- I 0..1 Name for this measure (computer friendly) -->
 <title value="[string]"/><!-- 0..1 Name for this measure (human friendly) -->
 <subtitle value="[string]"/><!-- 0..1 Subordinate title of the measure -->
 <status value="[code]"/><!-- 1..1 draft | active | retired | unknown -->
 <experimental value="[boolean]"/><!-- 0..1 For testing purposes, not real usage -->
 <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
 <basis value="[code]"/><!-- 0..1 Population basis -->
 <date value="[dateTime]"/><!-- 0..1 Date last changed -->
 <publisher value="[string]"/><!-- 0..1 Name of the publisher/steward (organization or individual) -->
 <contact><!-- 0..* ContactDetail Contact details for the publisher --></contact>
 <description value="[markdown]"/><!-- 0..1 Natural language description of the measure -->
 <useContext><!-- 0..* UsageContext The context that the content is intended to support --></useContext>
 <jurisdiction><!-- 0..* CodeableConcept Intended jurisdiction for measure (if applicable) --></jurisdiction>
 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <usage value="[string]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Use and/or publishing restrictions -->
 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed -->
 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. --></topic>
 <author><!-- 0..* ContactDetail Who authored the content --></author>
 <editor><!-- 0..* ContactDetail Who edited the content --></editor>
 <reviewer><!-- 0..* ContactDetail Who reviewed the content --></reviewer>
 <endorser><!-- 0..* ContactDetail Who endorsed the content --></endorser>
 <relatedArtifact><!-- 0..* RelatedArtifact Additional documentation, citations, etc. --></relatedArtifact>
 <library><!-- 0..* canonical(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for use of the measure or its referenced content -->
 <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
 <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
 <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted --></compositeScoring>
 <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
 <riskAdjustment value="[string]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Detailed description of why the measure exists -->
 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Summary of clinical guidelines -->
 <improvementNotation><!-- 0..1 CodeableConcept increase | decrease --></improvementNotation>
 <term>  <!-- 0..* Defined terms used in the measure documentation -->
  <code><!-- 0..1 CodeableConcept What term? --></code>
  <definition value="[markdown]"/><!-- 0..1 Meaning of the term -->
 </term>
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers -->
 <group>  <!-- 0..* Population criteria group -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[string]"/><!-- 0..1 Summary description -->
  <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
  <basis value="[code]"/><!-- 0..1 Population basis -->
  <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
  <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
  <improvementNotation><!-- 0..1 CodeableConcept increase | decrease --></improvementNotation>
  <population>  <!-- 0..* Population criteria -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria><!-- 1..1 Expression The criteria that defines this population --></criteria>
   <inputPopulationId value="[string]"/><!-- 0..1 Which population -->
   <aggregateMethod><!-- 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) --></aggregateMethod>
  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <code><!-- 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this stratifier -->
   <criteria><!-- 0..1 Expression How the measure should be stratified --></criteria>
   <component>  <!-- 0..* Stratifier criteria component for the measure -->
    <code><!-- 0..1 CodeableConcept Meaning of the stratifier component --></code>
    <description value="[string]"/><!-- 0..1 The human readable description of this stratifier component -->
    <criteria><!-- 1..1 Expression Component of how the measure should be stratified --></criteria>
   </component>
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor --></usage>
  <description value="[string]"/><!-- 0..1 The human readable description of this supplemental data -->
  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>
 </supplementalData>
</Measure>

JSON Template

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "url" : "<uri>", // Canonical identifier for this measure, represented as a URI (globally unique)
  "identifier" : [{ Identifier }], // Additional identifier for the measure
  "version" : "<string>", // Business version of the measure
  "name" : "<string>", // I Name for this measure (computer friendly)
  "title" : "<string>", // Name for this measure (human friendly)
  "subtitle" : "<string>", // Subordinate title of the measure
  "status" : "<code>", // R!  draft | active | retired | unknown
  "experimental" : <boolean>, // For testing purposes, not real usage
  // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:
  "subjectCodeableConcept" : { CodeableConcept },
  "subjectReference" : { Reference(Group) },
  "basis" : "<code>", // Population basis
  "date" : "<dateTime>", // Date last changed
  "publisher" : "<string>", // Name of the publisher/steward (organization or individual)
  "contact" : [{ ContactDetail }], // Contact details for the publisher
  "description" : "<markdown>", // Natural language description of the measure
  "useContext" : [{ UsageContext }], // The context that the content is intended to support
  "jurisdiction" : [{ CodeableConcept }], // Intended jurisdiction for measure (if applicable)
  "purpose" : "<markdown>", // Why this measure is defined
  "usage" : "<string>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Use and/or publishing restrictions
  "approvalDate" : "<date>", // When the measure was approved by publisher
  "lastReviewDate" : "<date>", // When the measure was last reviewed
  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "topic" : [{ CodeableConcept }], // The category of the measure, such as Education, Treatment, Assessment, etc.
  "author" : [{ ContactDetail }], // Who authored the content
  "editor" : [{ ContactDetail }], // Who edited the content
  "reviewer" : [{ ContactDetail }], // Who reviewed the content
  "endorser" : [{ ContactDetail }], // Who endorsed the content
  "relatedArtifact" : [{ RelatedArtifact }], // Additional documentation, citations, etc.
  "library" : ["<canonical(Library)>"], // Logic used by the measure
  "disclaimer" : "<markdown>", // Disclaimer for use of the measure or its referenced content
  "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
  "scoringUnit" : { CodeableConcept }, // What units?
  "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted
  "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
  "riskAdjustment" : "<string>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Detailed description of why the measure exists
  "clinicalRecommendationStatement" : "<markdown>", // Summary of clinical guidelines
  "improvementNotation" : { CodeableConcept }, // increase | decrease
  "term" : [{ // Defined terms used in the measure documentation
    "code" : { CodeableConcept }, // What term?
    "definition" : "<markdown>" // Meaning of the term
  }],
  "guidance" : "<markdown>", // Additional guidance for implementers
  "group" : [{ // Population criteria group
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<string>", // Summary description
    "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
    "basis" : "<code>", // Population basis
    "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
    "scoringUnit" : { CodeableConcept }, // What units?
    "improvementNotation" : { CodeableConcept }, // increase | decrease
    "population" : [{ // Population criteria
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      "description" : "<string>", // The human readable description of this population criteria
      "criteria" : { Expression }, // R!  The criteria that defines this population
      "inputPopulationId" : "<string>", // Which population
      "aggregateMethod" : { CodeableConcept } // Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "code" : { CodeableConcept }, // Meaning of the stratifier
      "description" : "<string>", // The human readable description of this stratifier
      "criteria" : { Expression }, // How the measure should be stratified
      "component" : [{ // Stratifier criteria component for the measure
        "code" : { CodeableConcept }, // Meaning of the stratifier component
        "description" : "<string>", // The human readable description of this stratifier component
        "criteria" : { Expression } // R!  Component of how the measure should be stratified
      }]
    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor
    "description" : "<string>", // The human readable description of this supplemental data
    "criteria" : { Expression } // R!  Expression describing additional data to be reported
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Measure;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Measure.url [ uri ]; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)
  fhir:Measure.identifier [ Identifier ], ... ; # 0..* Additional identifier for the measure
  fhir:Measure.version [ string ]; # 0..1 Business version of the measure
  fhir:Measure.name [ string ]; # 0..1 I Name for this measure (computer friendly)
  fhir:Measure.title [ string ]; # 0..1 Name for this measure (human friendly)
  fhir:Measure.subtitle [ string ]; # 0..1 Subordinate title of the measure
  fhir:Measure.status [ code ]; # 1..1 draft | active | retired | unknown
  fhir:Measure.experimental [ boolean ]; # 0..1 For testing purposes, not real usage
  # Measure.subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:Measure.subjectCodeableConcept [ CodeableConcept ]
    fhir:Measure.subjectReference [ Reference(Group) ]
  fhir:Measure.basis [ code ]; # 0..1 Population basis
  fhir:Measure.date [ dateTime ]; # 0..1 Date last changed
  fhir:Measure.publisher [ string ]; # 0..1 Name of the publisher/steward (organization or individual)
  fhir:Measure.contact [ ContactDetail ], ... ; # 0..* Contact details for the publisher
  fhir:Measure.description [ markdown ]; # 0..1 Natural language description of the measure
  fhir:Measure.useContext [ UsageContext ], ... ; # 0..* The context that the content is intended to support
  fhir:Measure.jurisdiction [ CodeableConcept ], ... ; # 0..* Intended jurisdiction for measure (if applicable)
  fhir:Measure.purpose [ markdown ]; # 0..1 Why this measure is defined
  fhir:Measure.usage [ string ]; # 0..1 Describes the clinical usage of the measure
  fhir:Measure.copyright [ markdown ]; # 0..1 Use and/or publishing restrictions
  fhir:Measure.approvalDate [ date ]; # 0..1 When the measure was approved by publisher
  fhir:Measure.lastReviewDate [ date ]; # 0..1 When the measure was last reviewed
  fhir:Measure.effectivePeriod [ Period ]; # 0..1 When the measure is expected to be used
  fhir:Measure.topic [ CodeableConcept ], ... ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc.
  fhir:Measure.author [ ContactDetail ], ... ; # 0..* Who authored the content
  fhir:Measure.editor [ ContactDetail ], ... ; # 0..* Who edited the content
  fhir:Measure.reviewer [ ContactDetail ], ... ; # 0..* Who reviewed the content
  fhir:Measure.endorser [ ContactDetail ], ... ; # 0..* Who endorsed the content
  fhir:Measure.relatedArtifact [ RelatedArtifact ], ... ; # 0..* Additional documentation, citations, etc.
  fhir:Measure.library [ canonical(Library) ], ... ; # 0..* Logic used by the measure
  fhir:Measure.disclaimer [ markdown ]; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:Measure.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
  fhir:Measure.scoringUnit [ CodeableConcept ]; # 0..1 What units?
  fhir:Measure.compositeScoring [ CodeableConcept ]; # 0..1 opportunity | all-or-nothing | linear | weighted
  fhir:Measure.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
  fhir:Measure.riskAdjustment [ string ]; # 0..1 How risk adjustment is applied for this measure
  fhir:Measure.rateAggregation [ string ]; # 0..1 How is rate aggregation performed for this measure
  fhir:Measure.rationale [ markdown ]; # 0..1 Detailed description of why the measure exists
  fhir:Measure.clinicalRecommendationStatement [ markdown ]; # 0..1 Summary of clinical guidelines
  fhir:Measure.improvementNotation [ CodeableConcept ]; # 0..1 increase | decrease
  fhir:Measure.term [ # 0..* Defined terms used in the measure documentation
    fhir:Measure.term.code [ CodeableConcept ]; # 0..1 What term?
    fhir:Measure.term.definition [ markdown ]; # 0..1 Meaning of the term
  ], ...;
  fhir:Measure.guidance [ markdown ]; # 0..1 Additional guidance for implementers
  fhir:Measure.group [ # 0..* Population criteria group
    fhir:Measure.group.code [ CodeableConcept ]; # 0..1 Meaning of the group
    fhir:Measure.group.description [ string ]; # 0..1 Summary description
    fhir:Measure.group.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
    fhir:Measure.group.basis [ code ]; # 0..1 Population basis
    fhir:Measure.group.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
    fhir:Measure.group.scoringUnit [ CodeableConcept ]; # 0..1 What units?
    fhir:Measure.group.improvementNotation [ CodeableConcept ]; # 0..1 increase | decrease
    fhir:Measure.group.population [ # 0..* Population criteria
      fhir:Measure.group.population.code [ CodeableConcept ]; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:Measure.group.population.description [ string ]; # 0..1 The human readable description of this population criteria
      fhir:Measure.group.population.criteria [ Expression ]; # 1..1 The criteria that defines this population
      fhir:Measure.group.population.inputPopulationId [ string ]; # 0..1 Which population
      fhir:Measure.group.population.aggregateMethod [ CodeableConcept ]; # 0..1 Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    ], ...;
    fhir:Measure.group.stratifier [ # 0..* Stratifier criteria for the measure
      fhir:Measure.group.stratifier.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier
      fhir:Measure.group.stratifier.description [ string ]; # 0..1 The human readable description of this stratifier
      fhir:Measure.group.stratifier.criteria [ Expression ]; # 0..1 How the measure should be stratified
      fhir:Measure.group.stratifier.component [ # 0..* Stratifier criteria component for the measure
        fhir:Measure.group.stratifier.component.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier component
        fhir:Measure.group.stratifier.component.description [ string ]; # 0..1 The human readable description of this stratifier component
        fhir:Measure.group.stratifier.component.criteria [ Expression ]; # 1..1 Component of how the measure should be stratified
      ], ...;
    ], ...;
  ], ...;
  fhir:Measure.supplementalData [ # 0..* What other data should be reported with the measure
    fhir:Measure.supplementalData.code [ CodeableConcept ]; # 0..1 Meaning of the supplemental data
    fhir:Measure.supplementalData.usage [ CodeableConcept ], ... ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:Measure.supplementalData.description [ string ]; # 0..1 The human readable description of this supplemental data
    fhir:Measure.supplementalData.criteria [ Expression ]; # 1..1 Expression describing additional data to be reported
  ], ...;
]

Changes since Release 4

Measure
Measure.subject[x]
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to http://hl7.org/fhir/ValueSet/participant-resource-types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/resource-types" to "http://hl7.org/fhir/fhir-types"
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to http://hl7.org/fhir/ValueSet/participant-resource-types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/resource-types" to "http://hl7.org/fhir/fhir-types"
Measure.basis
  • Added Element
Measure.scoringUnit
  • Added Element
Measure.term
  • Added Element
Measure.term.code
  • Added Element
Measure.term.definition
  • Added Element
Measure.group.type
  • Added Element
Measure.group.basis
  • Added Element
Measure.group.scoring
  • Added Element
Measure.group.scoringUnit
  • Added Element
Measure.group.improvementNotation
  • Added Element
Measure.group.population.inputPopulationId
  • Added Element
Measure.group.population.aggregateMethod
  • Added Element
Measure.definition
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 6 tests that all execute ok. All tests pass round-trip testing and 6 r3 resources are invalid (0 errors).)

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) , the spreadsheet version & the dependency analysis

14.18.4.1 Terminology Bindings

PathDefinitionTypeReference
Measure.status

The lifecycle status of an artifact.

RequiredPublicationStatus
Measure.subject[x]

All Resource Types that represent participant resources

ExtensibleParticipantResourceTypes
Measure.basis

All FHIR types

RequiredFHIRTypes
Measure.jurisdiction

This value set defines a base set of codes for country, country subdivision and region for indicating where a resource is intended to be used.

Note: The codes for countries and country subdivisions are taken from ISO 3166 while the codes for "supra-national" regions are from UN Standard country or area codes for statistical use (M49) .

ExtensibleJurisdiction ValueSet
Measure.topic

High-level categorization of the definition, used for searching, sorting, and filtering.

ExampleDefinitionTopic
Measure.scoring

The scoring type of the measure.

ExtensibleMeasureScoring
Measure.scoringUnit

This is an example value set illustrating some typical scoring units used in quality measure specifications.

ExampleMeasureScoringUnit
Measure.compositeScoring

The composite scoring method of the measure.

ExtensibleCompositeMeasureScoring
Measure.type

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

ExtensibleMeasureType
Measure.improvementNotation

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

RequiredMeasureImprovementNotation
Measure.term.code

Example Measure Definitions for the Measure Resource.

ExampleMeasureDefinitionExample
Measure.group.code

Example Measure Groups for the Measure Resource.

ExampleMeasureGroupExample
Measure.group.type

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

ExtensibleMeasureType
Measure.group.basis

All FHIR types

RequiredFHIRTypes
Measure.group.scoring

The scoring type of the measure.

ExtensibleMeasureScoring
Measure.group.scoringUnit

This is an example value set illustrating some typical scoring units used in quality measure specifications.

ExampleMeasureScoringUnit
Measure.group.improvementNotation

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

RequiredMeasureImprovementNotation
Measure.group.population.code

The type of population.

ExtensibleMeasurePopulationType
Measure.group.population.aggregateMethod

Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)

ExtensibleMeasureAggregateMethod
Measure.group.stratifier.code

Identifier subgroups in a population for measuring purposes.

ExampleMeasureStratifierExample
Measure.group.stratifier.component.code

Identifier subgroups in a population for measuring purposes.

ExampleMeasureStratifierExample
Measure.supplementalData.code

Supplemental data in a population for measuring purposes.

ExampleMeasureSupplementalDataExample
Measure.supplementalData.usage

The intended usage for supplemental data elements in the measure.

ExtensibleMeasureDataUsage

14.18.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
 cnl-0Warning (base)Name should be usable as an identifier for the module by machine processing applications such as code generationname.exists() implies name.matches('[A-Z]([A-Za-z0-9_]){1,254}')
 mea-1Rule (base)Stratifier SHALL be either a single criteria or a set of criteria componentsgroup.stratifier.all((code | description | criteria).exists() xor component.exists())
 cnl-1Warning Measure.urlURL should not contain | or # - these characters make processing canonical references problematicurl.matches('([^|#])*')

14.18.5 Search Parameters

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

NameTypeDescriptionExpressionIn Common
composed-ofreferenceWhat resource is being referencedMeasure.relatedArtifact.where(type='composed-of').resource
(Any)
contexttokenA use context assigned to the measure(Measure.useContext.value as CodeableConcept)
context-quantityquantityA quantity- or range-valued use context assigned to the measure(Measure.useContext.value as Quantity) | (Measure.useContext.value as Range)
context-typetokenA type of use context assigned to the measureMeasure.useContext.code
context-type-quantitycompositeA use context type and quantity- or range-based value assigned to the measureOn Measure.useContext:
  context-type: code
  context-quantity: value.ofType(Quantity) | value.ofType(Range)
context-type-valuecompositeA use context type and value assigned to the measureOn Measure.useContext:
  context-type: code
  context: value.ofType(CodeableConcept)
date NdateThe measure publication dateMeasure.date
depends-onreferenceWhat resource is being referencedMeasure.relatedArtifact.where(type='depends-on').resource | Measure.library
(Library, Any)
derived-fromreferenceWhat resource is being referencedMeasure.relatedArtifact.where(type='derived-from').resource
(Any)
description NstringThe description of the measureMeasure.description
effectivedateThe time during which the measure is intended to be in useMeasure.effectivePeriod
identifiertokenExternal identifier for the measureMeasure.identifier
jurisdictiontokenIntended jurisdiction for the measureMeasure.jurisdiction
name NstringComputationally friendly name of the measureMeasure.name
predecessorreferenceWhat resource is being referencedMeasure.relatedArtifact.where(type='predecessor').resource
(Any)
publisher NstringName of the publisher of the measureMeasure.publisher
status NtokenThe current status of the measureMeasure.status
successorreferenceWhat resource is being referencedMeasure.relatedArtifact.where(type='successor').resource
(Any)
title NstringThe human-friendly name of the measureMeasure.title
topictokenTopics associated with the measureMeasure.topic
url NuriThe uri that identifies the measureMeasure.url
version NtokenThe business version of the measureMeasure.version