Quality Measure Implementation Guide (STU4)
4.0.0-ballot - ballot US

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v4.0.0-ballot: STU 4 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

: EXM Ratio Measure - TTL Representation

Active as of 2022-02-22

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@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-ratio-exm"]; # 
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/ratio-measure-cqfm";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/ratio-measure-cqfm>     ], [
       fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm";
       fhir:index 1;
       fhir:link <http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm>     ]
  ]; # 
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n        <tr>\n            <th scope=\"row\"><b>Id: </b></th>\n            <td style=\"padding-left: 4px;\">measure-ratio-exm</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Url: </b></th>\n            <td style=\"padding-left: 4px;\"><a href=\"http://example.org/fhir/measures/measure-ratio-exm\">http://example.org/fhir/measures/measure-ratio-exm</a></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Version: </b></th>\n            <td style=\"padding-left: 4px;\">2.0.0</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Identifier: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                <p style=\"margin-bottom: 5px;\">\n                    <b>value: </b> <span>EXMRatio</span>\n                </p>\n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Name: </b></th>\n            <td style=\"padding-left: 4px;\">EXMRatioMeasure</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Title: </b></th>\n            <td style=\"padding-left: 4px;\">EXM Ratio Measure</td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Status: </b></th>\n            <td style=\"padding-left: 4px;\">active</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Experimental: </b></th>\n            <td style=\"padding-left: 4px;\">true</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Scoring: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span><a href=\"http://terminology.hl7.org/CodeSystem/measure-scoring\">http://terminology.hl7.org/CodeSystem/measure-scoring</a></span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>ratio</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>display: </b> <span>Ratio</span>\n                        </p>\n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Improvement Notation: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span><a href=\"http://terminology.hl7.org/CodeSystem/measure-improvement-notation\">http://terminology.hl7.org/CodeSystem/measure-improvement-notation</a></span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>decrease</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>display: </b> <span>Decreased score indicates improvement</span>\n                        </p>\n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Type: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span><a href=\"http://terminology.hl7.org/CodeSystem/measure-type\">http://terminology.hl7.org/CodeSystem/measure-type</a></span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>process</span>\n                        </p>\n                        \n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Date: </b></th>\n            <td style=\"padding-left: 4px;\">2022-02-22</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Publisher: </b></th>\n            <td style=\"padding-left: 4px;\">Clinical Quality Information WG</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Description: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>An example FHIR-based publishable measure</p>\n</div></td>\n        </tr>\n        \n        \n        \n        \n        \n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Use Context: </b></th>\n            <td style=\"padding-left: 4px;\">\n                <table class=\"grid-dict\">\n                    <tr><th><b>code</b></th><th><b>value</b></th></tr>\n                    \n                      <tr>\n                        <td>program</td>\n                        <td>eligible-provider</td>\n                      </tr>\n                    \n                </table>\n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Jurisdiction: </b></th>\n            <td style=\"padding-left: 25px;\">US</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Topic: </b></th>\n            <td style=\"padding-left: 25px;\">57024-2</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Purpose: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The purpose of this measure is to...</p>\n</div></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Usage: </b></th>\n            <td style=\"padding-left: 4px;\">Users of this measure should be aware of...</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Copyright: </b></th>\n            <td style=\"padding-left: 25px;\"><div><p>Example Copyright Statement</p>\n</div></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Disclaimer: </b></th>\n            <td style=\"padding-left: 25px;\"><div><p>Example disclaimer</p>\n</div></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Approval Date: </b></th>\n            <td style=\"padding-left: 4px;\">2019-02-17</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Last Review Date: </b></th>\n            <td style=\"padding-left: 4px;\">2019-02-17</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Effective Period: </b></th>\n            <td style=\"padding-left: 4px;\">2018-01-01..2018-12-31</td>\n        </tr>\n        \n        \n        \n        \n        \n        \n    </table>\n</div>"
  ]; # 
  fhir:DomainResource.contained [
     a fhir:Library;
     fhir:index 0;
     fhir:Resource.id [ fhir:value "effective-data-requirements" ];
     fhir:DomainResource.extension [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXMRatio" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Qualifying Encounters" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Qualifying Encounters\":   [\"Encounter\": \"Inpatient\"]" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "0"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 1;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXMRatio" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Initial Population" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Initial Population\":   \"Qualifying Encounters\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "1"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 2;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXMRatio" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Numerator" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Numerator\":   \"Initial Population\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "2"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 3;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXMRatio" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Denominator" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Denominator\":   \"Initial Population\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "3"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ];
     fhir:Library.name [ fhir:value "EffectiveDataRequirements" ];
     fhir:Library.status [ fhir:value "active" ];
     fhir:Library.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/library-type" ];
         fhir:Coding.code [ fhir:value "module-definition" ]       ]     ];
     fhir:Library.date [ fhir:value "2022-02-22T10:37:04-07:00"^^xsd:dateTime ];
     fhir:Library.relatedArtifact [
       fhir:index 0;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Inpatient" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://example.org/fhir/ValueSet/inpatient";
         fhir:link <http://example.org/fhir/ValueSet/inpatient>       ]     ];
     fhir:Library.parameter [
       fhir:index 0;
       fhir:ParameterDefinition.name [ fhir:value "Numerator" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Encounter" ]     ], [
       fhir:index 1;
       fhir:ParameterDefinition.name [ fhir:value "Denominator" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Encounter" ]     ], [
       fhir:index 2;
       fhir:ParameterDefinition.name [ fhir:value "Initial Population" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Encounter" ]     ];
     fhir:Library.dataRequirement [
       fhir:index 0;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://example.org/fhir/ValueSet/inpatient";
           fhir:link <http://example.org/fhir/ValueSet/inpatient>         ]       ]     ]
  ]; # 
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis" ];
     fhir:Extension.valueCode [ fhir:value "Encounter" ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit" ];
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://unitsofmeasure.org" ];
         fhir:Coding.code [ fhir:value "/1000.d" ]       ]     ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "Device/software-system-example" ]     ]
  ], [
     fhir:index 3;
     fhir:Element.id [ fhir:value "effective-data-requirements" ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "#effective-data-requirements" ]     ]
  ]; # 
  fhir:Measure.url [ fhir:value "http://example.org/fhir/measures/measure-ratio-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 "EXMRatio" ]
  ]; # 
  fhir:Measure.version [ fhir:value "2.0.0"]; # 
  fhir:Measure.name [ fhir:value "EXMRatioMeasure"]; # 
  fhir:Measure.title [ fhir:value "EXM Ratio Measure"]; # 
  fhir:Measure.status [ fhir:value "active"]; # 
  fhir:Measure.experimental [ fhir:value "true"^^xsd:boolean]; # 
  fhir:Measure.date [ fhir:value "2022-02-22"^^xsd:date]; # 
  fhir:Measure.publisher [ fhir:value "Clinical Quality Information WG"]; # 
  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.hl7.org/Special/committees/cqi" ]     ]
  ]; # 
  fhir:Measure.description [ fhir:value "An example FHIR-based publishable measure"]; # 
  fhir:Measure.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "program" ]     ];
     fhir:UsageContext.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs" ];
         fhir:Coding.code [ fhir:value "ep-ec" ]       ];
       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: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 "2018-01-01"^^xsd:date ]     ], [
       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 "2018-01-01"^^xsd:date ];
     fhir:Period.end [ fhir:value "2018-12-31"^^xsd:date ]
  ]; # 
  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.library [
     fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/EXMRatio";
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/EXMRatio>
  ]; # 
  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 "ratio" ];
       fhir:Coding.display [ fhir:value "Ratio" ]     ]
  ]; # 
  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.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 "decrease" ];
       fhir:Coding.display [ fhir:value "Decreased score indicates improvement" ]     ]
  ]; # 
  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" ];
       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-identifier" ];
         fhir:Expression.expression [ fhir:value "Initial Population" ]       ]     ], [
       fhir:index 1;
       fhir:Element.id [ fhir:value "numerator" ];
       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-identifier" ];
         fhir:Expression.expression [ fhir:value "Numerator" ]       ]     ], [
       fhir:index 2;
       fhir:Element.id [ fhir:value "denominator" ];
       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-identifier" ];
         fhir:Expression.expression [ fhir:value "Denominator" ]       ]     ], [
       fhir:index 3;
       fhir:Element.id [ fhir:value "denominator-observation" ];
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference" ];
         fhir:Extension.valueString [ fhir:value "denominator" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod" ];
         fhir:Extension.valueCode [ fhir:value "sum" ]       ];
       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 "measure-observation" ];
           fhir:Coding.display [ fhir:value "Measure Observation" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Measure Denominator Observation" ]       ]     ], [
       fhir:index 4;
       fhir:Element.id [ fhir:value "numerator-observation" ];
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference" ];
         fhir:Extension.valueString [ fhir:value "numerator" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod" ];
         fhir:Extension.valueCode [ fhir:value "sum" ]       ];
       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 "measure-observation" ];
           fhir:Coding.display [ fhir:value "Measure Observation" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Measure Numerator Observation" ]       ]     ]
  ]. # 

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

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