The Measure resource provides the definition of a quality measure.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.

An Extension

The population basis specifies the type of elements in the population. For a subject-based measure, this would be boolean (because the population criteria define yes/no values for each individual subject). For a non-subject-based measure, this would be the type of elements in the population (such as encounters or procedures).

A published measure must have a canonical url defined.

In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

Specifies additional guidance for determining how the allocation for the measure specification should be performed.

May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance. This SHALL be a URL, SHOULD be globally unique, and SHOULD be an address at which this measure is (or will be) published. The URL SHOULD include the major version of the measure. For more information see Technical and Business Versions.

A published measure must have a canonical url defined.

Can be a urn:uuid: or a urn:oid:, but real http: addresses are preferred. Multiple instances may share the same url if they have a distinct version.

A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.

A published measure must have at least one identifier defined.

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, e.g., to identify this measure outside of FHIR, where it is not possible to use the logical URI.

The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.

A published measure must specify a content version.

There may be different measure instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a refrence to a particular business version of the measure with the format [url]|[version].

A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.

A published measure must specify a valid, machine-friendly name.

The name is not expected to be globally unique. The name should be a simple alpha-numeric type name to ensure that it is computable friendly.

A short, descriptive, user-friendly title for the measure.

A published measure must specify a human-friendly title.

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

The status of this measure. Enables tracking the life-cycle of the content.

Allows filtering of measures that are appropriate for use vs. not.
This is labeled as "Is Modifier" because applications should not use a retired measure without due consideration.

A boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing), and is not intended to be used for genuine usage.

Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.

Allows filtering of measure that are appropriate for use vs. not. This is labeled as "Is Modifier" because applications should not use an experimental measure in production.

The date (and optionally time) when the measure was published. The date must change if and when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.

A published measure must specify the date the measure content was last changed.

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

The name of the individual or organization that published the measure.

A published measure must provide publisher information.

Usually an organization, but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.

A free text natural language description of the measure from a consumer's perspective.

A published measure must provide a concise description of the measure content.

This description can be used to capture details such as why the measure was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the profile is presumed to be the predominant language in the place the profile was created).

Explaination of why this measure is needed and why it has been designed as it has.

A published measure should provide a clear description of the purpose of the measure.

This element does not describe the usage of the measure Instead it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this measure.

A detailed description of how the measure is used from a clinical perspective.

A published measure should provide clinical usage notes for the measure.

The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

A published measure must indicate the date the measure content was approved by the publisher.

The 'date' element may be more recent than the approval date because of minor changes / editorial corrections.

The date on which the resource content was last reviewed. Review happens periodically after approval, but doesn't change the original approval date.

A published measure must indicate when the measure content was last reviewed.

If specified, this is usually after the approval date.

The period during which the measure content was or is planned to be in active use.

A published measure should provide an indication of the period during which the measure content can be effectively applied.

The effective period for a measure determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching for appropriate measure instances.

A published measure should provide a clear indication of the expected contexts of use for the measure content.

When multiple useContexts are specified, there is no expectation whether all or any of the contexts apply.

A legal or geographic region in which the measure is intended to be used.

A published measure should indicate intended jurisdictions for the measure content.

It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.

Descriptive topics related to the content of the measure. Topics provide a high-level categorization of the type of the measure that can be useful for filtering and searching.

A published measure should provide relevant topics for the measure content.

A contributor to the content of the measure, including authors, editors, reviewers, and endorsers.

A published measure should provide information on contributors to the measure content.

Contact details to assist a user in finding and communicating with the publisher.

A published measure must provide contact information for the publisher.

May be a web site, an email address, a telephone number, etc.

A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.

A published measure should provide copyright information for the measure content.

Related artifacts such as additional documentation, justification, or bibliographic references.

A published measure should provide related information such as supporting evidence, citations, and documentation.

Each related artifact is either an attachment, or a reference to another resource, but not both.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Specifies whether the related artifact is defining a primary citation for the measure (i.e. one that should appear in the narrative for the measure specification.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Value of extension - may be a resource or one of a constrained set of the data types (see Extensibility in the spec for list).

The type of relationship to the related artifact.

A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

Additional structured information about citations should be captured as extensions.

A url for the artifact that can be followed to access the actual content.

If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).

The document being referenced, represented as an attachment. This is exclusive with the resource element.

The related resource, such as a library, value set, profile, or other knowledge resource.

If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

A reference to a Library resource containing the formal logic used by the measure.

A published measure must provide at least one library containing population criteria definitions for the measure.

Notices and disclaimers regarding the use of the measure, or related to intellectual property (such as code systems) referenced by the measure.

A published measure should provide legal disclaimer relating to the use of the measure content.

Indicates how the calculation is performed for the measure, including proportion, ratio, continuous variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

A published measure must indicate the scoring method used for the measure.

If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

A published measure must indicate the type of the measure.

A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.

Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

Provides a succint statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.

Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.

Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is whthin a range).

A published measure must indicate the improvement notation used for the measure.

Provides a description of an individual term used within the measure.

Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.

unique id for the element within a resource (for internal references)

An Extension

Specifies the term being defined in a definition element.

Primitive value for markdown

Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.

Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the logic of the measure.

The measure set, e.g. Preventive Care and Screening.

A group of population criteria for the measure.

A published measure must specify at least one population group.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A unique identifier for the group. This identifier will used to report data for the group in the measure report.

Optional name or short description of this group.

The human readable description of this population group.

A population criteria for the measure.

A published measure must specify at least one population for each population group.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

Specifies which population criteria is the input to an observation definition, or the initial population for a ratio numerator or denominator.

Specifies which method to be used to aggregate the measure observation values.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.

The type of population criteria.

A published measure must specify the type of population criteria.

Optional name or short description of this population.

The human readable description of this population criteria.

The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria.

In the case of a continuous variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.

The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library, or a valid FHIR Resource Path.

A published measure should provide stratification information if appropriate for the measure content.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

The identifier for the stratifier used to coordinate the reported data back to this stratifier.

The criteria for the stratifier. This must be the name of an expression defined within a referenced library.

The path to an element that defines the stratifier, specified as a valid FHIR resource path.

The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

A published measure should provide supplemental data appropriate for the measure content.

Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.

unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

An identifier for the supplemental data.

An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

The criteria for the supplemental data. This must be the name of a valid expression defined within a referenced library, and defines the data to be returned for this element.

The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Path.