Quality Measure STU2 for FHIR R4 Implementation Guide

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.1.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

MeasureEXM

@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Measure;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "measure-exm"];
  fhir:Resource.meta [
     fhir:Meta.versionId [ fhir:value "2" ];
     fhir:Meta.lastUpdated [ fhir:value "2019-11-06T23:55:48.200+00:00"^^xsd:dateTime ];
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <table style=\"width: 60%; border-bottom: none;\" class=\"header_table\">\n                \n            <tr style=\"vertical-align: top;\">\n                <td scope=\"row\" style=\"background-color:#656565; width:20%\">\n                    <span class=\"td_label\">Measure Title</span>\n                </td>\n                <td colspan=\"1\" style=\"width:60%\">\n                    <h1 style=\"font-size:10px\">EXM Measure</h1>\n                </td>\n                <td scope=\"row\" style=\"background-color:#656565; width:10%\">\n                    <span class=\"td_label\">Measure ID</span>\n                </td>\n                <td colspan=\"1\" style=\"width:10%\">\n                    <h1 style=\"font-size:10px\">MeasureEXM</h1>\n                </td>\n            </tr>\n            \n<tr style=\"vertical-align: top;\">\n    <td scope=\"row\" style=\"background-color:#656565; width:20%\">\n        <span class=\"td_label\">Description</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">\n        <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\n            <pre>\n                <p>An example FHIR-based measure</p>\n            </pre>\n        </div>\n    </td>\n</tr>\n<tr>\n    <td scope=\"row\" style=\"background-color:#656565; width:20%\">\n        <span class=\"td_label\">Measurement Period</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">January 1 - December 31</td>\n</tr>\n\n\n<tr>\n    <td scope=\"row\" style=\"background-color:#656565; width:20%\">\n        <span class=\"td_label\">Copyright and Disclaimer Notice</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">\n        <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\n            <pre>Example disclaimer</pre>\n            <br/>\n            <pre>Example Copyright Statement</pre>\n        </div>\n    </td>\n</tr>\n<tr>\n    <td scope=\"row\" style=\"background-color:#656565; width:20%\">\n        <span class=\"td_label\">Clinical Recommendation Statement</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">\n        <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\n            <p>The clinical recommendation statement for this measure is...</p>\n        </div>\n    </td>\n</tr>\n<tr>\n    <td colspan=\"4\" scope=\"row\" style=\"background-color:#656565; width:100%\">\n        <span class=\"td_label\">Characteristics</span>\n    </td>\n</tr>\n<tr>\n    <td scope=\"row\" style=\"width:20%\">\n        <span>Scoring</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">Proportion</td>\n</tr>\n\n<tr style=\"vertical-align: top;\">\n    <td rowspan=\"1\" scope=\"row\" style=\"width:20%\">\n        <span>Type</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">Process</td>\n</tr>\n\n\n<tr>\n    <td scope=\"row\" style=\"width:20%\">\n        <span>Risk Adjustment</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">\n        <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\n            <pre>Risk adjustment for this measure is performed by...</pre>\n        </div>\n    </td>\n</tr>\n\n<tr>\n    <td scope=\"row\" style=\"width:20%\">\n        <span>Improvement Notation</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">A higher rate indicates better performance.</td>\n</tr>\n<tr>\n    <td scope=\"row\" style=\"width:20%\">\n        <span>Guidance</span>\n    </td>\n    <td colspan=\"3\" style=\"width:80%\">\n        <div style=\"width:660px;overflow-x:hidden;overflow-y:auto\">\n            <p>Additional guidance provided to help communicate the intent of the measure</p>\n        </div>\n    </td>\n</tr>\n<tr>\n    <td colspan=\"4\" scope=\"row\" style=\"background-color:#656565; width:100%\">\n        <span class=\"td_label\">Definitions</span>\n    </td>\n</tr>\n<tr>\n    \n    <td colspan=\"4\" style=\"width:100%\">\n        <div style=\"width:880px;overflow-x:hidden;overflow-y:auto\">\n            <p>A term used in the measure that bears clearly defining to communicate the measure intent</p>\n        </div>\n    </td>\n</tr>\n\n\n</table>\n<table style=\"width: 60%; border-top: none; border-bottom: none\" class=\"header_table\">\n    <tr style=\"vertical-align: top;\">\n        <td rowspan=\"3\" scope=\"row\" style=\"background-color:#656565; width:20%\">\n            <span class=\"td_label\">Population Criteria 1</span>\n        </td>\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Initial Population</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n    <tr style=\"vertical-align: top;\">\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Numerator</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n    <tr style=\"vertical-align: top;\">\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Denominator</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n    <tr style=\"vertical-align: top;\">\n        <td rowspan=\"3\" scope=\"row\" style=\"background-color:#656565; width:20%\">\n            <span class=\"td_label\">Population Criteria 2</span>\n        </td>\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Initial Population</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n    <tr style=\"vertical-align: top;\">\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Numerator</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n    <tr style=\"vertical-align: top;\">\n        <td style=\"width:20%;\">\n            <span style=\"font-size:10px; font-weight: bold;\">Denominator</span>\n        </td>\n        <td colspan=\"2\" style=\"width:60%;\">\n            <div style=\"overflow-x:hidden;overflow-y:auto\">\n                <pre/>\n            </div>\n        </td>\n    </tr>\n</table>\n<table style=\"width: 60%; border-top: none;\" class=\"header_table\">\n    \n\n\n</table>\n<h2>\n    <a name=\"toc\">Table of Contents</a>\n</h2>\n<ul style=\"padding-left: 50px;\">\n    <li>\n        <a href=\"#d1e405\">Population Criteria</a>\n    </li>\n    <li>\n        <a href=\"#d1e649\">Definitions</a>\n    </li>\n    <li>\n        <a href=\"#d1e650\">Functions</a>\n    </li>\n    <li>\n        <a href=\"#d1e555\">Terminology</a>\n    </li>\n    <li>\n        <a href=\"#d1e647\">Data Criteria (QDM Data Elements)</a>\n    </li>\n    <li>\n        <a href=\"#d1e767\">Supplemental Data Elements</a>\n    </li>\n    <li>\n        <a href=\"#d1e879\">Risk Adjustment Variables</a>\n    </li>\n</ul>\n<div style=\"float:left; background:teal; height:3px; width:80%\"/>\n<pre>\n    <br/>\n</pre>\n<h3>\n    <a name=\"d1e405\" href=\"#toc\">Population Criteria 1</a>\n</h3>\n<div>\n    <ul style=\"list-style:none;padding-left:10px;\">\n        <li style=\"list-style:none;padding-left:0px;\" class=\"list-unstyled\">\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 1</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 1</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 2</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 2</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 3</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 3</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 4</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 4</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n        </li>\n    </ul>\n</div>\n<pre>\n    <br/>\n</pre>\n<h3>\n    <a name=\"d1e405\" href=\"#toc\">Population Criteria 2</a>\n</h3>\n<div>\n    <ul style=\"list-style:none;padding-left:10px;\">\n        <li style=\"list-style:none;padding-left:0px;\" class=\"list-unstyled\">\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\"> </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 1</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 1</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 2</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 2</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 3</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 3</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n            <div class=\"treeview hover p-l-10\">\n                <ul class=\"list-unstyled\">\n                    <li class=\"list-unstyled\">\n                        <strong>Stratifier 4</strong>\n                        <ul class=\"code\">\n                            <li class=\"list-unstyled\">\n                                <div class=\"treeview hover p-l-10\">\n                                    <ul>\n                                        <li style=\"padding-left: 0px;\">\n                                            <div>\n                                                <pre class=\"cql-definition-body\">Stratifier 4</pre>\n                                            </div>\n                                        </li>\n                                    </ul>\n                                </div>\n                            </li>\n                        </ul>\n                    </li>\n                </ul>\n            </div>\n        </li>\n    </ul>\n</div>\n<h3>\n    <a name=\"d1e649\" href=\"#toc\">Definitions</a>\n</h3>\n<h3>\n    <a name=\"d1e650\" href=\"#toc\">Functions</a>\n</h3>\n<h3>\n    <a name=\"d1e555\" href=\"#toc\">Terminology</a>\n</h3>\n<div>\n    <ul style=\"padding-left: 50px;\"> </ul>\n</div>\n<h3>\n    <a name=\"d1e647\" href=\"#toc\">Data Criteria (QDM Data Elements)</a>\n</h3>\n<div>\n    <ul style=\"padding-left: 50px;\"> </ul>\n</div>\n<h3>\n    <a name=\"d1e767\" href=\"#toc\">Supplemental Data Elements</a>\n</h3>\n<div>\n    <ul style=\"list-style:none;padding-left: 25px;\">\n        <li>None</li>\n    </ul>\n</div>\n<h3>\n    <a name=\"d1e879\" href=\"#toc\">Risk Adjustment Variables</a>\n</h3>\n<div>\n    <ul style=\"list-style:none;padding-left: 25px;\">\n        <li>None</li>\n    </ul>\n</div>\n<div style=\"float:left; background:teal; height:3px; width:80%\"/>\n<table>\n    \n</table>\n</div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "type" ];
       fhir:Extension.valueCode [ fhir:value "documentation" ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "text" ];
       fhir:Extension.valueString [ fhir:value "This illustrates an example comment" ]     ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-artifactComment" ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis" ];
     fhir:Extension.valueCode [ fhir:value "boolean" ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-allocation" ];
     fhir:Extension.valueMarkdown [ fhir:value "Additional guidance for allocation" ]
  ];
  fhir:Measure.url [ fhir:value "http://example.org/fhir/measures/measure-exm"];
  fhir:Measure.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm" ];
     fhir:Identifier.value [ fhir:value "EXM" ]
  ];
  fhir:Measure.version [ fhir:value "1.1.0"];
  fhir:Measure.name [ fhir:value "MeasureEXM"];
  fhir:Measure.title [ fhir:value "EXM Measure"];
  fhir:Measure.status [ fhir:value "active"];
  fhir:Measure.experimental [ fhir:value "true"^^xsd:boolean];
  fhir:Measure.date [ fhir:value "2019-02-17T00:00:00+00:00"^^xsd:dateTime];
  fhir:Measure.publisher [ fhir:value "Example Measure Publisher"];
  fhir:Measure.contact [
     fhir:index 0;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.example.org/" ]     ]
  ];
  fhir:Measure.description [ fhir:value "An example FHIR-based measure"];
  fhir:Measure.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.code [ fhir:value "program" ]     ];
     fhir:UsageContext.valueCodeableConcept [
       fhir:CodeableConcept.text [ fhir:value "eligible-provider" ]     ]
  ];
  fhir:Measure.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ];
       fhir:Coding.display [ fhir:value "United States of America" ]     ]
  ];
  fhir:Measure.purpose [ fhir:value "The purpose of this measure is to..."];
  fhir:Measure.usage [ fhir:value "Users of this measure should be aware of..."];
  fhir:Measure.copyright [ fhir:value "Example Copyright Statement"];
  fhir:Measure.approvalDate [ fhir:value "2019-02-17"^^xsd:date];
  fhir:Measure.lastReviewDate [ fhir:value "2019-02-17"^^xsd:date];
  fhir:Measure.effectivePeriod [
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodAnchor" ];
       fhir:Extension.valueDateTime [ fhir:value "2018-01-01T00:00:00+00:00"^^xsd:dateTime ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodDuration" ];
       fhir:Extension.valueDuration [
         fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ];
         fhir:Quantity.system [ fhir:value "http://unitsofmeasure.org" ];
         fhir:Quantity.code [ fhir:value "a" ]       ]     ];
     fhir:Period.start [ fhir:value "2018-01-01T00:00:00+00:00"^^xsd:dateTime ];
     fhir:Period.end [ fhir:value "2018-12-31T00:00:00+00:00"^^xsd:dateTime ]
  ];
  fhir:Measure.topic [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       a loinc:57024-2;
       fhir:Coding.system [ fhir:value "http://loinc.org" ];
       fhir:Coding.code [ fhir:value "57024-2" ]     ];
     fhir:CodeableConcept.text [ fhir:value "Health Quality Measure Document" ]
  ];
  fhir:Measure.author [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "Example Measure Content Developer" ]
  ];
  fhir:Measure.relatedArtifact [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation" ];
       fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]     ];
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. \"Antibiotic treatment       of children with sore throat.\" JAMA 294(18):2315-2322." ]
  ], [
     fhir:index 1;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation" ];
       fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]     ];
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Infectious Diseases Society of America. 2012. \"Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update.\"" ]
  ], [
     fhir:index 2;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation" ];
       fhir:Extension.valueBoolean [ fhir:value "true"^^xsd:boolean ]     ];
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.citation [ fhir:value "Roberts, R.R., B. Hota, I. Ahmad, et al. \"Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship.\" Clin Infect Dis. Oct 2009; 49(8):1175-84." ]
  ];
  fhir:Measure.library [
     fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/exm-logic";
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/exm-logic>
  ];
  fhir:Measure.disclaimer [ fhir:value "Example disclaimer"];
  fhir:Measure.scoring [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-scoring" ];
       fhir:Coding.code [ fhir:value "proportion" ];
       fhir:Coding.display [ fhir:value "Proportion" ]     ]
  ];
  fhir:Measure.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-type" ];
       fhir:Coding.code [ fhir:value "process" ]     ]
  ];
  fhir:Measure.riskAdjustment [ fhir:value "Risk adjustment for this measure is performed by..."];
  fhir:Measure.rateAggregation [ fhir:value "Rate aggregation for this measure is performed by..."];
  fhir:Measure.rationale [ fhir:value "Rationale for this measure is..."];
  fhir:Measure.clinicalRecommendationStatement [ fhir:value "The clinical recommendation statement for this measure is..."];
  fhir:Measure.improvementNotation [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-improvement-notation" ];
       fhir:Coding.code [ fhir:value "increase" ];
       fhir:Coding.display [ fhir:value "Increased score indicates improvement" ]     ]
  ];
  fhir:Measure.definition [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "term" ];
         fhir:Extension.valueString [ fhir:value "Term" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "definition" ];
         fhir:Extension.valueMarkdown [ fhir:value "A term used in the measure that bears clearly definition to communicate the measure intent" ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm" ]     ]
  ];
  fhir:Measure.guidance [ fhir:value "Additional guidance provided to help communicate the intent of the measure"];
  fhir:Measure.group [
     fhir:index 0;
     fhir:Element.id [ fhir:value "group-1" ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Element.id [ fhir:value "initial-population-1" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "initial-population" ];
           fhir:Coding.display [ fhir:value "Initial Population" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Initial Population 1" ]       ]     ], [
       fhir:index 1;
       fhir:Element.id [ fhir:value "numerator-1" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "numerator" ];
           fhir:Coding.display [ fhir:value "Numerator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Numerator 1" ]       ]     ], [
       fhir:index 2;
       fhir:Element.id [ fhir:value "denominator-1" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator" ];
           fhir:Coding.display [ fhir:value "Denominator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Denominator 1" ]       ]     ];
     fhir:Measure.group.stratifier [
       fhir:index 0;
       fhir:Element.id [ fhir:value "stratifier-1-1" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 1-1" ]       ]     ], [
       fhir:index 1;
       fhir:Element.id [ fhir:value "stratifier-1-2" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 1-2" ]       ]     ], [
       fhir:index 2;
       fhir:Element.id [ fhir:value "stratifier-1-3" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 1-3" ]       ]     ], [
       fhir:index 3;
       fhir:Element.id [ fhir:value "stratifier-1-4" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 1-4" ]       ]     ]
  ], [
     fhir:index 1;
     fhir:Element.id [ fhir:value "group-2" ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Element.id [ fhir:value "initial-population-2" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "initial-population" ];
           fhir:Coding.display [ fhir:value "Initial Population" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Initial Population 2" ]       ]     ], [
       fhir:index 1;
       fhir:Element.id [ fhir:value "numerator-2" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "numerator" ];
           fhir:Coding.display [ fhir:value "Numerator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Numerator 2" ]       ]     ], [
       fhir:index 2;
       fhir:Element.id [ fhir:value "denominator-2" ];
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator" ];
           fhir:Coding.display [ fhir:value "Denominator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Denominator 2" ]       ]     ];
     fhir:Measure.group.stratifier [
       fhir:index 0;
       fhir:Element.id [ fhir:value "stratifier-2-1" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 2-1" ]       ]     ], [
       fhir:index 1;
       fhir:Element.id [ fhir:value "stratifier-2-2" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 2-2" ]       ]     ], [
       fhir:index 2;
       fhir:Element.id [ fhir:value "stratifier-2-3" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 2-3" ]       ]     ], [
       fhir:index 3;
       fhir:Element.id [ fhir:value "stratifier-2-4" ];
       fhir:Measure.group.stratifier.criteria [
         fhir:Expression.language [ fhir:value "text/cql" ];
         fhir:Expression.expression [ fhir:value "Stratifier 2-4" ]       ]     ]
  ];
  fhir:Measure.supplementalData [
     fhir:index 0;
     fhir:Element.id [ fhir:value "sde-ethnicity" ];
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql" ];
       fhir:Expression.expression [ fhir:value "SDE Ethnicity" ]     ]
  ], [
     fhir:index 1;
     fhir:Element.id [ fhir:value "sde-race" ];
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql" ];
       fhir:Expression.expression [ fhir:value "SDE Race" ]     ]
  ], [
     fhir:index 2;
     fhir:Element.id [ fhir:value "sde-payer" ];
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql" ];
       fhir:Expression.expression [ fhir:value "SDE Payer" ]     ]
  ], [
     fhir:index 3;
     fhir:Element.id [ fhir:value "sde-sex" ];
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql" ];
       fhir:Expression.expression [ fhir:value "SDE Sex" ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.