Quality Measure Implementation Guide
1.0.0 - STU 1

Quality Measure Implementation Guide - Downloaded Version null See the Directory of published versions

## Quality Measure Implementation Guide Homepage

Official URL: http://hl7.org/fhir/uv/cqm/ImplementationGuide/hl7.fhir.uv.cqm | Version: 1.0.0
IG Standards status: Trial-use | Maturity Level: 4 | Computable Name: CQMeasures
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61

> This implementation guide is the Universal Realm successor of the US-based Quality Measure IG STU 5, and incorporates stakeholder feedback and implementation experience from that specification.

## Quality Measure Implementation Guide

### Summary

The Fast Healthcare Interoperability Resource (FHIR) Quality Measure Implementation Guide (QM IG) describes an approach to representing Quality Measures (QMs) using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) in the Universal Realm. The initial approach to quality measures focused on using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) within the US Realm. Adoption of this IG to use cases outside of US is simplified as a universal realm IG.

This IG is built on FHIR Version R4 and accounts for content in previous generations of QM standards, the HL7 V3-based Health Quality Measure Format (HQMF) and accompanying implementation guides using FHIR. As an HL7 FHIR Implementation Guide, changes to this specification are managed by the sponsoring Clinical Quality Information Work Group and are incorporated as part of the standard balloting process.

#### Examples

Refer to the QI-Core implementation guide for examples of how to represent data involved in calculation of quality measures.

### How to read this Guide

This Guide is divided into several pages which are listed at the top of each page in the menu bar:

- Home: The home page provides the summary and background information for the FHIR Quality Measure Implementation Guide.
- Introduction: The introduction provides a more detailed overview of quality measurement and the background for this guide.
- QMs: This page describes measure representation and conformance requirements for QMs.
- Using CQL: This page covers using Clinical Quality Language to author QMs.
- Composites: This page covers composite measure representation and conformance requirements.
- Packaging: This page describes measure packaging and distribution requirements for QMs.
- FHIR Artifacts
  - Profiles: This page lists the set of profiles defined for use by QMs.
  - Extensions: This page lists the set of extensions defined for use by QMs.
  - Terminology: This page lists value sets and code systems defined in this IG.
  - Capabilities: This page defines the workflows and roles for QMs and contains the capability statements.
  - Operations: This page defines services and operations in support of authoring, publishing, and distributing QMs.
  - Artifacts Summary: This page defines the workflows and roles for QMs and contains the capability statements.
- Examples: This page provides examples used in the other pages, as well as by the Data Exchange for Quality.
- Glossary This page defines terms related to quality measurement.
- Downloads: This page provides links to downloadable artifacts for implementations.
- Changes: This page details changes made in each version of the Quality Measure IG.

### Background

#### Quality Improvement Ecosystem

The diagram below shows the quality improvement ecosystem. Each step is discussed in the following order:
Step 1: Researcher and public health surveillance – begins with information, preferably evidence-based from research, public health surveillance, and data mining and other analyses performed by third parties such as academic institutions or payers. Such information indicates existing status and knowledge about a given clinical topic.
Step 2: Clinical practice guidelines – stakeholders, such as professional societies, public health agencies, and governmental bodies, publish such information to provide current recommendations to consumers, healthcare practitioners, and healthcare organizations about what is known and suggested methods for managing the clinical topic. Ideally, suggested management efforts are captured and documented in guidelines based on collaboration among clinical subject matter experts, terminologists, informaticists, clinicians and consumers.
Step 3: Clinical decision support - the clinical guidelines developed in step 2 are translated into clinical decision support (CDS) artifacts to incorporate relevant, evidence-based, and patient-specific clinical recommendations and actions directly within clinical workflow.
Step 4: Clinical Care - To adequately impact clinical care for clinicians and patients requires local implementation activities as shown in CDS is not intended to replace clinician judgment, but rather to provide information to assist care team members in managing the complex and expanding volume of biomedical and person-specific data needed to make timely, informed, and higher quality decisions based on current clinical science. Ideally, the clinical guidelines and CDS include methods for evaluating what successful implementation means, (i.e., whether the clinical care ultimately provided included processes that addressed the intent of the guideline and if it achieved the desired outcomes). Further information on CDS and its optimization of care delivery can be found here.
Step 5: Measurement and Analytics – closes the loop and enables continuous improvement; the results of such measurement analytics must be reported for aggregate review.
Step 6: Reporting – serves the purpose of evaluating clinical performance and outcomes, whether it be internally for healthcare organizations, or for third parties such as public health or for payers. Ultimately, this information may then serve as part of the evidence base shown in step 1.

Figure 1-1: The Quality Improvement Ecosystem Diagram

> Practitioner organizations along with stakeholders such as public health have ongoing needs for quality improvement at the point of care. Every effort should be made to establish a capable distributed rule processing environment in FHIR. For additional information about idealized processes for moving evidence and information from guidelines to CDS and measurement, refer to an effort by the Centers for Disease Control and Prevention (CDC) called Adapting Clinical Guidelines for the Digital Age.

#### Quality Measurement Standards Landscape

This implementation guide is part of a larger FHIR-based quality improvement and quality measurement standards landscape, depicted in the following diagram:

Figure 1-2: The Quality Measurement Standards Landscape Diagram

The left side of the quality measurement standards landscape diagram depicts the activities and standards associated with measure specification, while the right side depicts measure reporting. Stakeholders and the roles they play are represented by the three rounded rectangles in the foreground labeled Producer, Consumer and Specifier. Note that the lists are representative of typical stakeholders, but that a single stakeholder may play any or all of the roles in this diagram. For example, an institution specifying its own measures for internal use would be the Producer, Consumer, and Specifier.

Quality measure (or performance measure) is a numeric quantification of healthcare quality for a designated accountable healthcare entity, such as hospital, health plan, nursing home, clinician, etc. A healthcare performance measure is a way to calculate whether and how often the healthcare system does what it should. Measures are based on scientific evidence about processes, outcomes, perceptions, or systems that relate to high-quality care. Source

Measure specification involves the end product of the measure development process, a precisely specified, valid, reliable, and clinically significant measure specification to support accurate data representation and capture of quality measures. Clinical Quality Measures (CQMs) are tools that help measure and track the quality of healthcare services provided in care delivery environments, including eligible clinicians (ECs), eligible hospitals (EHs), and critical access hospitals (CAHs). Measuring and reporting CQMs helps to ensure that our healthcare system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. CQMs measure many aspects of patient care, including patient and family engagement, patient safety, care coordination, public health, population health management, efficient use of healthcare resources, and clinical process and effectiveness. For more information on the basics of Clinical Quality Measures, see Clinical Quality Measures Basics. Before Electronic Health Record (EHR) systems, chart-abstracted CQMs were predominant. Modern EHR systems enable electronic CQMs, or eCQMs.

Measure reporting involves the data collection and aggregation, calculation and analytics, and ultimately reporting of quality measures. Measure reporting may be accomplished in different ways at various levels of the healthcare delivery system, from individual providers attesting to specific quality measures as part of federally-regulated healthcare quality initiatives, to provider organizations reporting to healthcare plans as part of payer quality improvement activities, to institutions reporting on the quality of their own healthcare delivery.

Stakeholders in the quality space, represented by the three rounded rectangles in the foreground of the above diagram, fall into three broad categories:

1. Data Producers in the diagram represent the various stakeholders involved in the de novo creation of healthcare data. Data Producers can include providers and provider systems; patients, care teams, caregivers, and patient engagement systems; and other related clinical systems such as laboratory, clinic, and hospital information systems that are primary producers of patient healthcare information.

2. Data Consumers in the diagram represent the various stakeholders involved in the consumption and use of healthcare data. Data Consumers can include data routers and aggregators, payers, health information exchanges and health integrated networks, as well as public health, registries, and other healthcare-related agencies.

3. Specifiers in the diagram represents the various stakeholders involved in the specification of quality measures for use in healthcare quality measurement and reporting. Specifiers can include quality agencies, public health, and other healthcare-related agencies, industry consortiums concerned with improving care quality, and clinical professional societies. Specifiers may also be institutions and clinics using the quality measurement standards to specify quality measures for use in their own environments and quality improvement initiatives.

The shaded areas underlying the stakeholders depict the various standards involved (see Clinical Quality Framework for more information).

##### Fast Healthcare Interoperability Resources (FHIR)

Fast Healthcare Interoperability Resources, or FHIR, is a Health Level 7 (HL7) platform specification for healthcare that supports exchange of healthcare information between systems. FHIR is universally applicable, meaning that it can be used in a broad variety of implementation environments. The platform provides layers of implementation that support foundational protocols; base implementation functionality such as conformance and terminology; administrative functionality to represent patients, care teams, locations, and organizations; healthcare processes including clinical and diagnostic information, as well as medication, workflow, and financial; and finally, a clinical reasoning layer that provides support for the representation of knowledge and reasoning about healthcare.

The quality measurement standards landscape makes use of all these layers of FHIR: the foundational and implementation layers to define interactions and profiles; the administrative and process layers to represent the data of interest for quality measurement; and the clinical reasoning layer to specify and support evaluation and reporting of quality measures.

##### Clinical Quality Language (CQL)

Clinical Quality Language, or CQL, is an HL7 cross-paradigm specification that defines a high-level, domain-specific language focused on clinical quality and targeted for use by measure and decision support artifact authors. In addition, the specification describes a machine-readable canonical representation called Expression Logical Model (ELM) targeted at implementations and designed to facilitate sharing and evaluation of clinical knowledge.

This ability to render clinical knowledge in a high-level human-readable form as well as an intermediate-level, platform-independent machine-readable form makes CQL an ideal mechanism for specifying the criteria involved in quality measures.

##### FHIR Quality Measure Implementation Guide

The FHIR Quality Measure Implementation Guide (this IG) defines conformance profiles and guidance focused on the specification of quality measures using the FHIR Measure and Library resources. The IG does not standardize the content of any particular measure, rather it defines the standard approach to the representation of that content so that quality measure specifiers can define and share standardized FHIR-based electronic Clinical Quality Measures (eCQMs).

##### Quality Improvement Core Implementation Guide (QI-Core)

The Quality Improvement Core Implementation Guide, or QI-Core, defines a set of FHIR profiles with extensions and bindings needed to create interoperable, quality-focused applications. Importantly, the scope of QI-Core includes both quality measurement and decision support to ensure that knowledge expressed can be shared across both domains. QI-Core is derived from US Core, meaning that where possible, QI-Core profiles are based on US Core to ensure alignment with and support for quality improvement data within healthcare systems in the US Realm.

##### Data Exchange for Quality Measures (DEQM)

The Data Exchange for Quality Measures Implementation Guide, or DEQM, provides a framework that defines conformance profiles and guidance to enable the exchange of quality information and quality measure reporting (e.g. for transferring quality information from a healthcare provider to a payer). The DEQM expects to use quality measures specified in accordance with the Quality Measure IG and QI-Core.

#### Data Model Standards Landscape

The quality improvement ecosystem covers every aspect of the healthcare delivery system, and needs to be able to represent information across that entire spectrum. FHIR provides a foundation for representation of this information in a universally applicable way. In particular cases, more specificity is required to capture the intended meaning of healthcare information. As FHIR is more and more broadly adopted, consensus among participating stakeholders on the use of particular profiles and patterns enables semantic interoperability for more use cases.

Within the US Realm, US Core profiles comprise this base consensus, and although it enables a variety of interoperability use cases, the profiles do not represent all of the requirements for quality improvement. The QI-Core profiles are derived from US Core and provide this additional functionality.

There are occasional instances where additional specificity or functionality is required explicitly for quality measurement, or a particular component within a quality measure. In these cases, creation of measure content IG can be considered to facilitate measure development.

The following diagram depicts this data model standards landscape:

Figure 3: The Data Model Standards Landscape Diagram

As illustrated, FHIR provides the foundation, and sets of profiles are built on top of FHIR that provide more and more focused use cases by constraining profiles and extending functionality to cover gaps. While the additional layers are necessary to represent specific operations and provide space for agreement among relevant stakeholders, the consensus-based standards development process is used to suggest changes to the layers below, resulting in an ever-broadening umbrella of interoperability.

This layering of profiles balances the relative adoption and implementation maturity of FHIR and the data representation requirements of the use cases involved, guided by the following principles:

1. Avoid proliferation of profiles. To the extent possible, make use of existing profiles at the lowest level of the stack, only defining a new profile if absolutely necessary to express a requirement for a particular use case that cannot be represented by an existing one.
2. Share profiles across measures. There should not be profiles specific to any particular measure. Instead, QI Core provides a layer for the expression of quality improvement requirements across measures and decision support artifacts.
3. No terminology-narrowing-only profiles. Profiles should not be used to specify only terminology narrowing constraints. The FHIR Clinical Reasoning module and CQL enable the representation of data requirements for quality measures and decision support artifacts.
4. Promote data-related profiles. When it becomes necessary to define a data-related profile at the measurement-specific level (in Measure Content IG for example), steps should be taken to promote that profile to the broadest consensus group possible.

### References

Centers for Medicare & Medicaid. Clinical Quality Measures Basics. [Online]. Available from: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html [Accessed 11 October 2019].

Michaels, M. (2023). Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary approach. American Journal of Medical Quality, 38(5S), S3–S11. https://doi.org/10.1097/jmq.0000000000000138

Health level seven. Clinical Quality Framework - HL7 Clinical Quality Information Work Group Confluence Page. [Online]. Available from: https://confluence.hl7.org/display/CQIWC/Clinical Quality Framework [Accessed 11 October 2019].

### Dependencies

The dependency on QI-Core is included for the purposes of example validation only. In addition, the dependency on VSAC packages is indirect via the QI Core and US Core. The conformance profiles in this IG do not make use of the value sets in VSAC.

IG | Package | FHIR
--- | --- | ---
Quality Measure Implementation Guide | hl7.fhir.uv.cqm#1.0.0 | R4
HL7 Terminology (THO) | hl7.terminology.r4#6.5.0 | R4
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4
Canonical Resource Management Infrastructure Implementation Guide | hl7.fhir.uv.crmi#1.0.0 | R4
HL7 Terminology (THO) | hl7.terminology#5.5.0 | R4
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#1.0.0 | R4
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4
Using CQL With FHIR | hl7.fhir.uv.cql#2.0.0 | R4
QI-Core Implementation Guide | hl7.fhir.us.qicore#6.0.0 | R4
FHIR Tooling Extensions IG | hl7.fhir.uv.tools.r4#0.8.0 | R4

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package hl7.fhir.uv.crmi#1.0.0 This implementation guide defines profiles, operations, capability statements and guidance to facilitate the content management lifecycle for authoring, publishing, distribution, and implementation of FHIR knowledge artifacts such as value sets, profiles, libraries, rules, and measures. The guide is intended to be used by specification and content implementation guide authors as both a dependency for validation of published artifacts, and a guide for construction and publication of content. (built Fri, May 31, 2024 16:38+0000+00:00)

Package hl7.fhir.uv.cql#2.0.0 This implementation guide defines profiles, operations and guidance for the use of CQL with FHIR, both as a mechanism for querying, as well as inline and integrated usage as part of knowledge artifacts. (built Tue, Jul 8, 2025 14:47+0000+00:00)

Package hl7.fhir.us.qicore#6.0.0 The QICore Implementation Guide defines a set of FHIR profiles with extensions and bindings needed to create interoperable, quality-focused applications. The profiles in this implementation guide derive from and extend the US Core profiles to provide a common foundation for building, sharing, and evaluating knowledge artifacts across quality improvement efforts in the US Realm. (built Fri, Mar 1, 2024 18:46+0000+00:00)

Package hl7.fhir.uv.tools.r4#0.8.0 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Aug 5, 2025 20:09+1000+10:00)

### Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B} systems. Packages for both R4 (hl7.fhir.uv.cqm.r4) and R4B (hl7.fhir.uv.cqm.r4b) are available.

### Global Profiles

Global Profiles:

Type | Source | Profile
Encounter | hl7.fhir.us.qicore#6.0.0 | QICore Encounter
Immunization | hl7.fhir.us.qicore#6.0.0 | QICore Immunization
Observation | hl7.fhir.us.qicore#6.0.0 | QICore Simple Observation
Organization | hl7.fhir.us.qicore#6.0.0 | QICore Organization
Patient | hl7.fhir.us.qicore#6.0.0 | QICore Patient
Practitioner | hl7.fhir.us.qicore#6.0.0 | QICore Practitioner
PractitionerRole | hl7.fhir.us.qicore#6.0.0 | QICore PractitionerRole

All resources of these types must conform to these profiles.

### IP Statements

This publication includes IP covered under the following statements.

- Adapted from content published by IHE Copyright (c) 2015 IHE International, Inc . Used here according to the terms of the CC BY 4 License . Makes use of duration definitions as defined in the ISO 8601 specification.
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  - ISO-8601-Derived Periods Codes: AgeStratifiedExampleAgeGroups, ISO8601DerivedPeriods and MeasureAgeStratifiedExample
- The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  - Unified Code for Units of Measure (UCUM): EXMRatioMeasure
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  - LOINC: Bundle/measurereport-bundle-example, EXM108... Show 11 more, EXM124, EXM125, EXM130, EXM146, EXM55, EXMPromotingInteroperabilityMeasure, EXMRatioMeasure, HBPComponent, MeasureEXM, PublishableMeasureEXM and Terminology_FHIR
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  - SNOMED Clinical Terms&reg; (SNOMED CT&reg;): BCSComponent, CCSComponent... Show 6 more, ChronicLiverDiseaseLegacyExample, EXM124, EXM125, EXM130, PVSComponent and Terminology
- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  - Artifact Identifier Type Codes: BCSComponent, CCSComponent... Show 7 more, CQMPublishableMeasure, EXM124, HBPComponent, MeasureCQMPublishableExample, PVSComponent, PublishableMeasureEXM and TSCComponent
  - CompositeMeasureScoring: CQMCompositeMeasure, CQMCompositeScoring... Show 5 more, MultiRateExample, PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite and PreventiveCareandWellnessWeightedComposite
  - Condition Category Codes: Bundle/sde-example-artifact-bundle
  - Condition Clinical Status Codes: EXM108, EXM125, EXM146 and TSCComponent
  - ConditionVerificationStatus: EXM146
  - Diagnosis Role: Bundle/sde-example-artifact-bundle, EXM55, EXMLogicModuleDefinitionDirectReference and MeasureEXM
  - LibraryType: AdultOutpatientEncounters, AdvancedIllnessandFrailtyExclusion... Show 41 more, AgeStratificationExample, BCSComponent, Bundle/sde-example-artifact-bundle, CCSComponent, Common, CommonTerminologies, ECQMUpdate2024FinalDraft, ECQMUpdate2024InitialDraft, ECQMUpdate2024Release, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMAggregate, EXMComputableLibrary, EXMExecutableLibrary, EXMIA, EXMLogic, EXMLogicModuleDefinition, EXMLogicModuleDefinitionDirectReference, EXMPublishableLibrary, EXMRatio, EXMRatioMeasure, HBPComponent, Hospice, MATGlobalCommonFunctions, MeasureAgeStratifiedExample, MeasureEXM, ModuleDefinitionEXMLogic, MultiRateExample, PVSComponent, PublishableMeasureEXM, QualityProgramExample, SupplementalDataElements, TJCOverall, TSCComponent, Terminology, Terminology_FHIR and VTEICU
  - Measure Aggregate Method: CQMAggregateMethod
  - MeasureDataUsage: BCSComponent, CCSComponent... Show 10 more, CQMSupplementalDataGuidance, EXM108, EXM124, EXM125, EXM130, HBPComponent, MeasureEXM, PVSComponent, PublishableMeasureEXM and TSCComponent
  - MeasureImprovementNotation: BCSComponent, Bundle/measurereport-bundle-example... Show 23 more, CCSComponent, CQMComputableMeasure, CQMImprovementNotation, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMPromotingInteroperabilityMeasure, EXMRatioMeasure, HBPComponent, MeasureEXM, MeasureReport/testcase-example, MultiRateExample, PVSComponent, PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite, PreventiveCareandWellnessWeightedComposite, PublishableMeasureEXM, TSCComponent and Terminology_FHIR
  - Measure Population Type: BCSComponent, Bundle/measurereport-bundle-example... Show 25 more, Bundle/sde-example-artifact-bundle, CCSComponent, CQMAppliesTo, CQMCohortMeasure, CQMContinuousVariableMeasure, CQMProportionMeasure, CQMRatioMeasure, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMPromotingInteroperabilityMeasure, EXMRatioMeasure, HBPComponent, MeasureAgeStratifiedExample, MeasureCQMPublishableExample, MeasureEXM, MeasureReport/testcase-example, MultiRateExample, PVSComponent, PublishableMeasureEXM, TSCComponent and Terminology_FHIR
  - Measure Scoring: BCSComponent, Bundle/sde-example-artifact-bundle... Show 29 more, CCSComponent, CQMAttestationMeasure, CQMCohortMeasure, CQMCompositeMeasure, CQMComputableMeasure, CQMContinuousVariableMeasure, CQMProportionMeasure, CQMRatioMeasure, CQMScoring, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMPromotingInteroperabilityMeasure, EXMRatioMeasure, HBPComponent, MeasureAgeStratifiedExample, MeasureEXM, MultiRateExample, PVSComponent, PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite, PreventiveCareandWellnessWeightedComposite, PublishableMeasureEXM, TSCComponent and Terminology_FHIR
  - MeasureType: BCSComponent, Bundle/sde-example-artifact-bundle... Show 20 more, CCSComponent, CQMPublishableMeasure, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMRatioMeasure, HBPComponent, MeasureEXM, MultiRateExample, PVSComponent, PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite, PreventiveCareandWellnessWeightedComposite, PublishableMeasureEXM, TSCComponent and Terminology_FHIR
  - Observation Category Codes: Bundle/measurereport-bundle-example and Bundle/sde-example-artifact-bundle
  - Organization type: Bundle/measurereport-bundle-example
  - Software System Type Codes: Device/software-system-example
  - UsageContextType: BCSComponent, CCSComponent... Show 19 more, CQMPublishableMeasure, EXM108, EXM124, EXM125, EXM130, EXM146, EXM55, EXMPromotingInteroperabilityMeasure, EXMRatioMeasure, HBPComponent, MeasureEXM, MultiRateExample, PVSComponent, PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite, PreventiveCareandWellnessWeightedComposite, PublishableMeasureEXM and TSCComponent
  - identifierType: Bundle/measurereport-bundle-example
  - ActCode: Bundle/sde-example-artifact-bundle
  - MaritalStatus: Bundle/measurereport-bundle-example
  - ObservationValue: CQMComputableMeasure and CQMType