Quality Measure Implementation Guide
1.0.0-ballot - ballot International flag

This page is part of the Quality Measure Implementation Guide (v1.0.0-ballot: STU1 (v1.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions

Resource Profile: CQMCompositeMeasure - Detailed Descriptions

Active as of 2024-12-16

Definitions for the cqm-compositemeasure resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Measure
2. Measure.extension:scoringUnit
Slice NamescoringUnit
Control0..1
This element is affected by the following invariants: ele-1, cmp-3
TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
Must Supporttrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
4. Measure.relatedArtifact
Control0..*
Must Supporttrue
SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ type
  • 6. Measure.relatedArtifact:component
    Slice Namecomponent
    Control0..*
    Must Supporttrue
    8. Measure.relatedArtifact:component.extension:groupId
    Slice NamegroupId
    Control0..1
    TypeExtension(CQM Group Id) (Extension Type: string)
    Must Supporttrue
    10. Measure.relatedArtifact:component.extension:weight
    Slice Nameweight
    Control0..1
    TypeExtension(CQM Weight) (Extension Type: decimal)
    Must Supporttrue
    12. Measure.relatedArtifact:component.type
    Definition

    A component of the composite measure.

    ShortComponent measure
    Control1..1
    Typecode
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Fixed Valuecomposed-of
    14. Measure.relatedArtifact:component.display
    Control0..1
    Must Supporttrue
    16. Measure.relatedArtifact:component.resource
    Control1..1
    Typecanonical(Measure)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    18. Measure.scoring
    Shortcomposite
    BindingUnless not suitable, these codes SHALL be taken from Measure Scoring
    (extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
    TypeCodeableConcept
    Must Supporttrue
    Pattern Value{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "composite"
      }]
    }
    20. Measure.compositeScoring
    BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoring
    (extensible to http://terminology.hl7.org/ValueSet/composite-measure-scoring)
    Must Supporttrue
    22. Measure.group
    Is Modifierfalse
    Must Supporttrue
    Invariantscmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
    cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
    24. Measure.group.extension:scoring
    Slice Namescoring
    Control0..1
    This element is affected by the following invariants: cmp-10, cmp-11, ele-1, cmp-2, cmp-8, cmp-9
    TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    26. Measure.group.extension:scoringUnit
    Slice NamescoringUnit
    Control0..1
    This element is affected by the following invariants: ele-1, cmp-8
    TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    28. Measure.group.extension:compositeScoring
    Slice NamecompositeScoring
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(CQM Composite Scoring) (Extension Type: CodeableConcept)
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    30. Measure.group.extension:component
    Slice Namecomponent
    Definition

    Specifies an artifact this is a component of a composite artifact.

    ShortWhat artifact
    Control0..*
    This element is affected by the following invariants: ele-1, cmp-11
    TypeExtension(CQM Component) (Extension Type: RelatedArtifact)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    32. Measure.group.extension:component.extension:groupId
    Slice NamegroupId
    Control0..1
    TypeExtension(CQM Group Id) (Extension Type: string)
    Must Supporttrue
    34. Measure.group.extension:component.extension:weight
    Slice Nameweight
    Control0..1
    TypeExtension(CQM Weight) (Extension Type: decimal)
    Must Supporttrue
    36. Measure.group.population
    Must Supporttrue

    Guidance on how to interpret the contents of this table can be found here

    0. Measure
    Definition

    The Measure resource provides the definition of a quality measure.

    ShortA quality measure definition
    Control0..*
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    mea-0: 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: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
    cmp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists()).allTrue())
    cmp-2: 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/uv/cqm/StructureDefinition/cqm-scoring').exists()).allTrue()))
    cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists())
    cmp-4: 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/uv/cqm/StructureDefinition/cqm-scoring').exists() and (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort')))
    cmp-5: 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/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse())
    cmp-6: 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/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse())
    cmp-7: 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/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse())
    mea-0: 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: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
    2. Measure.implicitRules
    Definition

    A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

    ShortA set of rules under which this content was created
    Comments

    Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. Measure.extension:populationBasis
    Slice NamepopulationBasis
    Definition

    The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

    ShortWhat type of population
    Comments

    In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

    Control0..1
    This element is affected by the following invariants: ele-1, cmp-1
    TypeExtension(CQM Population Basis) (Extension Type: code)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. Measure.extension:scoringUnit
    Slice NamescoringUnit
    Definition

    Defines the expected units of measure for the measure score.

    ShortWhat units?
    Control0..1
    This element is affected by the following invariants: ele-1, cmp-3
    TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Measure.extension:effectiveDataRequirements
    Slice NameeffectiveDataRequirements
    Definition

    A module definition library that contains the effective data requirements for the artifact (i.e. the calculated data requirements for the expressions referenced by the artifact structure).

    ShortEffective required data for evaluation
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(CRMI Effective Data Requirements) (Extension Type: canonical(CRMI Module Definition Library))
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Measure.extension:scoringPrecision
    Slice NamescoringPrecision
    Definition

    Defines the precision of the measure score when it is a decimal value.

    ShortNumber of decimal places
    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(CQM Scoring Precision) (Extension Type: positiveInt)
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. Measure.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. Measure.status
    Definition

    The status of this measure. Enables tracking the life-cycle of the content.

    Shortdraft | active | retired | unknown
    Comments

    Allows filtering of measures that are appropriate for use versus not.

    Control1..1
    BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

    The lifecycle status of an artifact.

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. Measure.subject[x]
    Definition

    The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anything.

    ShortE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
    Comments

    The subject of the measure is critical in interpreting the criteria definitions, as the logic in the measures is evaluated with respect to a particular subject. This corresponds roughly to the notion of a Compartment in that it limits what content is available based on its relationship to the subject. In CQL, this corresponds to the context declaration.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from Subject Type Value Sethttp://hl7.org/fhir/ValueSet/subject-type
    (extensible to http://hl7.org/fhir/uv/cqm/ValueSet/subject-type)
    TypeChoice of: CodeableConcept, Reference(Group)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    Summaryfalse
    Meaning if MissingPatient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. Measure.relatedArtifact
    Definition

    Related artifacts such as additional documentation, justification, or bibliographic references.

    ShortAdditional documentation, citations, etc.
    Comments

    Each related artifact is either an attachment, or a reference to another resource, but not both.

    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Requirements

    Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ type
    • 20. Measure.relatedArtifact:component
      Slice Namecomponent
      Definition

      Related artifacts such as additional documentation, justification, or bibliographic references.

      ShortAdditional documentation, citations, etc.
      Comments

      Each related artifact is either an attachment, or a reference to another resource, but not both.

      Control0..*
      TypeRelatedArtifact
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Measure.relatedArtifact:component.extension:groupId
      Slice NamegroupId
      Definition

      Specifies the id of a particular group within the measure referenced by the related artifact resource.

      ShortWhat group
      Comments

      Note that a composite measure may reference component groups defined within itself.

      Control0..1
      TypeExtension(CQM Group Id) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. Measure.relatedArtifact:component.extension:weight
      Slice Nameweight
      Definition

      What is the weight of the contribution of this measure to the overall score.

      ShortContribution?
      Comments

      If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

      Control0..1
      TypeExtension(CQM Weight) (Extension Type: decimal)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. Measure.relatedArtifact:component.type
      Definition

      A component of the composite measure.


      The type of relationship to the related artifact.

      ShortComponent measuredocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of
      Control1..1
      BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1)

      The type of relationship to the related artifact.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Fixed Valuecomposed-of
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Measure.relatedArtifact:component.display
      Definition

      A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

      ShortBrief description of the related artifact
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Measure.relatedArtifact:component.resource
      Definition

      The related resource, such as a library, value set, profile, or other knowledge resource.

      ShortWhat resource is being referenced
      Comments

      If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

      Control10..1
      Typecanonical(Measure, Resource)
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Measure.library
      Definition

      A reference to a Library resource containing the formal logic used by the measure.

      ShortLogic used by the measure
      Control0..1*
      Typecanonical(CRMI Computable Library, Library)
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Measure.scoring
      Definition

      Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

      Shortcompositeproportion | ratio | continuous-variable | cohort
      Control0..1
      This element is affected by the following invariants: cmp-2, cmp-3, cmp-4
      BindingUnless not suitable, these codes SHALL be taken from Measure Scoringhttp://hl7.org/fhir/ValueSet/measure-scoring
      (extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "code" : "composite"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Measure.compositeScoring
      Definition

      If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

      Shortopportunity | all-or-nothing | linear | weighted
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoringhttp://hl7.org/fhir/ValueSet/composite-measure-scoring
      (extensible to http://terminology.hl7.org/ValueSet/composite-measure-scoring)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Measure.type
      Definition

      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.

      Shortprocess | outcome | structure | patient-reported-outcome | composite
      Control0..*
      This element is affected by the following invariants: cmp-5
      BindingUnless not suitable, these codes SHALL be taken from MeasureTypehttp://hl7.org/fhir/ValueSet/measure-type
      (extensible to http://hl7.org/fhir/ValueSet/measure-type)

      The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Measure.improvementNotation
      Definition

      Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

      Shortincrease | decrease
      Control0..1
      This element is affected by the following invariants: cmp-4
      BindingThe codes SHALL be taken from MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
      (required to http://terminology.hl7.org/ValueSet/measure-improvement-notation)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Measure consumers and implementers must be able to determine how to interpret a measure score.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Measure.group
      Definition

      A group of population criteria for the measure.

      ShortPopulation criteria group
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())
      cmp-9: Improvement notation must be specified for scoring types other than cohort (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())
      cmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
      cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
      44. Measure.group.extension:populationBasis
      Slice NamepopulationBasis
      Definition

      The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

      ShortWhat type of population
      Comments

      In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

      Control0..1
      This element is affected by the following invariants: ele-1, cmp-1
      TypeExtension(CQM Population Basis) (Extension Type: code)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      46. Measure.group.extension:scoring
      Slice Namescoring
      Definition

      Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

      Shortproportion | ratio | continuous-variable | cohort
      Control0..1
      This element is affected by the following invariants: ele-1, cmp-2, cmp-8, cmp-9, cmp-10, cmp-11
      TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      48. Measure.group.extension:scoringUnit
      Slice NamescoringUnit
      Definition

      Defines the expected units of measure for the measure score.

      ShortWhat units?
      Control0..1
      This element is affected by the following invariants: ele-1, cmp-8
      TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      50. Measure.group.extension:scoringPrecision
      Slice NamescoringPrecision
      Definition

      Defines the precision of the measure score when it is a decimal value.

      ShortNumber of decimal places
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CQM Scoring Precision) (Extension Type: positiveInt)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      52. Measure.group.extension:compositeScoring
      Slice NamecompositeScoring
      Definition

      Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

      Shortproportion | ratio | continuous-variable | cohort
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(CQM Composite Scoring) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      54. Measure.group.extension:component
      Slice Namecomponent
      Definition

      Specifies an artifact this is a component of a composite artifact.

      ShortWhat artifact
      Control0..*
      This element is affected by the following invariants: ele-1, cmp-11
      TypeExtension(CQM Component) (Extension Type: RelatedArtifact)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      56. Measure.group.extension:component.extension:groupId
      Slice NamegroupId
      Definition

      Specifies the id of a particular group within the measure referenced by the related artifact resource.

      ShortWhat group
      Comments

      Note that a composite measure may reference component groups defined within itself.

      Control0..1
      TypeExtension(CQM Group Id) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      58. Measure.group.extension:component.extension:weight
      Slice Nameweight
      Definition

      What is the weight of the contribution of this measure to the overall score.

      ShortContribution?
      Comments

      If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

      Control0..1
      TypeExtension(CQM Weight) (Extension Type: decimal)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. Measure.group.extension:component.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
      62. Measure.group.extension:type
      Slice Nametype
      Definition

      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.

      Shortprocess | outcome | structure | patient-reported-outcome
      Control0..*
      This element is affected by the following invariants: ele-1, cmp-5
      TypeExtension(CQM Type) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      64. Measure.group.extension:riskAdjustment
      Slice NameriskAdjustment
      Definition

      A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

      ShortHow risk adjustment is applied for this measure
      Comments

      Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

      Control0..1
      This element is affected by the following invariants: ele-1, cmp-6
      TypeExtension(CQM Risk Adjustment) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      66. Measure.group.extension:rateAggregation
      Slice NamerateAggregation
      Definition

      Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

      ShortHow is rate aggregation performed for this measure
      Comments

      The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

      Control0..1
      This element is affected by the following invariants: ele-1, cmp-7
      TypeExtension(CQM Rate Aggregation) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      68. Measure.group.extension:improvementNotation
      Slice NameimprovementNotation
      Definition

      Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

      Shortincrease | decrease
      Control0..1
      This element is affected by the following invariants: ele-1, cmp-9
      TypeExtension(CQM Improvement Notation) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      70. Measure.group.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      72. Measure.group.code
      Definition

      Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measures.

      ShortMeaning of the group
      Control0..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      74. Measure.group.description
      Definition

      The human readable description of this population group.

      ShortSummary description
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      76. Measure.group.population
      Definition

      A population criteria for the measure.

      ShortPopulation criteria
      Control0..*
      This element is affected by the following invariants: cmp-10
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. Measure.group.population.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      80. Measure.group.population.code
      Definition

      The type of population criteria.

      Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population
      (extensible to http://hl7.org/fhir/ValueSet/measure-population)

      The type of population.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      82. Measure.group.population.description
      Definition

      The human readable description of this population criteria.

      ShortThe human readable description of this population criteria
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      84. Measure.group.population.criteria
      Definition

      An expression that specifies the criteria for the population, typically the name of an expression in a library.

      ShortThe criteria that defines this population
      Comments

      In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.

      Control1..1
      TypeExpression
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      86. Measure.group.stratifier
      Definition

      The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

      ShortStratifier criteria for the measure
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      88. Measure.group.stratifier.extension:appliesTo
      Slice NameappliesTo
      Definition

      Indicates the population that this stratifier should apply to. If no appliesTo extension is present, the stratifier is calculated based on the result of the population calculation (e.g. the calculated numerator for a proportion scoring).

      ShortWhich population does this stratifier apply to?
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(CQM Applies To) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      90. Measure.group.stratifier.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      92. Measure.group.stratifier.code
      Definition

      Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

      ShortMeaning of the stratifier
      Control0..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      94. Measure.group.stratifier.description
      Definition

      The human readable description of this stratifier criteria.

      ShortThe human readable description of this stratifier
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      96. Measure.group.stratifier.component
      Definition

      A component of the stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

      ShortStratifier criteria component for the measure
      Comments

      Stratifiers are defined either as a single criteria, or as a set of component criteria.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      98. Measure.group.stratifier.component.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      100. Measure.group.stratifier.component.code
      Definition

      Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

      ShortMeaning of the stratifier component
      Control0..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      102. Measure.group.stratifier.component.description
      Definition

      The human readable description of this stratifier criteria component.

      ShortThe human readable description of this stratifier component
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      104. Measure.group.stratifier.component.criteria
      Definition

      An expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.

      ShortComponent of how the measure should be stratified
      Control1..1
      TypeExpression
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      106. Measure.supplementalData
      Definition

      The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

      ShortWhat other data should be reported with the measure
      Comments

      Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      108. Measure.supplementalData.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      110. Measure.supplementalData.code
      Definition

      Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.

      ShortMeaning of the supplemental data
      Control0..1
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      112. Measure.supplementalData.usage
      Definition

      An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

      Shortsupplemental-data | risk-adjustment-factor
      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from MeasureDataUsagehttp://hl7.org/fhir/ValueSet/measure-data-usage
      (extensible to http://hl7.org/fhir/ValueSet/measure-data-usage)

      The intended usage for supplemental data elements in the measure.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      114. Measure.supplementalData.description
      Definition

      The human readable description of this supplemental data.

      ShortThe human readable description of this supplemental data
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      116. Measure.supplementalData.criteria
      Definition

      The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.

      ShortExpression describing additional data to be reported
      Control1..1
      TypeExpression
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. Measure
      Definition

      The Measure resource provides the definition of a quality measure.

      ShortA quality measure definition
      Control0..*
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      mea-0: 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: Stratifier SHALL be either a single criteria or a set of criteria components (group.stratifier.all((code | description | criteria).exists() xor component.exists()))
      cmp-1: Population basis must be specified at the root, or on each group (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists() or group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis').exists()).allTrue())
      cmp-2: 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/uv/cqm/StructureDefinition/cqm-scoring').exists()).allTrue()))
      cmp-3: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists())
      cmp-4: 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/uv/cqm/StructureDefinition/cqm-scoring').exists() and (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('proportion') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('ratio') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('continuous-variable') or extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code.contains('composite')) and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())).allTrue()) xor (scoring.exists() and scoring.coding.code.contains('cohort')))
      cmp-5: 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/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse())
      cmp-6: 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/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse())
      cmp-7: 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/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse())
      2. Measure.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. Measure.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Measure.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Measure.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Measure.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Measure.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Measure.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Measure.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Measure.extension:populationBasis
        Slice NamepopulationBasis
        Definition

        The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

        ShortWhat type of population
        Comments

        In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

        Control0..1
        This element is affected by the following invariants: ele-1, cmp-1
        TypeExtension(CQM Population Basis) (Extension Type: code)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Measure.extension:scoringUnit
        Slice NamescoringUnit
        Definition

        Defines the expected units of measure for the measure score.

        ShortWhat units?
        Control0..1
        This element is affected by the following invariants: ele-1, cmp-3
        TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. Measure.extension:effectiveDataRequirements
        Slice NameeffectiveDataRequirements
        Definition

        A module definition library that contains the effective data requirements for the artifact (i.e. the calculated data requirements for the expressions referenced by the artifact structure).

        ShortEffective required data for evaluation
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CRMI Effective Data Requirements) (Extension Type: canonical(CRMI Module Definition Library))
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        22. Measure.extension:scoringPrecision
        Slice NamescoringPrecision
        Definition

        Defines the precision of the measure score when it is a decimal value.

        ShortNumber of decimal places
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CQM Scoring Precision) (Extension Type: positiveInt)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        24. Measure.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        26. Measure.url
        Definition

        An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers.

        ShortCanonical identifier for this measure, represented as a URI (globally unique)
        Comments

        Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

        The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

        In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

        Control0..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Allows the measure to be referenced by a single globally unique identifier.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Measure.identifier
        Definition

        A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.

        ShortAdditional identifier for the measure
        Comments

        Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows externally provided and/or usable business identifiers to be easily associated with the module.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Measure.version
        Definition

        The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.

        ShortBusiness version of the measure
        Comments

        There may be different measure instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the measure with the format [url]|[version].

        NoteThis is a business version Id, not a resource version Id (see discussion)
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Measure.name
        Definition

        A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.

        ShortName for this measure (computer friendly)
        Comments

        The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

        Control0..1
        This element is affected by the following invariants: inv-0
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Support human navigation and code generation.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Measure.title
        Definition

        A short, descriptive, user-friendly title for the measure.

        ShortName for this measure (human friendly)
        Comments

        This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Measure.subtitle
        Definition

        An explanatory or alternate title for the measure giving additional information about its content.

        ShortSubordinate title of the measure
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Measure.status
        Definition

        The status of this measure. Enables tracking the life-cycle of the content.

        Shortdraft | active | retired | unknown
        Comments

        Allows filtering of measures that are appropriate for use versus not.

        Control1..1
        BindingThe codes SHALL be taken from PublicationStatus
        (required to http://hl7.org/fhir/ValueSet/publication-status|4.0.1)

        The lifecycle status of an artifact.

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Measure.experimental
        Definition

        A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.

        ShortFor testing purposes, not real usage
        Comments

        Allows filtering of measures that are appropriate for use versus not.

        Control0..1
        Typeboolean
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Measure.subject[x]
        Definition

        The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anything.

        ShortE.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
        Comments

        The subject of the measure is critical in interpreting the criteria definitions, as the logic in the measures is evaluated with respect to a particular subject. This corresponds roughly to the notion of a Compartment in that it limits what content is available based on its relationship to the subject. In CQL, this corresponds to the context declaration.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from Subject Type Value Set
        (extensible to http://hl7.org/fhir/uv/cqm/ValueSet/subject-type)
        TypeChoice of: CodeableConcept, Reference(Group)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Meaning if MissingPatient
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Measure.date
        Definition

        The date (and optionally time) when the measure was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.

        ShortDate last changed
        Comments

        Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamesRevision Date
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Measure.publisher
        Definition

        The name of the organization or individual that published the measure.

        ShortName of the publisher (organization or individual)
        Comments

        Usually an organization but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Helps establish the "authority/credibility" of the measure. May also allow for contact.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Measure.contact
        Definition

        Contact details to assist a user in finding and communicating with the publisher.

        ShortContact details for the publisher
        Comments

        May be a web site, an email address, a telephone number, etc.

        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Measure.description
        Definition

        A free text natural language description of the measure from a consumer's perspective.

        ShortNatural language description of the measure
        Comments

        This description can be used to capture details such as why the measure was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the measure is presumed to be the predominant language in the place the measure was created).

        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. Measure.useContext
        Definition

        The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.

        ShortThe context that the content is intended to support
        Comments

        When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

        Control0..*
        TypeUsageContext
        Is Modifierfalse
        Summarytrue
        Requirements

        Assist in searching for appropriate content.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. Measure.jurisdiction
        Definition

        A legal or geographic region in which the measure is intended to be used.

        ShortIntended jurisdiction for measure (if applicable)
        Comments

        It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.

        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSet
        (extensible to http://hl7.org/fhir/ValueSet/jurisdiction)

        Countries and regions within which this artifact is targeted for use.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Measure.purpose
        Definition

        Explanation of why this measure is needed and why it has been designed as it has.

        ShortWhy this measure is defined
        Comments

        This element does not describe the usage of the measure. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this measure.

        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. Measure.usage
        Definition

        A detailed description, from a clinical perspective, of how the measure is used.

        ShortDescribes the clinical usage of the measure
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Measure.copyright
        Definition

        A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.

        ShortUse and/or publishing restrictions
        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Consumers must be able to determine any legal restrictions on the use of the measure and/or its content.

        Alternate NamesLicense, Restrictions
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Measure.approvalDate
        Definition

        The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

        ShortWhen the measure was approved by publisher
        Comments

        The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

        Control0..1
        Typedate
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. Measure.lastReviewDate
        Definition

        The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

        ShortWhen the measure was last reviewed
        Comments

        If specified, this date follows the original approval date.

        Control0..1
        Typedate
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        66. Measure.effectivePeriod
        Definition

        The period during which the measure content was or is planned to be in active use.

        ShortWhen the measure is expected to be used
        Comments

        The effective period for a measure determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

        Control0..1
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the measure are or are expected to be used instead.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        68. Measure.topic
        Definition

        Descriptive topics related to the content of the measure. Topics provide a high-level categorization grouping types of measures that can be useful for filtering and searching.

        ShortThe category of the measure, such as Education, Treatment, Assessment, etc.
        Control0..*
        BindingFor example codes, see DefinitionTopic
        (example to http://hl7.org/fhir/ValueSet/definition-topic)

        High-level categorization of the definition, used for searching, sorting, and filtering.

        TypeCodeableConcept
        Is Modifierfalse
        Summaryfalse
        Requirements

        Repositories must be able to determine how to categorize the measure so that it can be found by topical searches.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. Measure.author
        Definition

        An individiual or organization primarily involved in the creation and maintenance of the content.

        ShortWho authored the content
        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. Measure.editor
        Definition

        An individual or organization primarily responsible for internal coherence of the content.

        ShortWho edited the content
        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. Measure.reviewer
        Definition

        An individual or organization primarily responsible for review of some aspect of the content.

        ShortWho reviewed the content
        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        76. Measure.endorser
        Definition

        An individual or organization responsible for officially endorsing the content for use in some setting.

        ShortWho endorsed the content
        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. Measure.relatedArtifact
        Definition

        Related artifacts such as additional documentation, justification, or bibliographic references.

        ShortAdditional documentation, citations, etc.
        Comments

        Each related artifact is either an attachment, or a reference to another resource, but not both.

        Control0..*
        TypeRelatedArtifact
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Measure.relatedArtifact. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ type
        • 80. Measure.relatedArtifact:component
          Slice Namecomponent
          Definition

          Related artifacts such as additional documentation, justification, or bibliographic references.

          ShortAdditional documentation, citations, etc.
          Comments

          Each related artifact is either an attachment, or a reference to another resource, but not both.

          Control0..*
          TypeRelatedArtifact
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Requirements

          Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. Measure.relatedArtifact:component.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          84. Measure.relatedArtifact:component.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Measure.relatedArtifact.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 86. Measure.relatedArtifact:component.extension:groupId
            Slice NamegroupId
            Definition

            Specifies the id of a particular group within the measure referenced by the related artifact resource.

            ShortWhat group
            Comments

            Note that a composite measure may reference component groups defined within itself.

            Control0..1
            TypeExtension(CQM Group Id) (Extension Type: string)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            88. Measure.relatedArtifact:component.extension:weight
            Slice Nameweight
            Definition

            What is the weight of the contribution of this measure to the overall score.

            ShortContribution?
            Comments

            If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

            Control0..1
            TypeExtension(CQM Weight) (Extension Type: decimal)
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            90. Measure.relatedArtifact:component.type
            Definition

            A component of the composite measure.

            ShortComponent measure
            Control1..1
            BindingThe codes SHALL be taken from RelatedArtifactType
            (required to http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1)

            The type of relationship to the related artifact.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Fixed Valuecomposed-of
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. Measure.relatedArtifact:component.label
            Definition

            A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

            ShortShort label
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. Measure.relatedArtifact:component.display
            Definition

            A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

            ShortBrief description of the related artifact
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. Measure.relatedArtifact:component.citation
            Definition

            A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

            ShortBibliographic citation for the artifact
            Comments

            Additional structured information about citations should be captured as extensions.

            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. Measure.relatedArtifact:component.url
            Definition

            A url for the artifact that can be followed to access the actual content.

            ShortWhere the artifact can be accessed
            Comments

            If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).

            Control0..1
            Typeurl
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            100. Measure.relatedArtifact:component.document
            Definition

            The document being referenced, represented as an attachment. This is exclusive with the resource element.

            ShortWhat document is being referenced
            Control0..1
            TypeAttachment
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            102. Measure.relatedArtifact:component.resource
            Definition

            The related resource, such as a library, value set, profile, or other knowledge resource.

            ShortWhat resource is being referenced
            Comments

            If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

            Control1..1
            Typecanonical(Measure)
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            104. Measure.library
            Definition

            A reference to a Library resource containing the formal logic used by the measure.

            ShortLogic used by the measure
            Control0..1
            Typecanonical(CRMI Computable Library)
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            106. Measure.disclaimer
            Definition

            Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.

            ShortDisclaimer for use of the measure or its referenced content
            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Some organizations require that notices and disclosures be included when publishing measures that reference their intellecutal property.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            108. Measure.scoring
            Definition

            Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

            Shortcomposite
            Control0..1
            This element is affected by the following invariants: cmp-2, cmp-3, cmp-4
            BindingUnless not suitable, these codes SHALL be taken from Measure Scoring
            (extensible to http://terminology.hl7.org/ValueSet/measure-scoring)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code" : "composite"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. Measure.compositeScoring
            Definition

            If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

            Shortopportunity | all-or-nothing | linear | weighted
            Control0..1
            BindingUnless not suitable, these codes SHALL be taken from CompositeMeasureScoring
            (extensible to http://terminology.hl7.org/ValueSet/composite-measure-scoring)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            112. Measure.type
            Definition

            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.

            Shortprocess | outcome | structure | patient-reported-outcome | composite
            Control0..*
            This element is affected by the following invariants: cmp-5
            BindingUnless not suitable, these codes SHALL be taken from MeasureType
            (extensible to http://hl7.org/fhir/ValueSet/measure-type)

            The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            114. Measure.riskAdjustment
            Definition

            A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

            ShortHow risk adjustment is applied for this measure
            Comments

            Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

            Control0..1
            This element is affected by the following invariants: cmp-6
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            116. Measure.rateAggregation
            Definition

            Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

            ShortHow is rate aggregation performed for this measure
            Comments

            The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

            Control0..1
            This element is affected by the following invariants: cmp-7
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            118. Measure.rationale
            Definition

            Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.

            ShortDetailed description of why the measure exists
            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Measure developers need to be able to provide a detailed description of the purpose of the measure. This element provides detailed rationale, where the purpose element provides a summary of the rationale.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            120. Measure.clinicalRecommendationStatement
            Definition

            Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.

            ShortSummary of clinical guidelines
            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            122. Measure.improvementNotation
            Definition

            Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

            Shortincrease | decrease
            Control0..1
            This element is affected by the following invariants: cmp-4
            BindingThe codes SHALL be taken from MeasureImprovementNotation
            (required to http://terminology.hl7.org/ValueSet/measure-improvement-notation)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Measure consumers and implementers must be able to determine how to interpret a measure score.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. Measure.definition
            Definition

            Provides a description of an individual term used within the measure.

            ShortDefined terms used in the measure documentation
            Control0..*
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            126. Measure.guidance
            Definition

            Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.

            ShortAdditional guidance for implementers
            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the population criteria of the measure. This element provides detailed guidance, where the usage element provides a summary of the guidance.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            128. Measure.group
            Definition

            A group of population criteria for the measure.

            ShortPopulation criteria group
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            cmp-8: Scoring unit may only be specified at the root if the scoring is also specified at the root (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())
            cmp-9: Improvement notation must be specified for scoring types other than cohort (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists())
            cmp-10: Composite measures may not specify population criteria (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies population.count() = 0)
            cmp-11: Composite measures must specify composite scoring and at least one component (extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').value.coding.code contains 'composite' implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring').exists() and extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component').exists())
            130. Measure.group.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            132. Measure.group.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on Measure.group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 134. Measure.group.extension:populationBasis
              Slice NamepopulationBasis
              Definition

              The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

              ShortWhat type of population
              Comments

              In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.

              Control0..1
              This element is affected by the following invariants: ele-1, cmp-1
              TypeExtension(CQM Population Basis) (Extension Type: code)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              136. Measure.group.extension:scoring
              Slice Namescoring
              Definition

              Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

              Shortproportion | ratio | continuous-variable | cohort
              Control0..1
              This element is affected by the following invariants: ele-1, cmp-2, cmp-8, cmp-9, cmp-10, cmp-11
              TypeExtension(CQM Scoring) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              138. Measure.group.extension:scoringUnit
              Slice NamescoringUnit
              Definition

              Defines the expected units of measure for the measure score.

              ShortWhat units?
              Control0..1
              This element is affected by the following invariants: ele-1, cmp-8
              TypeExtension(CQM Scoring Unit) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              140. Measure.group.extension:scoringPrecision
              Slice NamescoringPrecision
              Definition

              Defines the precision of the measure score when it is a decimal value.

              ShortNumber of decimal places
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(CQM Scoring Precision) (Extension Type: positiveInt)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              142. Measure.group.extension:compositeScoring
              Slice NamecompositeScoring
              Definition

              Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented. When present on a group, specifies the scoring to be used for this group, overriding the scoring specified for the overall measure.

              Shortproportion | ratio | continuous-variable | cohort
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(CQM Composite Scoring) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              144. Measure.group.extension:component
              Slice Namecomponent
              Definition

              Specifies an artifact this is a component of a composite artifact.

              ShortWhat artifact
              Control0..*
              This element is affected by the following invariants: ele-1, cmp-11
              TypeExtension(CQM Component) (Extension Type: RelatedArtifact)
              Is Modifierfalse
              Must Supporttrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              146. Measure.group.extension:component.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              148. Measure.group.extension:component.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on Measure.group.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 150. Measure.group.extension:component.extension:groupId
                Slice NamegroupId
                Definition

                Specifies the id of a particular group within the measure referenced by the related artifact resource.

                ShortWhat group
                Comments

                Note that a composite measure may reference component groups defined within itself.

                Control0..1
                TypeExtension(CQM Group Id) (Extension Type: string)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                152. Measure.group.extension:component.extension:weight
                Slice Nameweight
                Definition

                What is the weight of the contribution of this measure to the overall score.

                ShortContribution?
                Comments

                If the weight of a composite is not specified, a default of 1 is assumed (identity contribution).

                Control0..1
                TypeExtension(CQM Weight) (Extension Type: decimal)
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                154. Measure.group.extension:component.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuehttp://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
                156. Measure.group.extension:component.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                ShortValue of extension
                Control0..1
                TypeRelatedArtifact
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                158. Measure.group.extension:type
                Slice Nametype
                Definition

                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.

                Shortprocess | outcome | structure | patient-reported-outcome
                Control0..*
                This element is affected by the following invariants: ele-1, cmp-5
                TypeExtension(CQM Type) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Must Supportfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                160. Measure.group.extension:riskAdjustment
                Slice NameriskAdjustment
                Definition

                A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

                ShortHow risk adjustment is applied for this measure
                Comments

                Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

                Control0..1
                This element is affected by the following invariants: ele-1, cmp-6
                TypeExtension(CQM Risk Adjustment) (Extension Type: string)
                Is Modifierfalse
                Must Supportfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                162. Measure.group.extension:rateAggregation
                Slice NamerateAggregation
                Definition

                Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

                ShortHow is rate aggregation performed for this measure
                Comments

                The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

                Control0..1
                This element is affected by the following invariants: ele-1, cmp-7
                TypeExtension(CQM Rate Aggregation) (Extension Type: string)
                Is Modifierfalse
                Must Supportfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                164. Measure.group.extension:improvementNotation
                Slice NameimprovementNotation
                Definition

                Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

                Shortincrease | decrease
                Control0..1
                This element is affected by the following invariants: ele-1, cmp-9
                TypeExtension(CQM Improvement Notation) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Must Supporttrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                166. Measure.group.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                168. Measure.group.code
                Definition

                Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measures.

                ShortMeaning of the group
                Control0..1
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                170. Measure.group.description
                Definition

                The human readable description of this population group.

                ShortSummary description
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                172. Measure.group.population
                Definition

                A population criteria for the measure.

                ShortPopulation criteria
                Control0..*
                This element is affected by the following invariants: cmp-10
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                174. Measure.group.population.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                176. Measure.group.population.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                178. Measure.group.population.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                180. Measure.group.population.code
                Definition

                The type of population criteria.

                Shortinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from MeasurePopulationType
                (extensible to http://hl7.org/fhir/ValueSet/measure-population)

                The type of population.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                182. Measure.group.population.description
                Definition

                The human readable description of this population criteria.

                ShortThe human readable description of this population criteria
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                184. Measure.group.population.criteria
                Definition

                An expression that specifies the criteria for the population, typically the name of an expression in a library.

                ShortThe criteria that defines this population
                Comments

                In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.

                Control1..1
                TypeExpression
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                186. Measure.group.stratifier
                Definition

                The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

                ShortStratifier criteria for the measure
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                188. Measure.group.stratifier.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                190. Measure.group.stratifier.extension
                Definition

                An Extension

                ShortExtension
                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on Measure.group.stratifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 192. Measure.group.stratifier.extension:appliesTo
                  Slice NameappliesTo
                  Definition

                  Indicates the population that this stratifier should apply to. If no appliesTo extension is present, the stratifier is calculated based on the result of the population calculation (e.g. the calculated numerator for a proportion scoring).

                  ShortWhich population does this stratifier apply to?
                  Control0..*
                  This element is affected by the following invariants: ele-1
                  TypeExtension(CQM Applies To) (Extension Type: CodeableConcept)
                  Is Modifierfalse
                  Must Supportfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  194. Measure.group.stratifier.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  196. Measure.group.stratifier.code
                  Definition

                  Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

                  ShortMeaning of the stratifier
                  Control0..1
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  198. Measure.group.stratifier.description
                  Definition

                  The human readable description of this stratifier criteria.

                  ShortThe human readable description of this stratifier
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  200. Measure.group.stratifier.criteria
                  Definition

                  An expression that specifies the criteria for the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.

                  ShortHow the measure should be stratified
                  Control0..1
                  TypeExpression
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  202. Measure.group.stratifier.component
                  Definition

                  A component of the stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

                  ShortStratifier criteria component for the measure
                  Comments

                  Stratifiers are defined either as a single criteria, or as a set of component criteria.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  204. Measure.group.stratifier.component.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  206. Measure.group.stratifier.component.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  208. Measure.group.stratifier.component.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  210. Measure.group.stratifier.component.code
                  Definition

                  Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

                  ShortMeaning of the stratifier component
                  Control0..1
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  212. Measure.group.stratifier.component.description
                  Definition

                  The human readable description of this stratifier criteria component.

                  ShortThe human readable description of this stratifier component
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  214. Measure.group.stratifier.component.criteria
                  Definition

                  An expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.

                  ShortComponent of how the measure should be stratified
                  Control1..1
                  TypeExpression
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  216. Measure.supplementalData
                  Definition

                  The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

                  ShortWhat other data should be reported with the measure
                  Comments

                  Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  218. Measure.supplementalData.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  220. Measure.supplementalData.extension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                  ShortAdditional content defined by implementations
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  222. Measure.supplementalData.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  224. Measure.supplementalData.code
                  Definition

                  Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.

                  ShortMeaning of the supplemental data
                  Control0..1
                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  226. Measure.supplementalData.usage
                  Definition

                  An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

                  Shortsupplemental-data | risk-adjustment-factor
                  Control0..*
                  BindingUnless not suitable, these codes SHALL be taken from MeasureDataUsage
                  (extensible to http://hl7.org/fhir/ValueSet/measure-data-usage)

                  The intended usage for supplemental data elements in the measure.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  228. Measure.supplementalData.description
                  Definition

                  The human readable description of this supplemental data.

                  ShortThe human readable description of this supplemental data
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  230. Measure.supplementalData.criteria
                  Definition

                  The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.

                  ShortExpression describing additional data to be reported
                  Control1..1
                  TypeExpression
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))