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 Ratio Measure

The CQFM Ratio Measure Profile describes a ratio scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.

Usage:

• Examples for this Resource Profile: EXMRatioMeasure

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 CQFMComputableMeasure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	CQFMComputableMeasure	A quality measure definition
scoring	S	0..1	CodeableConcept	ratio Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
group	SC	1..*	BackboneElement	Population criteria group cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
Slices for extension				Content/Rules for all slices
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:initialPopulation	S	1..2	BackboneElement	Initial Population
Slices for extension				Content/Rules for all slices
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
population:denominator	S	1..1	BackboneElement	Denominator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
population:numerator	S	1..1	BackboneElement	Numerator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
population:measureObservation	S	0..2	BackboneElement	Measure Observation
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()

Name	Flags	Card.	Type	Description & Constraints
Measure	SC	0..*	CQFMComputableMeasure	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 cmp-1: Population basis must be specified at the root, or on each group cmp-2: Scoring must either be specified at the root, or on each group cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-4: Improvement notation must be specified for scoring types other than cohort cmp-5: If type is specified at the root, it may not be specified on any group cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group cmp-7: If rateAggregation is specified at the root, it may not be specified on any group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
effectiveDataRequirements	S	0..1	canonical(CRMI Module Definition Library)	Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
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.
subject[x]	S	0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept			CodeableConcept
subjectReference			Reference(Group)
library	S	0..1	canonical(CRMI Computable Library)	Logic used by the measure
scoring	SΣC	0..1	CodeableConcept	ratio Binding: Measure Scoring (extensible) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
type	SΣC	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).
improvementNotation	SΣC	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required)
group	SC	1..*	BackboneElement	Population criteria group cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-9: Improvement notation must be specified for scoring types other than cohort cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
Slices for extension				Content/Rules for all slices
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
compositeScoring	S	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
component	S	0..*	RelatedArtifact	What artifact URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-component
type	C	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type Binding: MeasureType (extensible): Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustment	C	0..1	string	How risk adjustment is applied for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment
rateAggregation	C	0..1	string	How is rate aggregation performed for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation
improvementNotation	SC	0..1	CodeableConcept	increase | decrease URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the group
description	S	0..1	string	Summary description
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	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	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:initialPopulation	S	1..2	BackboneElement	Initial Population
Slices for extension				Content/Rules for all slices
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominator	S	1..1	BackboneElement	Denominator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numerator	S	1..1	BackboneElement	Numerator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:measureObservation	S	0..2	BackboneElement	Measure Observation
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	S	0..*	BackboneElement	Stratifier criteria for the measure
Slices for extension				Content/Rules for all slices
appliesTo		0..*	CodeableConcept	Which population does this stratifier apply to? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier
description	S	0..1	string	The human readable description of this stratifier
component	S	0..*	BackboneElement	Stratifier criteria component for the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier component
description	S	0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	S	0..*	BackboneElement	What other data should be reported with the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the supplemental data
usage	S	0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description	S	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 / Code	URI
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
Measure.subject[x]	extensible	SubjectTypeValueSet http://hl7.org/fhir/us/cqfmeasures/ValueSet/subject-type from this IG
Measure.scoring	extensible	Pattern: ratio http://terminology.hl7.org/ValueSet/measure-scoring
Measure.type	extensible	MeasureType http://hl7.org/fhir/ValueSet/measure-type from the FHIR Standard
Measure.improvementNotation	required	MeasureImprovementNotation http://terminology.hl7.org/ValueSet/measure-improvement-notation
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:initialPopulation.code	extensible	Pattern: initial-population http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominator.code	extensible	Pattern: denominator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominatorExclusion.code	extensible	Pattern: denominator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numerator.code	extensible	Pattern: numerator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numeratorExclusion.code	extensible	Pattern: numerator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:measureObservation.code	extensible	Pattern: measure-observation 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
cmp-1	error	Measure	Population basis must be specified at the root, or on each group : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue()
cmp-2	error	Measure	Scoring must either be specified at the root, or on each group : scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue())
cmp-3	error	Measure	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists()
cmp-4	error	Measure	Improvement notation must be specified for scoring types other than cohort : (scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort'))
cmp-5	error	Measure	If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse()
cmp-6	error	Measure	If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse()
cmp-7	error	Measure	If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse()
cmp-8	error	Measure.group	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()
cmp-9	error	Measure.group	Improvement notation must be specified for scoring types other than cohort : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists()
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()
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())
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	SC	0..*	CQFMComputableMeasure	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 cmp-1: Population basis must be specified at the root, or on each group cmp-2: Scoring must either be specified at the root, or on each group cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-4: Improvement notation must be specified for scoring types other than cohort cmp-5: If type is specified at the root, it may not be specified on any group cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group cmp-7: If rateAggregation is specified at the root, it may not be specified on any group
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
effectiveDataRequirements	S	0..1	canonical(CRMI Module Definition Library)	Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
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]	S	0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
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	0..1	canonical(CRMI Computable Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	SΣC	0..1	CodeableConcept	ratio Binding: Measure Scoring (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	SΣC	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	ΣC	0..1	string	How risk adjustment is applied for this measure
rateAggregation	ΣC	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	SΣC	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required)
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	SC	1..*	BackboneElement	Population criteria group cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-9: Improvement notation must be specified for scoring types other than cohort cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
compositeScoring	S	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
component	S	0..*	RelatedArtifact	What artifact URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-component
type	C	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type Binding: MeasureType (extensible): Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustment	C	0..1	string	How risk adjustment is applied for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment
rateAggregation	C	0..1	string	How is rate aggregation performed for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation
improvementNotation	SC	0..1	CodeableConcept	increase | decrease URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the group
description	S	0..1	string	Summary description
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:All Slices				Content/Rules for all slices
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	S	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	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:initialPopulation	S	1..2	BackboneElement	Initial Population
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominator	S	1..1	BackboneElement	Denominator
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numerator	S	1..1	BackboneElement	Numerator
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:measureObservation	S	0..2	BackboneElement	Measure Observation
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	S	0..*	BackboneElement	Stratifier criteria for the measure
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
appliesTo		0..*	CodeableConcept	Which population does this stratifier apply to? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier
description	S	0..1	string	The human readable description of this stratifier
criteria		0..1	Expression	How the measure should be stratified
component	S	0..*	BackboneElement	Stratifier criteria component for the measure
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	S	0..1	CodeableConcept	Meaning of the stratifier component
description	S	0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	S	0..*	BackboneElement	What other data should be reported with the measure
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	S	0..1	CodeableConcept	Meaning of the supplemental data
usage	S	0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description	S	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 / Code	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	SubjectTypeValueSet http://hl7.org/fhir/us/cqfmeasures/ValueSet/subject-type from this IG
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	Pattern: ratio http://terminology.hl7.org/ValueSet/measure-scoring
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://terminology.hl7.org/ValueSet/measure-improvement-notation
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:initialPopulation.code	extensible	Pattern: initial-population http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominator.code	extensible	Pattern: denominator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominatorExclusion.code	extensible	Pattern: denominator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numerator.code	extensible	Pattern: numerator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numeratorExclusion.code	extensible	Pattern: numerator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:measureObservation.code	extensible	Pattern: measure-observation 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
cmp-1	error	Measure	Population basis must be specified at the root, or on each group : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue()
cmp-2	error	Measure	Scoring must either be specified at the root, or on each group : scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue())
cmp-3	error	Measure	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists()
cmp-4	error	Measure	Improvement notation must be specified for scoring types other than cohort : (scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort'))
cmp-5	error	Measure	If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse()
cmp-6	error	Measure	If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse()
cmp-7	error	Measure	If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse()
cmp-8	error	Measure.group	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()
cmp-9	error	Measure.group	Improvement notation must be specified for scoring types other than cohort : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists()
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()
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())
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 CQFMComputableMeasure

Summary

Mandatory: 7 elements(4 nested mandatory elements)
Must-Support: 22 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Measure.group.population

Differential View

This structure is derived from CQFMComputableMeasure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	CQFMComputableMeasure	A quality measure definition
scoring	S	0..1	CodeableConcept	ratio Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
group	SC	1..*	BackboneElement	Population criteria group cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
Slices for extension				Content/Rules for all slices
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:initialPopulation	S	1..2	BackboneElement	Initial Population
Slices for extension				Content/Rules for all slices
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
population:denominator	S	1..1	BackboneElement	Denominator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
population:numerator	S	1..1	BackboneElement	Numerator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
population:measureObservation	S	0..2	BackboneElement	Measure Observation
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Measure	SC	0..*	CQFMComputableMeasure	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 cmp-1: Population basis must be specified at the root, or on each group cmp-2: Scoring must either be specified at the root, or on each group cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-4: Improvement notation must be specified for scoring types other than cohort cmp-5: If type is specified at the root, it may not be specified on any group cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group cmp-7: If rateAggregation is specified at the root, it may not be specified on any group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension				Content/Rules for all slices
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
effectiveDataRequirements	S	0..1	canonical(CRMI Module Definition Library)	Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
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.
subject[x]	S	0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept			CodeableConcept
subjectReference			Reference(Group)
library	S	0..1	canonical(CRMI Computable Library)	Logic used by the measure
scoring	SΣC	0..1	CodeableConcept	ratio Binding: Measure Scoring (extensible) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
type	SΣC	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).
improvementNotation	SΣC	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required)
group	SC	1..*	BackboneElement	Population criteria group cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-9: Improvement notation must be specified for scoring types other than cohort cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
Slices for extension				Content/Rules for all slices
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
compositeScoring	S	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
component	S	0..*	RelatedArtifact	What artifact URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-component
type	C	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type Binding: MeasureType (extensible): Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustment	C	0..1	string	How risk adjustment is applied for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment
rateAggregation	C	0..1	string	How is rate aggregation performed for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation
improvementNotation	SC	0..1	CodeableConcept	increase | decrease URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the group
description	S	0..1	string	Summary description
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	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	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:initialPopulation	S	1..2	BackboneElement	Initial Population
Slices for extension				Content/Rules for all slices
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominator	S	1..1	BackboneElement	Denominator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numerator	S	1..1	BackboneElement	Numerator
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
Slices for extension				Content/Rules for all slices
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:measureObservation	S	0..2	BackboneElement	Measure Observation
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	S	0..*	BackboneElement	Stratifier criteria for the measure
Slices for extension				Content/Rules for all slices
appliesTo		0..*	CodeableConcept	Which population does this stratifier apply to? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier
description	S	0..1	string	The human readable description of this stratifier
component	S	0..*	BackboneElement	Stratifier criteria component for the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier component
description	S	0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	S	0..*	BackboneElement	What other data should be reported with the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the supplemental data
usage	S	0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description	S	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 / Code	URI
Measure.status	required	PublicationStatus http://hl7.org/fhir/ValueSet/publication-status|4.0.1 from the FHIR Standard
Measure.subject[x]	extensible	SubjectTypeValueSet http://hl7.org/fhir/us/cqfmeasures/ValueSet/subject-type from this IG
Measure.scoring	extensible	Pattern: ratio http://terminology.hl7.org/ValueSet/measure-scoring
Measure.type	extensible	MeasureType http://hl7.org/fhir/ValueSet/measure-type from the FHIR Standard
Measure.improvementNotation	required	MeasureImprovementNotation http://terminology.hl7.org/ValueSet/measure-improvement-notation
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:initialPopulation.code	extensible	Pattern: initial-population http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominator.code	extensible	Pattern: denominator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominatorExclusion.code	extensible	Pattern: denominator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numerator.code	extensible	Pattern: numerator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numeratorExclusion.code	extensible	Pattern: numerator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:measureObservation.code	extensible	Pattern: measure-observation 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
cmp-1	error	Measure	Population basis must be specified at the root, or on each group : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue()
cmp-2	error	Measure	Scoring must either be specified at the root, or on each group : scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue())
cmp-3	error	Measure	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists()
cmp-4	error	Measure	Improvement notation must be specified for scoring types other than cohort : (scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort'))
cmp-5	error	Measure	If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse()
cmp-6	error	Measure	If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse()
cmp-7	error	Measure	If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse()
cmp-8	error	Measure.group	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()
cmp-9	error	Measure.group	Improvement notation must be specified for scoring types other than cohort : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists()
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()
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())
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	SC	0..*	CQFMComputableMeasure	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 cmp-1: Population basis must be specified at the root, or on each group cmp-2: Scoring must either be specified at the root, or on each group cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-4: Improvement notation must be specified for scoring types other than cohort cmp-5: If type is specified at the root, it may not be specified on any group cmp-6: If riskAdjustment is specified at the root, it may not be specified on any group cmp-7: If rateAggregation is specified at the root, it may not be specified on any group
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
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
effectiveDataRequirements	S	0..1	canonical(CRMI Module Definition Library)	Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
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]	S	0..1		E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
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	0..1	canonical(CRMI Computable Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	SΣC	0..1	CodeableConcept	ratio Binding: Measure Scoring (extensible) Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ratio
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	SΣC	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	ΣC	0..1	string	How risk adjustment is applied for this measure
rateAggregation	ΣC	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	SΣC	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required)
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	SC	1..*	BackboneElement	Population criteria group cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root cmp-9: Improvement notation must be specified for scoring types other than cohort cmp-13: Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
populationBasis	SC	0..1	code	What type of population URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
scoring	SC	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
scoringUnit	SC	0..1	CodeableConcept	What units? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit
scoringPrecision		0..1	positiveInt	Number of decimal places URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringPrecision
compositeScoring	S	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
component	S	0..*	RelatedArtifact	What artifact URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-component
type	C	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type Binding: MeasureType (extensible): Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustment	C	0..1	string	How risk adjustment is applied for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment
rateAggregation	C	0..1	string	How is rate aggregation performed for this measure URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation
improvementNotation	SC	0..1	CodeableConcept	increase | decrease URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the group
description	S	0..1	string	Summary description
Slices for population	SC	4..8	BackboneElement	Population criteria Slice: Unordered, Open by value:code
population:All Slices				Content/Rules for all slices
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	S	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	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:initialPopulation	S	1..2	BackboneElement	Initial Population
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
populationBasis		0..1	code	Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure. URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: initial-population
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominator	S	1..1	BackboneElement	Denominator
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:denominatorExclusion	S	0..1	BackboneElement	Denominator Exclusion
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: denominator-exclusion
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numerator	S	1..1	BackboneElement	Numerator
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:numeratorExclusion	S	0..1	BackboneElement	Numerator Exclusion
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: numerator-exclusion
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
population:measureObservation	S	0..2	BackboneElement	Measure Observation
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
criteriaReference	S	0..1	string	Which criteria URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
aggregateMethod	S	1..1	code	Aggregate with URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod Binding: Measure Aggregate Method (preferred): Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..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. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-population
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: measure-observation
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
description	S	0..1	string	The human readable description of this population criteria
criteria		1..1	Expression	The criteria that defines this population
stratifier	S	0..*	BackboneElement	Stratifier criteria for the measure
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
appliesTo		0..*	CodeableConcept	Which population does this stratifier apply to? URL: http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	0..1	CodeableConcept	Meaning of the stratifier
description	S	0..1	string	The human readable description of this stratifier
criteria		0..1	Expression	How the measure should be stratified
component	S	0..*	BackboneElement	Stratifier criteria component for the measure
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	S	0..1	CodeableConcept	Meaning of the stratifier component
description	S	0..1	string	The human readable description of this stratifier component
criteria		1..1	Expression	Component of how the measure should be stratified
supplementalData	S	0..*	BackboneElement	What other data should be reported with the measure
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	S	0..1	CodeableConcept	Meaning of the supplemental data
usage	S	0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description	S	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 / Code	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	SubjectTypeValueSet http://hl7.org/fhir/us/cqfmeasures/ValueSet/subject-type from this IG
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	Pattern: ratio http://terminology.hl7.org/ValueSet/measure-scoring
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://terminology.hl7.org/ValueSet/measure-improvement-notation
Measure.group.population.code	extensible	MeasurePopulationType http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:initialPopulation.code	extensible	Pattern: initial-population http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominator.code	extensible	Pattern: denominator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:denominatorExclusion.code	extensible	Pattern: denominator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numerator.code	extensible	Pattern: numerator http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:numeratorExclusion.code	extensible	Pattern: numerator-exclusion http://hl7.org/fhir/ValueSet/measure-population from the FHIR Standard
Measure.group.population:measureObservation.code	extensible	Pattern: measure-observation 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
cmp-1	error	Measure	Population basis must be specified at the root, or on each group : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis').exists()).allTrue()
cmp-2	error	Measure	Scoring must either be specified at the root, or on each group : scoring.exists() xor (group.exists() and group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()).allTrue())
cmp-3	error	Measure	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies scoring.exists()
cmp-4	error	Measure	Improvement notation must be specified for scoring types other than cohort : (scoring.exists() and (scoring.coding.code.contains('proportion') or scoring.coding.code.contains('ratio') or scoring.coding.code.contains('continuous-variable') or scoring.coding.code.contains('composite')) and improvementNotation.exists()) xor (group.exists() and group.select((extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and (extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort'))
cmp-5	error	Measure	If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type').exists()).allFalse()
cmp-6	error	Measure	If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-riskAdjustment').exists()).allFalse()
cmp-7	error	Measure	If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation').exists()).allFalse()
cmp-8	error	Measure.group	Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoringUnit').exists() implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists()
cmp-9	error	Measure.group	Improvement notation must be specified for scoring types other than cohort : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation').exists()
cmp-13	error	Measure.group	Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria : extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').exists() and extension('http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring').value.coding.code contains 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()
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())
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 CQFMComputableMeasure

Summary

Mandatory: 7 elements(4 nested mandatory elements)
Must-Support: 22 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference
• http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Measure.group.population