Quality Measure Implementation Guide

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R3. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

D.4.1 StructureDefinition: cohort-measure-cqfm

Examples:

Terminology Example (cohort measure)

D.4.1.1 Formal Views of Profile Content

The official URL for this profile is: 

http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cohort-measure-cqfm

The CQFM Cohort Measure Profile describes a cohort scoring measure

This profile builds on CQFMMeasure.

This profile was published on Wed Feb 13 00:00:00 AEDT 2019 as a active by Health Level Seven, Inc. - CQI WG.

Description of Profiles, Differentials, and Snapshots.

Summary

Mandatory: 3 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices:

  • The element Measure.group.population is sliced based on the value of value:code
NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure 0..*
... scoring 1..1CodeableConceptFixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"cohort","display":"Cohort"}]}
... group 1..*BackboneElement
.... population BackboneElementSlice: Unordered, Open by value:code
.... population 1..1BackboneElementInitial Population
..... code 1..1CodeableConceptFixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]}

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure I0..*A quality measure definition
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
Max Binding: All Languages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... cqfm-populationBasis SI1..1codeWhat type of population
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
Binding: FHIRAllTypes (required)
... cqfm-allocation I0..1markdownAllocation guidance
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-allocation
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... url SΣ1..1uriLogical URI to reference this measure (globally unique)
... identifier SΣ1..*IdentifierAdditional identifier for the measure
... version SΣ1..1stringBusiness version of the measure
... name SΣ1..1stringName for this measure (computer friendly)
... title SΣ1..1stringName for this measure (human friendly)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... experimental ?!Σ0..1booleanFor testing purposes, not real usage
... date SΣ1..1dateTimeDate this was last changed
... publisher SΣ1..1stringName of the publisher (organization or individual)
... description SΣ1..1markdownNatural language description of the measure
... purpose S0..1markdownWhy this measure is defined
... usage S0..1stringDescribes the clinical usage of the measure
... approvalDate S1..1dateWhen the measure was approved by publisher
... lastReviewDate S1..1dateWhen the measure was last reviewed
... effectivePeriod SΣ0..1PeriodWhen the measure is expected to be used
... useContext SΣ0..*UsageContextContext the content is intended to support
... jurisdiction SΣ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (extensible)
... topic S0..*CodeableConceptE.g. Education, Treatment, Assessment, etc
Binding: DefinitionTopic (example)
... contributor S0..*ContributorA content contributor
... contact SΣ1..*ContactDetailContact details for the publisher
... copyright S0..1markdownUse and/or publishing restrictions
... relatedArtifact S0..*RelatedArtifactAdditional documentation, citations, etc
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... cqfm-isPrimaryCitation 0..1booleanPrimary reference
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1uri"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation"
..... valueBoolean 0..1booleanValue of extension
.... type Σ1..1codedocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of
Binding: RelatedArtifactType (required)
.... display Σ0..1stringBrief description of the related artifact
.... citation Σ0..1stringBibliographic citation for the artifact
.... url Σ0..1uriWhere the artifact can be accessed
.... document Σ0..1AttachmentWhat document is being referenced
.... resource Σ0..1Reference(Resource)What resource is being referenced
... library S1..*Reference(CQFMLibrary)Logic used by the measure
... disclaimer SΣ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ1..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring (extensible)
Fixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"cohort","display":"Cohort"}]}
... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring (extensible)
... type SΣ1..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType (extensible)
... riskAdjustment Σ0..1stringHow is risk adjustment applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownWhy does this measure exist
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation SΣ1..1stringincrease | decrease
Binding: MeasureImprovementNotation (required)
... definition Σ0..*markdownDefined terms used in the measure documentation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... cqfm-definitionTerm I1..1stringTerm to define
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm
.... value 0..1Primitive value for markdown
... guidance Σ0..1markdownAdditional guidance for implementers
... set Σ0..1stringThe measure set, e.g. Preventive Care and Screening
... group I1..*BackboneElementPopulation criteria group
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... identifier 1..1IdentifierUnique identifier
.... name 0..1stringShort name
.... description 0..1stringSummary description
.... population IBackboneElementPopulation criteria
Slice: Unordered, Open by value:code
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... cqfm-criteriaReference I0..1stringWhich criteria
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
..... cqfm-aggregateMethod I0..1codeAggregate with
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod
Binding: MeasureAggregateMethod (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierUnique identifier
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible)
..... name 0..1stringShort name
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... population I1..1BackboneElementInitial Population
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... cqfm-criteriaReference I0..1stringWhich criteria
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
..... cqfm-aggregateMethod I0..1codeAggregate with
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod
Binding: MeasureAggregateMethod (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierUnique identifier
..... code 1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible)
Fixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]}
..... name 0..1stringShort name
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... stratifier SI0..*BackboneElementStratifier criteria for the measure
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierThe identifier for the stratifier used to coordinate the reported data back to this stratifier
..... criteria 0..1stringHow the measure should be stratified
..... path 0..1stringPath to the stratifier
... supplementalData SI0..*BackboneElementWhat other data should be reported with the measure
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... identifier 0..1IdentifierIdentifier, unique within the measure
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage (extensible)
.... criteria 0..1stringExpression describing additional data to be reported
.... path 0..1stringPath to the supplemental data element

doco Documentation for this format

Summary

Mandatory: 3 elements
Fixed Value: 2 elements

Slices

This structure defines the following Slices:

  • The element Measure.group.population is sliced based on the value of value:code

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure 0..*
... scoring 1..1CodeableConceptFixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"cohort","display":"Cohort"}]}
... group 1..*BackboneElement
.... population BackboneElementSlice: Unordered, Open by value:code
.... population 1..1BackboneElementInitial Population
..... code 1..1CodeableConceptFixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]}

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure I0..*A quality measure definition
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... language 0..1codeLanguage of the resource content
Binding: Common Languages (extensible)
Max Binding: All Languages
... text I0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... cqfm-populationBasis SI1..1codeWhat type of population
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
Binding: FHIRAllTypes (required)
... cqfm-allocation I0..1markdownAllocation guidance
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-allocation
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... url SΣ1..1uriLogical URI to reference this measure (globally unique)
... identifier SΣ1..*IdentifierAdditional identifier for the measure
... version SΣ1..1stringBusiness version of the measure
... name SΣ1..1stringName for this measure (computer friendly)
... title SΣ1..1stringName for this measure (human friendly)
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (required)
... experimental ?!Σ0..1booleanFor testing purposes, not real usage
... date SΣ1..1dateTimeDate this was last changed
... publisher SΣ1..1stringName of the publisher (organization or individual)
... description SΣ1..1markdownNatural language description of the measure
... purpose S0..1markdownWhy this measure is defined
... usage S0..1stringDescribes the clinical usage of the measure
... approvalDate S1..1dateWhen the measure was approved by publisher
... lastReviewDate S1..1dateWhen the measure was last reviewed
... effectivePeriod SΣ0..1PeriodWhen the measure is expected to be used
... useContext SΣ0..*UsageContextContext the content is intended to support
... jurisdiction SΣ0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (extensible)
... topic S0..*CodeableConceptE.g. Education, Treatment, Assessment, etc
Binding: DefinitionTopic (example)
... contributor S0..*ContributorA content contributor
... contact SΣ1..*ContactDetailContact details for the publisher
... copyright S0..1markdownUse and/or publishing restrictions
... relatedArtifact S0..*RelatedArtifactAdditional documentation, citations, etc
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... cqfm-isPrimaryCitation 0..1booleanPrimary reference
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... url 1..1uri"http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation"
..... valueBoolean 0..1booleanValue of extension
.... type Σ1..1codedocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of
Binding: RelatedArtifactType (required)
.... display Σ0..1stringBrief description of the related artifact
.... citation Σ0..1stringBibliographic citation for the artifact
.... url Σ0..1uriWhere the artifact can be accessed
.... document Σ0..1AttachmentWhat document is being referenced
.... resource Σ0..1Reference(Resource)What resource is being referenced
... library S1..*Reference(CQFMLibrary)Logic used by the measure
... disclaimer SΣ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ1..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring (extensible)
Fixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-scoring","code":"cohort","display":"Cohort"}]}
... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring (extensible)
... type SΣ1..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType (extensible)
... riskAdjustment Σ0..1stringHow is risk adjustment applied for this measure
... rateAggregation Σ0..1stringHow is rate aggregation performed for this measure
... rationale Σ0..1markdownWhy does this measure exist
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation SΣ1..1stringincrease | decrease
Binding: MeasureImprovementNotation (required)
... definition Σ0..*markdownDefined terms used in the measure documentation
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
.... cqfm-definitionTerm I1..1stringTerm to define
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm
.... value 0..1Primitive value for markdown
... guidance Σ0..1markdownAdditional guidance for implementers
... set Σ0..1stringThe measure set, e.g. Preventive Care and Screening
... group I1..*BackboneElementPopulation criteria group
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... identifier 1..1IdentifierUnique identifier
.... name 0..1stringShort name
.... description 0..1stringSummary description
.... population IBackboneElementPopulation criteria
Slice: Unordered, Open by value:code
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... cqfm-criteriaReference I0..1stringWhich criteria
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
..... cqfm-aggregateMethod I0..1codeAggregate with
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod
Binding: MeasureAggregateMethod (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierUnique identifier
..... code S1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible)
..... name 0..1stringShort name
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... population I1..1BackboneElementInitial Population
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
..... cqfm-criteriaReference I0..1stringWhich criteria
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
..... cqfm-aggregateMethod I0..1codeAggregate with
URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod
Binding: MeasureAggregateMethod (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierUnique identifier
..... code 1..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType (extensible)
Fixed Value: {"coding":[{"system":"http://terminology.hl7.org/CodeSystem/measure-population","code":"initial-population","display":"Initial Population"}]}
..... name 0..1stringShort name
..... description 0..1stringThe human readable description of this population criteria
..... criteria 1..1stringThe name of a valid referenced CQL expression (may be namespaced) that defines this population criteria
.... stratifier SI0..*BackboneElementStratifier criteria for the measure
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... identifier 0..1IdentifierThe identifier for the stratifier used to coordinate the reported data back to this stratifier
..... criteria 0..1stringHow the measure should be stratified
..... path 0..1stringPath to the stratifier
... supplementalData SI0..*BackboneElementWhat other data should be reported with the measure
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... identifier 0..1IdentifierIdentifier, unique within the measure
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage (extensible)
.... criteria 0..1stringExpression describing additional data to be reported
.... path 0..1stringPath to the supplemental data element

doco Documentation for this format

 

D.4.1.2 Terminology Bindings

Terminology Bindings

PathConformanceValueSet
Measure.jurisdictionextensibleJurisdiction ValueSet
Measure.topicexampleDefinitionTopic
Measure.typeextensibleMeasureType
Measure.improvementNotationrequiredMeasureImprovementNotation
Measure.group.population.codeextensibleMeasurePopulationType

D.4.1.3 Constraints

Constraints

IdPathDetailsRequirements
dom-2MeasureIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-1MeasureIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-4MeasureIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-3MeasureIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
ele-1Measure.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.definition.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.definition.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.definition.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.definition.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.groupAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Measure.group.populationAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.populationAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.population.extensionAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1Measure.group.population.extensionMust have either extensions or value[x], not both
: extension.exists() != value.exists()
ele-1Measure.group.stratifierAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ele-1Measure.supplementalDataAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())