This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v5.0.0: STU5 (v5.0.0)) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

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Resource Profile: CQFM ELM Measure

The CQFM ELM Measure Profile describes minimum expectations for an executable electronic Clinical Quality Measure (eCQM) that uses ELM (i.e. compiled CQL) to represent the logic of the measure.

Usage:

• Examples for this Resource Profile: MeasureEXM

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Measure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	Measure	A quality measure definition
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')

Name	Flags	Card.	Type	Description & Constraints
Measure	C	0..*	Measure	A quality measure definition mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation mea-1: Stratifier SHALL be either a single criteria or a set of criteria components
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	The criteria that defines this population
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	Expression describing additional data to be reported
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Measure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Measure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Measure	If 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-5	error	Measure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Measure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mea-0	warning	Measure	Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
mea-1	error	Measure	Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists())

Name	Flags	Card.	Type	Description & Constraints
Measure	C	0..*	Measure	A quality measure definition mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation mea-1: Stratifier SHALL be either a single criteria or a set of criteria components
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
url	Σ	0..1	uri	Canonical identifier for this measure, represented as a URI (globally unique)
identifier	Σ	0..*	Identifier	Additional identifier for the measure
version	Σ	0..1	string	Business version of the measure
name	ΣC	0..1	string	Name for this measure (computer friendly)
title	Σ	0..1	string	Name for this measure (human friendly)
subtitle		0..1	string	Subordinate title of the measure
status	?!Σ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
experimental	Σ	0..1	boolean	For testing purposes, not real usage
subject[x]		0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).
subjectCodeableConcept			CodeableConcept
subjectReference			Reference(Group)
date	Σ	0..1	dateTime	Date last changed
publisher	Σ	0..1	string	Name of the publisher (organization or individual)
contact	Σ	0..*	ContactDetail	Contact details for the publisher
description	Σ	0..1	markdown	Natural language description of the measure
useContext	Σ	0..*	UsageContext	The context that the content is intended to support
jurisdiction	Σ	0..*	CodeableConcept	Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose		0..1	markdown	Why this measure is defined
usage		0..1	string	Describes the clinical usage of the measure
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the measure was approved by publisher
lastReviewDate		0..1	date	When the measure was last reviewed
effectivePeriod	Σ	0..1	Period	When the measure is expected to be used
topic		0..*	CodeableConcept	The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author		0..*	ContactDetail	Who authored the content
editor		0..*	ContactDetail	Who edited the content
reviewer		0..*	ContactDetail	Who reviewed the content
endorser		0..*	ContactDetail	Who endorsed the content
relatedArtifact		0..*	RelatedArtifact	Additional documentation, citations, etc.
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	Σ	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort Binding: MeasureScoring (extensible): The scoring type of the measure.
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	Σ	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome | composite Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
riskAdjustment	Σ	0..1	string	How risk adjustment is applied for this measure
rateAggregation	Σ	0..1	string	How is rate aggregation performed for this measure
rationale	Σ	0..1	markdown	Detailed description of why the measure exists
clinicalRecommendationStatement	Σ	0..1	markdown	Summary of clinical guidelines
improvementNotation	Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	S	0..*	BackboneElement	Population criteria group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the group
description		0..1	string	Summary description
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description		0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the stratifier
description		0..1	string	The human readable description of this stratifier
criteria		0..1	Expression	How the measure should be stratified
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the stratifier component
description		0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the supplemental data
usage		0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description		0..1	string	The human readable description of this supplemental data
criteria		1..1	Expression	Expression describing additional data to be reported
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Measure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
Measure.subject[x]	extensible	SubjectType http://hl7.org/fhir/ValueSet/subject-type from the FHIR Standard
Measure.jurisdiction	extensible	Jurisdiction ValueSet http://hl7.org/fhir/ValueSet/jurisdiction from the FHIR Standard
Measure.topic	example	DefinitionTopic http://hl7.org/fhir/ValueSet/definition-topic from the FHIR Standard
Measure.scoring	extensible	MeasureScoring http://hl7.org/fhir/ValueSet/measure-scoring from the FHIR Standard
Measure.compositeScoring	extensible	CompositeMeasureScoring http://hl7.org/fhir/ValueSet/composite-measure-scoring from the FHIR Standard
Measure.type	extensible	MeasureType http://hl7.org/fhir/ValueSet/measure-type from the FHIR Standard
Measure.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.supplementalData.usage	extensible	MeasureDataUsage http://hl7.org/fhir/ValueSet/measure-data-usage from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Measure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Measure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Measure	If 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-5	error	Measure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Measure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mea-0	warning	Measure	Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
mea-1	error	Measure	Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists())

This structure is derived from Measure

Summary

Mandatory: 1 element
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• ELM JSON Library (http://hl7.org/fhir/uv/cql/StructureDefinition/elm-json-library)
• ELM XML Library (http://hl7.org/fhir/uv/cql/StructureDefinition/elm-xml-library)

Differential View

This structure is derived from Measure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	Measure	A quality measure definition
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Measure	C	0..*	Measure	A quality measure definition mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation mea-1: Stratifier SHALL be either a single criteria or a set of criteria components
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	The criteria that defines this population
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
criteria		1..1	Expression	Expression describing additional data to be reported
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Measure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Measure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Measure	If 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-5	error	Measure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Measure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mea-0	warning	Measure	Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
mea-1	error	Measure	Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists())

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Measure	C	0..*	Measure	A quality measure definition mea-0: Name should be usable as an identifier for the module by machine processing applications such as code generation mea-1: Stratifier SHALL be either a single criteria or a set of criteria components
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
url	Σ	0..1	uri	Canonical identifier for this measure, represented as a URI (globally unique)
identifier	Σ	0..*	Identifier	Additional identifier for the measure
version	Σ	0..1	string	Business version of the measure
name	ΣC	0..1	string	Name for this measure (computer friendly)
title	Σ	0..1	string	Name for this measure (human friendly)
subtitle		0..1	string	Subordinate title of the measure
status	?!Σ	1..1	code	draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
experimental	Σ	0..1	boolean	For testing purposes, not real usage
subject[x]		0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).
subjectCodeableConcept			CodeableConcept
subjectReference			Reference(Group)
date	Σ	0..1	dateTime	Date last changed
publisher	Σ	0..1	string	Name of the publisher (organization or individual)
contact	Σ	0..*	ContactDetail	Contact details for the publisher
description	Σ	0..1	markdown	Natural language description of the measure
useContext	Σ	0..*	UsageContext	The context that the content is intended to support
jurisdiction	Σ	0..*	CodeableConcept	Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose		0..1	markdown	Why this measure is defined
usage		0..1	string	Describes the clinical usage of the measure
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the measure was approved by publisher
lastReviewDate		0..1	date	When the measure was last reviewed
effectivePeriod	Σ	0..1	Period	When the measure is expected to be used
topic		0..*	CodeableConcept	The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author		0..*	ContactDetail	Who authored the content
editor		0..*	ContactDetail	Who edited the content
reviewer		0..*	ContactDetail	Who reviewed the content
endorser		0..*	ContactDetail	Who endorsed the content
relatedArtifact		0..*	RelatedArtifact	Additional documentation, citations, etc.
library	S	1..1	canonical(ELM JSON Library | ELM XML Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	Σ	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort Binding: MeasureScoring (extensible): The scoring type of the measure.
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	Σ	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome | composite Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
riskAdjustment	Σ	0..1	string	How risk adjustment is applied for this measure
rateAggregation	Σ	0..1	string	How is rate aggregation performed for this measure
rationale	Σ	0..1	markdown	Detailed description of why the measure exists
clinicalRecommendationStatement	Σ	0..1	markdown	Summary of clinical guidelines
improvementNotation	Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	S	0..*	BackboneElement	Population criteria group
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the group
description		0..1	string	Summary description
population	SC	0..*	BackboneElement	Population criteria elm-1: ELM measures must use text/cql-identifier for all population criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description		0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	SC	0..*	BackboneElement	Stratifier criteria for the measure elm-2: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the stratifier
description		0..1	string	The human readable description of this stratifier
criteria		0..1	Expression	How the measure should be stratified
component	SC	0..*	BackboneElement	Stratifier criteria component for the measure elm-3: Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the stratifier component
description		0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	SC	0..*	BackboneElement	What other data should be reported with the measure elm-4: Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the supplemental data
usage		0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description		0..1	string	The human readable description of this supplemental data
criteria		1..1	Expression	Expression describing additional data to be reported
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Measure.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
Measure.subject[x]	extensible	SubjectType http://hl7.org/fhir/ValueSet/subject-type from the FHIR Standard
Measure.jurisdiction	extensible	Jurisdiction ValueSet http://hl7.org/fhir/ValueSet/jurisdiction from the FHIR Standard
Measure.topic	example	DefinitionTopic http://hl7.org/fhir/ValueSet/definition-topic from the FHIR Standard
Measure.scoring	extensible	MeasureScoring http://hl7.org/fhir/ValueSet/measure-scoring from the FHIR Standard
Measure.compositeScoring	extensible	CompositeMeasureScoring http://hl7.org/fhir/ValueSet/composite-measure-scoring from the FHIR Standard
Measure.type	extensible	MeasureType http://hl7.org/fhir/ValueSet/measure-type from the FHIR Standard
Measure.improvementNotation	required	MeasureImprovementNotation http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 from the FHIR Standard
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.supplementalData.usage	extensible	MeasureDataUsage http://hl7.org/fhir/ValueSet/measure-data-usage from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	Measure	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Measure	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Measure	If 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-5	error	Measure	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Measure	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
elm-1	error	Measure.group.population	ELM measures must use text/cql-identifier for all population criteria : criteria.language = 'text/cql-identifier'
elm-2	error	Measure.group.stratifier	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-3	error	Measure.group.stratifier.component	Executable measures must use text/cql-identifier or text/fhirpath for all stratifier component criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
elm-4	error	Measure.supplementalData	Executable measures must use text/cql-identifier or text/fhirpath for all supplemental data criteria : criteria.language in ('text/cql-identifier' | 'text/fhirpath')
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
mea-0	warning	Measure	Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
mea-1	error	Measure	Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists())

This structure is derived from Measure

Summary

Mandatory: 1 element
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• ELM JSON Library (http://hl7.org/fhir/uv/cql/StructureDefinition/elm-json-library)
• ELM XML Library (http://hl7.org/fhir/uv/cql/StructureDefinition/elm-xml-library)

Other representations of profile: CSV, Excel, Schematron