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. For a full list of available versions, see the Directory of published versions

Changes

STU5 Publication for FHIR R4 (v5.0.0)

• Applied: Rename the QMIG CQFM publishable manifest profile to CQFM Content Release (FHIR-45309)(Applied here), (here), and (here)
• Applied: Update text in Measure.improvementNotation cmp-4 (FHIR-45311)(Applied here)
• Applied: Allow support for stratification in ratio measures (FHIR-45321)(Applied here), (here), and (here)
• Applied: Deprecate the Rationale element (FHIR-45361)(Applied here), (here), (here), (here), (here), (here), (here), and (here)
• Applied: Measure.library cardinality(FHIR-45386) Applied across numerous profiles. (profiles page)- (Especially here), (here), and (here)
• Applied: Put example files in the examples folder of package.tgz (FHIR-45387)
• Applied: Adding a link on USING CQL page for data model information(FHIR-45389)(Applied here)
• Applied: Conformance requirement-3-14 text change (FHIR-45423)(Applied here)
• Applied: Editorial corrections to opening sentence(FHIR-45435)(Applied here)
• Applied: Remove conformance requirement 6.5(FHIR-45438)(Applied here)
• Applied: Fix link to Adapting Guidelines for the Digital Age(FHIR-45463)(Applied here), (here), and (here)
• Applied: Fix link to Adapting Guidelines for the Digital Age - another location(FHIR-45464)(Applied here), (here), and (here)
• Applied: Remove reference to the Measure Authoring Tool (MAT)(FHIR-45465)(Applied here)
• Applied: Align description of words - episode of care vs. non-patient based vs. encounter-based measure throughout IG(FHIR-45466)(Applied here)
• Applied: Better align graphic with text. Step 2 is clinical practice guidelines(FHIR-45558)(Applied here)
• Applied: There is reference to a ghost Figure 2-1 in this section.(FHIR-45560)(Applied here)
• Applied: Missing the word "to"(FHIR-45562)(Applied here)
• Applied: Formatting includes extra white space and spacing issues(FHIR-45563)(Applied here)
• Applied: Does this need clarification for users who are not experts in quality measures? Link to resource or definition(FHIR-45565)(Applied here)
• Applied: can this link out to the eCQM RC(FHIR-45567)(Applied here)
• Applied: Awareness is confusing.(FHIR-45568)(Applied here)
• Applied: Can links be created(FHIR-45570)(Applied here)
• Applied: Cannot find header data elements(FHIR-45571)(Applied here)
• Applied: Documentation Flow(FHIR-45572)(Applied here)
• Applied: Correction is Steps in section 1.3.1(FHIR-45573)(Applied here)
• Applied: Suggestion to link to the CQFMCohortMeasure profile(FHIR-45574)(Applied here)
• Applied: Update text in Quality Measurement Standards Landscape(FHIR-45575)(Applied here)
• Applied: Note to Ballot Reviewers Regarding When, Where and How to report(FHIR-45636)(Applied here)
• Applied: Misspells, Typos, Duplicates, Broken Links, Incomplete Sentences, Inconsistent Punctuation, Etcetera(FHIR-45643)(Applied here), (here), (here)
• Applied: Technical Correction(FHIR-45692)Applied throughout (pages)
• Applied: Remove the reference to Codesystem-artifact-comment-type (FHIR-45838)
• Applied: Update link text for code system (FHIR-45839)(Applied here)
• Applied: Update link text for value set (FHIR-45840)(Applied here)
• Applied: Remove the reference to ValueSet-artifact-comment-type (FHIR-45841)
• Applied: Remove the reference to ValueSet-value-filter-comparator.html (FHIR-45842)
• Applied: Run-on sentence in Conformance Requirement 3.1 (FHIR-45873)(Applied here)
• Applied: Use links for referenced profiles in Conformance Requirement 3.1 (FHIR-45875)(Applied here)
• Applied: Remove the requirement that URL tail match the name element(FHIR-45881)(Applied here)
• Applied: Remove the dependency on QICore (FHIR-45882) removed dependency
• Applied: Correct links to Using CQL With FHIR IG(FHIR-45885)(Applied here)
• Applied: Conformance statements text change (FHIR-45886)(Applied here)
• Applied: Update terminology guidance (FHIR-45887)(Applied here)
• Applied: Consider updating the CQFCommon dependency (FHIR-45888) removed dependency
• Applied: Consider alternative approach to presenting CQL guidance here (FHIR-45889)(Applied here)
• Applied: Consider revising packaging discussion (FHIR-45891) Applied (here), (here), (here), and (here)
• Applied: edits/comments to Introduction, QMs, and Using CQL pages (FHIR-45905)(Applied here)
• Applied: Correct description of capability profiles (FHIR-45914)(Applied here)
• Applied: Consider referencing the conformance requirements (FHIR-45915) Applied (here), (here), (here), and (here)
• Applied: Sync up short description and measure profile type (FHIR-45916)(Applied here), (here), (here), (here), and (here)
• Applied: Software system device should be using CRMI (FHIR-45917) Applied (here), and (here)
• Applied: Clarify the meaning of "not restricted to use terminology profiles" (FHIR-45918)(Applied here)
• Applied: Provided content for the operations page (FHIR-45919) (Applied here)
• Applied: Measure Profiles "SEP" combination (FHIR-45920) Applied (here), (here), (here), and (here)
• Applied: ShareableMeasureRepository text and links updates (FHIR-45921)(Applied here)
• Applied: Examples throughout seem to be rendered incorrectly? (FHIR-45922) Applied (here), (here), (here), and (here)
• Applied: CQFMComputableMeasure library - which Library profile to use (FHIR-45923)(Applied here)
• Applied: library profile usage (FHIR-45924)Applied to numerous measure files and (here), and (here)
• Applied: edits/comments to the Profiles page (FHIR-45930) Applied (here), (here), (here), and (here)
• Applied: Glossary page - minor edit to acronym (FHIR-45932)(Applied here)
• Applied: PublishableMeasureRepository capability statement expresses additional functionality (FHIR-45996)(Applied here)
• Applied: Clarify $package for CQFM Test Case MeasureReport (FHIR-46024)Applied (here), (here), (here), and (here)
• Applied: Added sybject-type valueset derived from FHIR value set and FHIR resource types. (FHIR-46063) (Applied here) (here) and (here)
• Applied: Changed scoring expression (cmp-2) from or to xor in computable measure cqfm (FHIR-46206) (Applied here)
• Applied: Add an attestation measure profile (FHIR-46231) (Applied here) (here), and (here)
• Applied: Update Sentence Regarding All Codes and Valuesets in Terminology section (FHIR-46290)(Applied here)
• Applied: clarify short description for appliesTo extension (FHIR-46387)(Applied here)
• Applied: Guidance on when to use multi-rate measures (FHIR-46421)(Applied here)
• Applied: Recover includeInReportType extension (FHIR-46462)(Applied here)
• Applied: Clarify the use of code-based stratifiers (including components) (FHIR-47396)(Applied here)
• Applied: CQMF Publishable Measure Profile Measure.status Fixed to Active (FHIR-47767)(Applied here)
• Applied: Support specifying intended venue for publishable measures (FHIR-48533)(Applied here), (here), (here), and numerous example files

STU5 Ballot2 for FHIR R4 (v5.0.0-ballot2)

• Applied: Remove code "ep-ec" from Quality Programs value set (FHIR-43323) Applied (here)
• Applied: Minor technical items or suggestions for QM IG (FHIR-43428)Applied (here), and here
• Applied: Created an improvementNotationGuidance extension in the FHIR extensions pack and added to Publishable Measure at root and group level. (FHIR-43463)(Applied here)
• Applied: Removed reference to QUICK (FHIR-43594)(Applied here)
• Applied: Corrected broken links (FHIR-43620)(Applied here), and (here)
• Applied: Misspells, Typos and Duplicates (FHIR-43621) Applied (here)
• Applied: Three possible changes (FHIR-43622)(Applied here)
• Applied: Updated the description of the Capabilities page on home page (FHIR-43628)(Applied here)
• Applied: Removed operations section from the capabilities page (FHIR-43629)(Applied here)
• Applied: broken and outdated links and typos on home page (FHIR-43632)(Applied here)
• Applied: Updated CQL version references from 1.4 to 1.5.2 introduction, measure-conformance and using-cql pages (FHIR-43635)(Applied here), (here), and (here)
• Applied: Updated paragraph in Scope section regarding Member Attribution (ATR) Lists (FHIR-43636)(Applied here)
• Applied: Updated CQL-base HQMF IF R1 version reference from STU4 to STU4.1 (FHIR-43637)(Applied here)
• Applied: Incorrect library name in Snippet 3-1 (FHIR-43638)(Applied here)
• Applied: Table 3.1 rendering is off (FHIR-43640)(Applied here)
• Applied: Issues with risk adjustment Snippet 3-28 (FHIR-43642)(Applied Here)
• Applied: update wording in Conformance Requirement 3.17 (FHIR-43643)(Applied Here)
• Applied: Context shown as unfiltered (FHIR-43644)(Applied Here)
• Applied: Denominator Exception (FHIR-43645)(Applied Here)
• Applied: Updated Sequence diagram on capabilities to add new actors and updated flow (FHIR-43681)(Applied Here)
• Applied: Remove QRDA/QDM to an appendix (FHIR-43682)(Applied Here)
• Applied: Composite measure score calculation (FHIR-43693)
• Applied: Remove rate and ratio measure language from Population Criteria Definitions for Proportion Measures (FHIR-43702)
• Applied: Refactor Using CQL to reference the Using CQL IG (FHIR-43710)
• Applied: State composite scoring in the composite measure profile (FHIR-43711)
• Applied: Canonical tail of Measure should be the name (FHIR-43713)
• Applied: Updated tables in composite measure page for clarity (FHIR-43714)(Applied here and subsequent sections))
• Applied: Added table to composite measure page for describing linear scoring vs. opportunity scoring (FHIR-43715) (Applied here)
• Applied: Removed section 1.3.3.1 FHIR Version Support and updated summary to reflect the current state of the IG (FHIR-43767)(Applied here)
• Applied: Data Model snippet out of sync with source file (FHIR-43768)
• Applied: Updated QI-core version reference from STU5 to STU6 (FHIR-43771)(Applied here)
• Applied: Table 3-1 did not render (FHIR-43772)
• Applied: population basis examples have json formatting errors (FHIR-43775)
• Applied: Formatting differences between similar tables 3-3, 3-4, 3-5, adn 3-6 (FHIR-43776)
• Applied: Corrected references of Library Bundles to Measure Bundles in Packaging Measures section (FHIR-43778)(Applied here)
• Applied: clarify the meaning of "de-duplicated" in effectiveDataRequirements extension (FHIR-43779)
• Applied: Clarify ELM -> DataRequirements expectations (FHIR-43781)
• Applied: PopulationBasis extension description should refer to Measure.subject[x] (FHIR-43782)
• Applied: Element subject[x] should be must support in ComputableMeasure (FHIR-43784)
• Applied: Clarify the use of the valueFilter extension (FHIR-43790)(Applied here)
• Applied: Add row for Composite scoring in Table 3-1 (FHIR-43962)
• Applied: Removed serveral CQFM extension definitions in favor of referencing equivalent CQF extensions in FHIR extension registry (FHIR-43969) (Applied throughout)
• Applied: Updated the Quality Improvement Ecosystem paragraph to increase readability (FHIR-44070)(Applied here)
• Applied: Correct the Opportunity Scoring CQL example (FHIR-44074)
• Applied: Correct example and conformance wording (FHIR-44078)(Applied here) and (Applied here)
• Applied: Minor edits to list items in 'How to read this guide' (FHIR-44118)(Applied here)
• Applied: Misspelling of Practitioner (FHIR-44119)
• Applied: Capitalize Proper Names (FHIR-44120)
• Applied: Comments Related to Note To Balloters (FHIR-44125)
• Applied: Definition for Ratio Numerator (FHIR-44136)
• Applied: Use the existing code system. (FHIR-44389)
• Applied: Code Systems and Valuesets should be anchored in THO (terminology.hl7.org). 3 (FHIR-44392)
• Applied: Code Systems and Valuesets should be anchored in THO (terminology.hl7.org). 5 (FHIR-44394)
• Applied: Use the existing value set. (FHIR-44397)
• Applied: Code Systems and Valuesets should be anchored in THO (terminology.hl7.org). 8 (FHIR-44399)
• Applied: Code Systems and Valuesets should be anchored in THO (terminology.hl7.org). 9 (FHIR-44400)
• Applied: Code Systems and Valuesets should be anchored in THO (terminology.hl7.org). 10 (FHIR-44401)
• Applied: change to lower case I in "Initial-population" (FHIR-44523)
• Applied: Updated the text and image in data model standard landscape section to remove DEQM and HEDIS and replaced with Measure Content IG (FHIR-44530)(Applied here)
• Applied: incorrect link for Clinical Reasoning Module (FHIR-44533)
• Applied: Issues with conformance requirement 3.1 and measure profiles (FHIR-44537)
• Applied: Large number of technical corrections (FHIR-44547)
• Applied: Remove requirement to have ELM in a Library resource (FHIR-44598)
• Applied: Refactor Shareable and Publishable profiles and repositories to use CRMI (FHIR-44642)
• Applied: Addition Change for ImprovementNotation (FHIR-44711)
• Applied: Correct the url for CQL specification (FHIR-44991)

STU5 Ballot for FHIR R4 (v5.0.0-ballot)

• Applied: Reference to composites should address content as entity and not limit to patient (FHIR-35922)(Applied here), (here), (here), and (here)
• Applied: Make R4 CQFM Publishable CodeSystem profile compatible with R5 (FHIR-37371)
• Applied: Notes to balloters improvement request (FHIR-39893)(Applied here)
• Applied: Update Dependency to US Core 6.0.0 (FHIR-39894)(Applied here)
• Applied: Hard to tell what is new content (FHIR-39895)(Applied here)
• Applied: ImprovementNotation Allowed Values (FHIR-42116)(Applied here), and (here)
• Applied: Please add 'Operations' as a an options on the FHIR artifacts menu (FHIR-42715)(Applied here), and (here)
• Applied: Clarify ratio measure Numerator definition (FHIR-42826)(Applied here), and (here)
• Applied: Clarify or Correct Conformance Requirement 3.4 (FHIR-42894)(Applied here)
• Applied: Enable QMIG to Handle Population-based Measures (FHIR-42898)(Applied here), and (here)
• Applied: Allow for use of multiple expressions in a population (FHIR-42907)
• Applied: Level of Precision/Rounding and Unit of Measure (FHIR-42908)(Applied here), and (here)
• Applied: Add support for measure manifests in the quality program profile (FHIR-42920)
• Applied: Consider requiring the use of a SignatureLevel higher than none (FHIR-42922)(Applied here), (here), and (here)
• Applied: Does improvementNotation field need to allow for additional guidance? (FHIR-42976)(Applied here), and (here)
• Applied: Draft 2018 should be Active 2023 (FHIR-43039) Applied to numerous json files throughout IG in profiles and vocabulary
• Applied: Correct invalid json in StructureDefinition-cqfm-fhirQueryPattern.json (FHIR-43086)
• Applied: Allow multiple quality programs and bind value set as example (FHIR-43320)(Applied here)
• Applied: Correct short description about appliesTo extension (FHIR-43358)(Applied here)

STU4 Publication for FHIR R4 (v4.0.0)

• Applied: Provide an example of PI measure (FHIR-27930)
• Applied: Correct context element to not limit to Library resources (FHIR-36064)
• Applied: Clarify Ratio Measures using Measure Observations (FHIR-39376)
• Applied: Use dQM in addition to eCQM (FHIR-39457)
• Applied: Fix text/cql.identifier and link to CQL spec (FHIR-39609)
• Applied: Update examples to use eCQM content repo templates for measure examples (FHIR-39621)
• Applied: incorrect links (FHIR-39726)
• Applied: Define profiles on Parameters to add constraints for OperationDefinition (FHIR-39729)
• Applied: Correction to Conformance Requirement 3.1, #12 (FHIR-39820)
• Applied: Question on Conformance Requirement 4.9( FHIR-39821)
• Applied: Minor redundancy in wording (FHIR-39908)
• Applied: Typo - Date Producers -> Data Producers (FHIR-39936)
• Applied: Typo - prescritive -> prescriptive (FHIR-39937)
• Applied: Update to purpose section (FHIR-40024)
• Applied: Update audience language (FHIR-40025)
• Applied: Update approach section (FHIR-40026)
• Applied: Update to background section (FHIR-40027)
• Applied: Update to CQL based HQMF Section (FHIR-40028)
• Applied: Update to ratio measure calculation to mirror HQMF (FHIR-40030)
• Applied: Remove QUICK from the acronyms list (FHIR-40101)
• Applied: double quotes rendering issues in CQL libraries (FHIR-40105)
• Applied: Remove text related to "Remove requirement related to code system order" issue (FHIR-40106)
• Applied: Description of appliesTo is not accurate (FHIR-40107)
• Applied: broken hyperlinks (FHIR-40188)
• Applied: No hyperlink for the reference to the HEDIS IG (FHIR-40189)
• Applied: Dependency on VSAC NPM package (FHIR-40207)
• Applied: Need more explanation about value set expansion profiles (FHIR-40210)
• Applied: Distinguish terminology dependencies in the $package operator (FHIR-40219)
• Applied: Return parameter of Measure/Library data-requirements should be a Library (FHIR-40226)
• Applied: include-dependencies wording should clearly indicate intent (FHIR-40231)
• Applied: Improve measure narrative (FHIR-40237)
• Applied: provide guidance about measure guidance v. usage (FHIR-40241)
• Applied: Mark the keyword element of PublishableValueSet as mustSupport (FHIR-40358)
• Applied: Resolve binding for supplementalData.code (FHIR-40385)
• Applied: Support specifying population level for supplemental data elements (FHIR-40420)
• Applied: Correct bindings for supplementalData and aggregateMethod (FHIR-40457)
• Applied: Surface translator version used in Libraries (FHIR-40487)
• Applied: Add a date to artifactComment (FHIR-40520)
• Applied: Quality Programs Code System and Value Set Need Updated (FHIR-40562)
• Applied: Clarification Needed Regarding Allocation Extension (FHIR-40590)
• Applied: Add evaluatedResource in a test case example (FHIR-40681)
• Applied: Clarify $package when count=0 (FHIR-40682)
• Applied: Consider relaxing statement about QI Core (FHIR-40684)
• Applied: Discrepancy between Measure.type and Group.extension['cqfm-type'] (FHIR-40697)
• Applied: Updates to measure narrative (FHIR-40738)
• Applied: Support liquid template for measure narrative (FHIR-40743)
• Applied: Add support for measure level guidance related to SDE and risk variables (FHIR-40768)
• Applied: Update Example for Effective Data Requirements Library and Provide Narrative for Module Definition Libraries (FHIR-40895)
• Applied: Measure Repository Approve operation should not call for update of endorser (FHIR-41201)
• Applied: Add SearchParameter for ValueSet keyword (FHIR-41449)
• Applied: Relax lastReviewDate and approvalDate cardinalities in publishable profiles (FHIR-41507)

STU4 Ballot for FHIR R4 (v4.0.0-ballot)

• Applied: Add a pertinence extension(FHIR-37826)
• Applied: Allow the fhirQueryPattern extension to be a superset of the data requirement(FHIR-39399)
• Applied: Characterize text search capabilities for a terminology service and repository service(FHIR-37528)
• Applied: Clarify guidance on SDE expression results(FHIR-38051)
• Applied: Use new template-based publishing mechanism(FHIR-25694)
• Applied: Update Cardinality for Composite Measure Profile's Stratification Applies To Extension(FHIR-39353)
• Applied: Clarify conformance related to patient-based CV measures(FHIR-39169)
• Applied: Support batch searches(FHIR-37537)
• Applied: Remove requirement related to code system order(FHIR-37681)
• Applied: Support missing information for hosted content(FHIR-38827)
• Applied: Provide guidance for hosted vs managed content(FHIR-38829)
• Applied: Measure terminology service must mark profile tags(FHIR-38830)
• Applied: PopulationBasis extension can be used on a population(FHIR-39311)
• Applied: QUICK Reference(FHIR-37542)
• Applied: Support keyword search for value sets(FHIR-37530)
• Applied: Add requirements to support maintenance of a quality program(FHIR-37506)
• Applied: Fix incorrect reference to text/cql.identifier(FHIR-38787)
• Applied: Snippet and link mismatch related to Supplemental Data Elements(FHIR-37548)
• Applied: Relaxed cardinality in Computable measure cqfm extension for 'cqfm-type' to 0..* from 0..1. (FHIR-40697)
• Applied: Relaxed introduction statement about QI Core (FHIR-40684)
• Applied: Fixed link for Colorectal Cancer Screening example (FHIR-39726)
• Applied: Clarified definition wording for usage element of Publishable Measure CQFM (FHIR-40241)
• Applied: Updated Quality Programs code system, value set and Structured Definition, cardinality of program slice to 0..1, binding to 'example', updated guidance. (FHIR-40562)
• Applied: Removed measure allocation extension and all references to it throughout (FHIR-40590)
• Applied: Added PI Measure example (no library) FHIR-27930

STU3 Release for FHIR R4 (v3.0.0)

This release includes changes due to ballot reconciliation and connectathon testing. The following sections summarize the changes from the balloted version (v2.*0), followed by a detailed changes list of all changes applied.

Terminology Services Change Summary

Changes to the CQFMExecutableValueSet profile:

• Changed the warning extension from cqfm-usageWarning to valueset-warning (base extension)
• Changed the fixed value of the warning extension to discuss conformance only (moved guidance to the IG)
• Changed expansion contains elements to require a version unless the parameters element has a system-version for the system

Changes to the CQFMQualityProgram profile:

• Removed cqfm-activeOnly and cqfm-expansionUri extensions in favor of the more general cqfm-expansionParameters extension

Changes to the ValueSet/$expand operation:

• Clarified semantics of the manifest parameter
• Clarified semantics of the expansion parameter
• Changed includePreview parameter to includeDraft

Changes to the Measure Terminology Service:

• Added Expansion Rules to describe expected expansion behavior in the presence of a manifest
• Recommended support for useContext search parameters
• Recommended support for reference search parameters

Changes to align with FHIR publishing

• Added support for the terminology model of a server's capability statement
• Added support for batch operations for $validate-code
• Required support for activeOnly and displayLanguage in $validate-code
• Required support for activeOnly, displayLanguage, limitedExpansion, and default-to-latest-version parameters in $expand
• Recommended support for includeDesignation, designation, and paging parameters in $expand

Outstanding Questions

• Search by URL should return all versions with that URL, otherwise there is no way to get the list of versions for a given value set URL
• If searches return a SUBSETTED resource by default, should the server should allow the _summary=false parameter to request full resources?
• Given the id of a ValueSet is the OID, how can I retrieve specific versions of a ValueSet?
• How can I retrieve a list of available expansions for a given ValueSet URL?
• Can I use a GET to invoke $expand with both the url and valueSetVersion parameters? (Connectathon testing resulted in an error)

Measure Representation Change Summary

Changes to the CQFMMeasure profile:

• Required CQFMMeasure Library reference to be a CQFMLibrary
• Relaxed scoring, type, and improvementNotation cardinality

Changes to the CQFMComputableMeasure profile:

• Changed cardinality of group to 0..*
• Changed the representation of effective data requirements on a measure to use a contained module definition library, rather than extensions in the measure
• Added fhirQueryPattern extension to communicate FHIR queries
• Added isSelective extension to dataRequirement
• Added valueFilter extension to support additional filtering in dataRequirement
• Added constraints to enforce scoring, populationBasis, and improvementNotation be specified at the root or all groups, but not both
• Added constraints to enforce population criteria in groups based on the group scoring extension
• Required Library to be a CQFMComputableLibrary and all expressions to be text/cql-expression or -identifier

Added CQFMExecutableMeasure

• Required Library to be a CQFMExecutableLibrary and all expressions to be text/cql-identifier

Changes to measure repository service:

• Removed the bundle-based packaging profiles in favor of artifact-based profiles to ensure artifact packaging can use paging when artifact packages contain a large number of components
• Added support for advertising CQL version support

Changes to measure authoring:

• Allowed any number of models to be referenced, rather than requiring one and only one reference to QICore
• Recommended not disabling method invocation to allow fluent functions to be used
• Added support for mixed-basis ratio measure
• Added ability to associated stratifiers with specific populations
• Added the ability to specify scoringUnit for a measure
• Added composite scoring code

Detailed Change Lists by Impact

Non-Compatible Changes

• FHIR-36156: Required scoring, populationBasis, and improvementNotation to be specified at the root or on all groups, but not both
• FHIR-33975: Changed executable value set to use the warning extension from the base specification
• FHIR-33971: Restricted the use of the content element in a quality program
• FHIR-33178: Required CQFMMeasure library reference to be a CQFMLibrary
• FHIR-32748: Changed cardinality of group to 0..*
• FHIR-32594: Changed the representation of expansion parameters to use a contained parameters resource rather than specific extensions per parameter
• FHIR-32593: Changed the representation of effective data requirements on a measure to use a contained module definition library, rather than extensions in the measure
• FHIR-30079: Removed the bundle-based packaging profiles in favor of artifact-based profiles to ensure that artifact packaging can use paging when artifact packages contain a large number of components

Compatible, Substantive Changes

• FHIR-36304: Added CQFMExecutableMeasure profile to separate computable/executable concerns of a measure
• FHIR-34290: Added capabilities to the measure terminology service to align with publishing terminology service capabilities
• FHIR-33970: Added searching by useContext
• FHIR-33968: Added searching for valuesets by artifacts that reference the value set
• FHIR-33458: Added the fhirQueryPattern extension to support representing the FHIR query for a given data requirement
• FHIR-33045: Added the ability to represent a mixed-basis population ratio measure (i.e. a ratio between encounters and procedures)
• FHIR-32970: Relaxed conformance requirements on the use of QI Core from SHALL to SHOULD, to allow any FHIR IG(s) to be used for measure development
• FHIR-32969: Added derivedFrom slice to support identifying previous versions of a measure
• FHIR-32808: Added an invariant to ensure system-version is unambiguously communicated for all the codes in an expansion
• FHIR-32686: Added an isSelective extension to support identifying "selective" data requirements (i.e. criteria that are positively indicative and likely to be selective of initial population membership)
• FHIR-32675: Added the ability for a FHIR server to advertise the versions of CQL it supports
• FHIR-32671: Added the ability to specify CQLOptions using a parameters resource
• FHIR-32668: Added conformance expectations and guidance for specifying the version of CQL/ELM content in a library
• FHIR-32372: Added a valueFilter extension to support representing additional filtering criteria in a data requirement
• FHIR-32334: Added defaultValue extension to support representing default values for parameters
• FHIR-32231: Updated measure narrative generation to display logic items in alphabetical order
• FHIR-31921: Changed "preview" parameter in valueSet$expand operation to "includeDraft"
• FHIR-31680: Added the ability to associated stratifiers with specific populations
• FHIR-31624: Corrected all-or-none composite measure calculation formulas
• FHIR-31409: Added quality domain and meaningful measure area to be specified for measures in a quality program
• FHIR-30875: Added measure repository service capability statement and description
• FHIR-30874: Added measure terminology service capability statement and description
• FHIR-30873: Added support for composite measures both within and across FHIR Measure resources
• FHIR-30770: Added a ModelDefinition profile to support the use of FHIR Library resources containing CQL ModelInfo content
• FHIR-30763: Added composite code to the scoring code system
• FHIR-30569: Added conformance requirements for the use of FHIR Library resources containing CQL content
• FHIR-30506: Added the ability to specify the scoringUnit of a measure
• FHIR-30395: Added slices for version-independent, version-specific, short-name, publisher, and endorser identifiers for measures
• FHIR-30394: Added a ComputableMeasure profile to represent the formal computation aspects common to all quality measures, regardless of the scoring method
• FHIR-28338: Added criteriaReference extension to the Ratio measure profile to support dual initial populations
• FHIR-27878: Relaxed conformance requirements on stratifier criteria to allow the use of codes and paths to elements
• FHIR-27795: Added inputParameters extension to support identifying the input parameters for a test case
• FHIR-21107: Added conformance requirement to support composite measure representation

Non-substantive Changes

• FHIR-34882: Added a data repository role to the quality reporting sequence diagram to make clear the separation between reporting capabilities and data repository capabilities
• FHIR-34197: Changed guidance on the use of DisableMethodInvocation to ensure fluent functions can be used in quality measures going forward
• FHIR-33992: Corrected broken hyperlink
• FHIR-33967: Clarified behavior of expansions when expansion parameters are specified in both the expand operation and the manifest used
• FHIR-33966: Clarified conformance requirements versus usage guidance in the executable value set profile
• FHIR-33016: Added guidance on avoiding the use of direct reference codes for UCUM units
• FHIR-32884: Corrected headings throughout
• FHIR-32747: Corrected typographical error
• FHIR-32746: Corrected typographical error
• FHIR-32745: Corrected typographical error
• FHIR-32744: Validated examples conform to expected profiles
• FHIR-32742: Clarified documentation of the use of value sets during the authoring phase of the content management lifecycle
• FHIR-32741: Corrected typographical error
• FHIR-32740: Clarified that the measure repository services are represented with a focus on measures, but conceptually are broadly applicable to other types of knowledge artifacts
• FHIR-32739: Clarified that the measure terminology service is represented with a focus on measures, but conceptually is broadly applicable to other types of knowledge artifacts
• FHIR-32738: Added an introductory description for the quality reporting sequence diagram
• FHIR-32737: Clarified quality program examples
• FHIR-32736: Clarified quality program documentation
• FHIR-32735: Clarified measure implementation as the focus of capabilities supported by this IG
• FHIR-32734: Fixed typographical error
• FHIR-32733: Clarified definition of a quality measure in the IG introduction
• FHIR-32732: Clarified the metric development step in the quality improvement ecosystem discussion
• FHIR-32731: Added registries as a stakeholder in the quality improvement ecosystem
• FHIR-32730: Added internal quality improvement initiatives as a use case in the quality improvement ecosystem discussion
• FHIR-32729: Clarified that payers are not primary developers of clinical guidelines
• FHIR-32728: Clarified that improvement of clinical care is the focus of the quality improvement ecosystem
• FHIR-32727: Clarified cyclic nature of the quality improvement ecosystem
• FHIR-32726: Added internal quality improvement initiatives as a potential use case in the quality improvement ecosystem discussion
• FHIR-32725: Highlighted the role of clinician judgement in the quality improvement ecosystem discussion
• FHIR-32722: Added additional examples of stakeholders to the quality improvement ecosystem discussion
• FHIR-32688: Noted that multiple versions of the same code system may be used in a single $expand
• FHIR-32687: Clarified that expansion identifiers are server-specific
• FHIR-32651: Added examples of expansions given the use of a manifest parameter
• FHIR-32596: Added Must Support documentation
• FHIR-32199: Corrected layout issue
• FHIR-32079: Added discussion about referencing any FHIR type, as opposed to only FHIR types profiled by QI Core
• FHIR-31942: Fixed a typographical error
• FHIR-31941: Clarified description of Conformance Requirement 3.15
• FHIR-31940: Fixed a typographical error
• FHIR-31592: Clarified description of population criteria in the population scoring algorithm diagrams
• FHIR-30764: Added trial-use note seeking feedback on the usefulness of a "Measure Source" metadata attribute
• FHIR-30401: Added discussion of the use of Group resource to characterize attribution models, such as DaVinci Attribution (ATR)
• FHIR-29649: Duplicate of 28239
• FHIR-28303: Added mapping from V3 Aggregate Method to FHIR Aggregate Method
• FHIR-28302: Added mapping from V3 Composite Measure Scoring to FHIR Composite Measure Scoring
• FHIR-28301: Added mapping from V3 Measure Scoring to FHIR Measure Scoring
• FHIR-28300: Added mapping from V3 Measure Types to FHIR Measure Types
• FHIR-28290: Clarified the definition of population basis
• FHIR-28288: Updated examples to use "citation" related artifact code, rather than "documentation" when they were citations of references
• FHIR-28239: Corrected cardinality of CQFMMeasure.profile meta constraint
• FHIR-28238: Corrected cardinality of CQFMLibrary.profile meta constraint
• FHIR-28210: Corrected description of EXM146 as an encounter-based measure
• FHIR-28206: Updated glossary terms
• FHIR-26331: Corrected breadcrumbs display throughout the IG
• FHIR-26329: Updated the IG to use the standard HL7 FHIR IG template

STU3 Ballot for FHIR R4 (v2.*0)

This ballot release introduces support for composite measures, and adds descriptions of a Measure Terminology Service and a Measure Repository in support of authoring, distributing, and evaluating quality measures.

• Applied:conformance requirement 1 does not mention composite measures. Should it? (FHIR-21107)
• Applied:Need to clarify how measure evaluation parameters are specified in a test case (FHIR-27795)
• Applied:Permit stratifier expression to have any type (Conformance requirement 15) (FHIR-27878)
• Applied:Glossary population criteria entries are inconsistent with population code system (FHIR-28206)
• Applied:Example measure 146 is incorrectly described as "patient-based" (FHIR-28210)
• Applied:CQFM Library has incorrect cardinality for profile constraint (FHIR-28238)
• Applied:CQFMMeasure profile has incorrect cardinality for profile constraint (FHIR-28239)
• Applied:Possible issue with related artifact example (FHIR-28288)
• Applied:PopulationBasis definition (FHIR-28290)
• Applied:Measure Type valueset needs a concept map to the V3 codes (FHIR-28300)
• Applied:Measure scoring value set needs a concept map from V3 (FHIR-28301)
• Applied:Composite Measure Scoring needs a mapping to V3 concepts (FHIR-28302)
• Applied:Aggregate method needs a mapping to HL7 V3 concepts (FHIR-28303)
• Applied:Ratio measure profile (FHIR-28338)
• Applied:Cardinality of Measure.meta.profile (FHIR-29649)
• Applied:Issues with Packaging and Bundle profiles (FHIR-30079)
• Applied:Define a computable measure profile (FHIR-30394)
• Applied:Add identifier slices for shortname, publisher, and endorser (FHIR-30395)
• Applied:Add attribution model identifier to quality program (FHIR-30401)
• Applied:Support specification of scoringUnit (FHIR-30506)
• Applied:Conformance requirements for CQL Library resource usage (FHIR-30569)
• Resolved - No Change Required:Support authoring concerns for inactive value set codes (FHIR-30573)
• Resolved - Change Required:Move the "composite" code from Measure Type to Measure Scoring (FHIR-30763)
• Resolved - Change Required:Allow the specification of "intended data source" (FHIR-30764)
• Applied:Add a profile for FHIR Model Info Library (FHIR-30770)
• Applied:Add composite measure support and profiles (FHIR-30873)
• Applied:Support measure terminology service (FHIR-30874)
• Applied:Create measure repository service (FHIR-30875)
• Applied:Support specifying quality domain and meaningful measure area in quality programs (FHIR-31409)
• Applied:Modify diagram text to "Population Relationships" Figures 3.2, 3.3, 3.4, 3.5 (FHIR-31592)
• Applied:All-or-nothing scoring should use "implies" (FHIR-31624)

STU2 Release for FHIR R4 (v2.0.0)

This release includes changes applied as a result of ballot feedback as well as connectathon testing.

Non-compatible

• FHIR-26534 - Use of text/cql.identifier media type for CQL expression references
• FHIR-21994 - Use of namespaces with CQL libraries
• FHIR-25285 - Changed definition term extension to preserve association of term and definition
• FHIR-21998 - Disallowed stratification of ratio measures
• FHIR-21996 - Required use of called clause for included libraries

Compatible, Substantive

• Corrections to proportion, ratio, and continuous-variable measure profiles
• Added profile layering for shareable, computable, publishable, and executable capabilities
• Added profiles and guidance for packaging, distribution, and testing
• Clarified risk adjustment conformance requirements
• Added support for identifying packaging, testing, and authoring tooling
• Library and measure resources require narrative and profile declarations
• Added publicationStatus and publicationDate extensions for relatedArtifact
• Clarified calculation flow diagrams for all measure types
• Clarified relationship of FHIR terminology to V3 measure terminology
• Added support for defining and referencing measure programs

Non-substantive

• Numerous clarifications and corrections throughout

STU2 Ballot for FHIR R4 (v**0)

This ballot is a minimal update to the STU1 ballot to address the following items:

• Updated to use FHIR R4
• Added artifact packaging guidance and conformance requirements

STU1 Release for FHIR STU3 (v*0.0)

• Clarifications and fixes throughout

Compatible, substantive

• 21181 *.1 relationships
• 21684 Risk adjustment naming conventions? - QM #15
• 21156 Clarify where the risk adjustment variables are stored in the fhir document.
• 21155 Inconsistent conformance requirements (16 and 17).
• 21986 Denominator exceptions in differential table? - QM #136
• 21988 Supporting measurement period without specifying year? - QM #137
• 21145 conformance requirement 13 states that a continuous variable measure SHALL have a criteriaReference extension but the profile has this extension as 0..1 rather than . Should the profile have *.1?
• 21187 consider for all slices that are not "measure observation" to make cqfm-criteriaReference and cqfm-aggregateMethod 0..0
• 21183 initial population slice for proportion measure is .2. Should be *. (*.2 is for ratio measure).
• 21192 EXM55 library references
• 21178 Does it make sense for the profile itself to specify usage for criteriaReference and aggregateMethod (measure observations)
• 21191 consider slicing content and including the required contentType (text/cql) and optional ones (application/elm+xml, application/elm+json)
• 21984 Require use of specific model? - QM #135
• 21158 Should this be a conformance requirement?
• 21188 consider making cqfm-criteriaReference and cqfm-aggregateMethod *.1 for "measure observation" slice.
• 21186 measure population exclusion slice should be 0..* population.code for this slice should still be required (*.1)
• 21182 should population.identifier, supplementalData.identifier and stratification.identifier be required?
• 21185 missing denominator exception slice
• 21173 This statement uses SHOULD NOT language but the conformance requirement is SHALL NOT. Recommend rewording for clarity.
• 21146 should conformance requirement 13 require an aggregateMethod extension on the measure observation criteria? It currently does not.

Non-compatible

• 21998 Restrict stratification of ratio measure - QM #142
• 21994 Library namespace guidance - QM #140
• 21056 Disallow the use of strings for membership testing in value sets and code systems
• 21996 Library alias guidance - QM #141

STU1 Ballot for FHIR STU3 (v0.*0)

STU1 Ballot for FHIR STU3 Version