Quality Measure Implementation Guide
1.0.0 - STU 1

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

## Resource Profile: CQM Composite Measure

Official URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositemeasure | Version: 1.0.0
Standards status: Trial-use | Maturity Level: 4 | Computable Name: CQMCompositeMeasure
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.42.7

The CQM Composite Measure Profile describes minimum expectations for a composite electronic Quality Measure (QM). For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.

Usages:

- Examples for this Profile: PreventiveCareandWellnessAllOrNothingComposite, PreventiveCareandWellnessOpportunityComposite, PreventiveCareandWellnessPatientLevelLinearComposite and PreventiveCareandWellnessWeightedComposite
- CapabilityStatements using this Profile: CQF Measures Shareable Measure Repository Capability Statement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure | S C | 0..* | CQMComputableMeasure | A quality measure definition Constraints: mea-0, mea-1, comp-1, comp-2, comp-3, comp-4, comp-5, comp-6, comp-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:populationBasis | S C | 0..* | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:effectiveDataRequirements | S | 0..1 | canonical(CRMI Module Definition Library) | Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
subject[x] | S | 0..1 |  | E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept |  |  | CodeableConcept |
subjectReference |  |  | Reference(Group) |
usage | S | 0..1 | string | Describes the clinical usage of the measure
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S Σ | 1..1 | code | Component measure Binding: RelatedArtifactType (required): The type of relationship to the related artifact. Fixed Value: composed-of
display | S Σ | 0..1 | string | Brief description of the related artifact
resource | S Σ | 1..1 | canonical(Measure) | What resource is being referenced
library | S | 0..1 | canonical(CRMI Computable Library) | Logic used by the measure
scoring | S Σ C | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
compositeScoring | S Σ | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
type | S Σ C | 0..* | CodeableConcept | 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. Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
improvementNotation | S Σ C | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required)
group | S C | 0..* | BackboneElement | Population criteria group Constraints: comp-8, comp-9, cmp-10, cmp-11
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
extension:populationBasis | S C | 0..1 | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component"
extension:type | C | 0..* | CodeableConcept | Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
extension:riskAdjustment | C | 0..1 | string | How risk adjustment is applied for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment
extension:rateAggregation | C | 0..1 | string | How is rate aggregation performed for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation
extension:improvementNotation | S C | 0..1 | CodeableConcept | increase | decrease URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the group
description | S | 0..1 | string | Summary description
population | S C | 0..* | BackboneElement | Population criteria
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description | S | 0..1 | string | The human readable description of this population criteria
criteria |  | 1..1 | Expression | The criteria that defines this population
stratifier | S | 0..* | BackboneElement | Stratifier criteria for the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:appliesTo |  | 0..* | CodeableConcept | Which population does this stratifier apply to? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier
component | S | 0..* | BackboneElement | Stratifier criteria component for the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.component.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier component Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier component
criteria |  | 1..1 | Expression | Component of how the measure should be stratified
supplementalData | S | 0..* | BackboneElement | What other data should be reported with the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the supplemental data
usage | S | 0..* | CodeableConcept | supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description | S | 0..1 | string | The human readable description of this supplemental data
criteria |  | 1..1 | Expression | Expression describing additional data to be reported
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Measure.status | required | PublicationStatus `http://hl7.org/fhir/ValueSet/publication-status|4.0.1` From the FHIR Standard
Measure.subject[x] | extensible | SubjectTypeValueSet `http://hl7.org/fhir/uv/cqm/ValueSet/subject-type` From this IG
Measure.relatedArtifact:component.type | required | Fixed Value: composed-of `http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1` From the FHIR Standard
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`
Measure.type | extensible | ObservationMeasureType `http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType`
Measure.improvementNotation | required | MeasureImprovementNotation `http://terminology.hl7.org/ValueSet/measure-improvement-notation`
Measure.group.population.code | extensible | MeasurePopulationType `http://hl7.org/fhir/ValueSet/measure-population|4.0.1` From the FHIR Standard
Measure.group.stratifier.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.group.stratifier.component.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.supplementalData.usage | extensible | MeasureDataUsage `http://hl7.org/fhir/ValueSet/measure-data-usage|4.0.1` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |
comp-1 | error | Measure | 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() |
comp-2 | error | Measure | Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. : (scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())) |
comp-3 | error | Measure | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists() |
comp-4 | error | Measure | If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. : scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists() |
comp-5 | error | Measure | If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse() |
comp-6 | error | Measure | If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse() |
comp-7 | error | Measure | If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse() |
comp-8 | error | Measure.group | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() |
comp-9 | error | Measure.group | If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. : 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 in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists() |
dom-2 | error | Measure | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Measure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Measure | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
mea-0 | warning | Measure | Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}') |
mea-1 | error | Measure | Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists()) |
popBasis-1 | error | Measure.extension:populationBasis, Measure.group.extension:populationBasis | If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. : value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()) |

This structure is derived from CQMComputableMeasure

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure |  | 0..* | CQMComputableMeasure | A quality measure definition
Slices for extension |  |  |  | Content/Rules for all slices
extension:scoringUnit | S | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S | 1..1 | code | Component measure Fixed Value: composed-of
display | S | 0..1 | string | Brief description of the related artifact
resource | S | 1..1 | canonical(Measure) | What resource is being referenced
scoring | S | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
compositeScoring | S | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
group | S C | 0..* | BackboneElement | Population criteria group Constraints: cmp-10, cmp-11
Slices for extension |  |  |  | Content/Rules for all slices
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
population | S C | 0..* | BackboneElement | Population criteria
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet / Code | URI
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure | S C | 0..* | CQMComputableMeasure | A quality measure definition Constraints: mea-0, mea-1, comp-1, comp-2, comp-3, comp-4, comp-5, comp-6, comp-7
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:populationBasis | S C | 0..* | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:effectiveDataRequirements | S | 0..1 | canonical(CRMI Module Definition Library) | Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
url | Σ | 0..1 | uri | Canonical identifier for this measure, represented as a URI (globally unique)
identifier | Σ | 0..* | Identifier | Additional identifier for the measure
version | Σ | 0..1 | string | Business version of the measure
name | Σ C | 0..1 | string | Name for this measure (computer friendly)
title | Σ | 0..1 | string | Name for this measure (human friendly)
subtitle |  | 0..1 | string | Subordinate title of the measure
status | ?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
experimental | Σ | 0..1 | boolean | For testing purposes, not real usage
subject[x] | S | 0..1 |  | E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept |  |  | CodeableConcept |
subjectReference |  |  | Reference(Group) |
date | Σ | 0..1 | dateTime | Date last changed
publisher | Σ | 0..1 | string | Name of the publisher (organization or individual)
contact | Σ | 0..* | ContactDetail | Contact details for the publisher
description | Σ | 0..1 | markdown | Natural language description of the measure
useContext | Σ | 0..* | UsageContext | The context that the content is intended to support
jurisdiction | Σ | 0..* | CodeableConcept | Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose |  | 0..1 | markdown | Why this measure is defined
usage | S | 0..1 | string | Describes the clinical usage of the measure
copyright |  | 0..1 | markdown | Use and/or publishing restrictions
approvalDate |  | 0..1 | date | When the measure was approved by publisher
lastReviewDate |  | 0..1 | date | When the measure was last reviewed
effectivePeriod | Σ | 0..1 | Period | When the measure is expected to be used
topic |  | 0..* | CodeableConcept | The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author |  | 0..* | ContactDetail | Who authored the content
editor |  | 0..* | ContactDetail | Who edited the content
reviewer |  | 0..* | ContactDetail | Who reviewed the content
endorser |  | 0..* | ContactDetail | Who endorsed the content
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S Σ | 1..1 | code | Component measure Binding: RelatedArtifactType (required): The type of relationship to the related artifact. Fixed Value: composed-of
label | Σ | 0..1 | string | Short label
display | S Σ | 0..1 | string | Brief description of the related artifact
citation | Σ | 0..1 | markdown | Bibliographic citation for the artifact
url | Σ | 0..1 | url | Where the artifact can be accessed
document | Σ | 0..1 | Attachment | What document is being referenced
resource | S Σ | 1..1 | canonical(Measure) | What resource is being referenced
library | S | 0..1 | canonical(CRMI Computable Library) | Logic used by the measure
disclaimer | Σ | 0..1 | markdown | Disclaimer for use of the measure or its referenced content
scoring | S Σ C | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
compositeScoring | S Σ | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
type | S Σ C | 0..* | CodeableConcept | 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. Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
riskAdjustment | Σ C | 0..1 | string | How risk adjustment is applied for this measure
rateAggregation | Σ C | 0..1 | string | How is rate aggregation performed for this measure
rationale | Σ | 0..1 | markdown | Detailed description of why the measure exists
clinicalRecommendationStatement | Σ | 0..1 | markdown | Summary of clinical guidelines
improvementNotation | S Σ C | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required)
definition | Σ | 0..* | markdown | Defined terms used in the measure documentation
guidance | Σ | 0..1 | markdown | Additional guidance for implementers
group | S C | 0..* | BackboneElement | Population criteria group Constraints: comp-8, comp-9, cmp-10, cmp-11
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
extension:populationBasis | S C | 0..1 | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component"
value[x] |  | 0..1 | RelatedArtifact | Value of extension
extension:type | C | 0..* | CodeableConcept | Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
extension:riskAdjustment | C | 0..1 | string | How risk adjustment is applied for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment
extension:rateAggregation | C | 0..1 | string | How is rate aggregation performed for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation
extension:improvementNotation | S C | 0..1 | CodeableConcept | increase | decrease URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the group
description | S | 0..1 | string | Summary description
population | S C | 0..* | BackboneElement | Population criteria
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description | S | 0..1 | string | The human readable description of this population criteria
criteria |  | 1..1 | Expression | The criteria that defines this population
stratifier | S | 0..* | BackboneElement | Stratifier criteria for the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:appliesTo |  | 0..* | CodeableConcept | Which population does this stratifier apply to? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier
criteria |  | 0..1 | Expression | How the measure should be stratified
component | S | 0..* | BackboneElement | Stratifier criteria component for the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.component.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier component Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier component
criteria |  | 1..1 | Expression | Component of how the measure should be stratified
supplementalData | S | 0..* | BackboneElement | What other data should be reported with the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the supplemental data
usage | S | 0..* | CodeableConcept | supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description | S | 0..1 | string | The human readable description of this supplemental data
criteria |  | 1..1 | Expression | Expression describing additional data to be reported
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Measure.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages|4.0.1` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Measure.status | required | PublicationStatus `http://hl7.org/fhir/ValueSet/publication-status|4.0.1` From the FHIR Standard
Measure.subject[x] | extensible | SubjectTypeValueSet `http://hl7.org/fhir/uv/cqm/ValueSet/subject-type` From this IG
Measure.jurisdiction | extensible | Jurisdiction ValueSet `http://hl7.org/fhir/ValueSet/jurisdiction|4.0.1` From the FHIR Standard
Measure.topic | example | DefinitionTopic `http://hl7.org/fhir/ValueSet/definition-topic|4.0.1` From the FHIR Standard
Measure.relatedArtifact:component.type | required | Fixed Value: composed-of `http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1` From the FHIR Standard
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`
Measure.type | extensible | ObservationMeasureType `http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType`
Measure.improvementNotation | required | MeasureImprovementNotation `http://terminology.hl7.org/ValueSet/measure-improvement-notation`
Measure.group.population.code | extensible | MeasurePopulationType `http://hl7.org/fhir/ValueSet/measure-population|4.0.1` From the FHIR Standard
Measure.group.stratifier.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.group.stratifier.component.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.supplementalData.usage | extensible | MeasureDataUsage `http://hl7.org/fhir/ValueSet/measure-data-usage|4.0.1` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |
comp-1 | error | Measure | 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() |
comp-2 | error | Measure | Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. : (scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())) |
comp-3 | error | Measure | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists() |
comp-4 | error | Measure | If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. : scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists() |
comp-5 | error | Measure | If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse() |
comp-6 | error | Measure | If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse() |
comp-7 | error | Measure | If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse() |
comp-8 | error | Measure.group | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() |
comp-9 | error | Measure.group | If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. : 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 in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists() |
dom-2 | error | Measure | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Measure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Measure | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
mea-0 | warning | Measure | Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}') |
mea-1 | error | Measure | Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists()) |
popBasis-1 | error | Measure.extension:populationBasis, Measure.group.extension:populationBasis | If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. : value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()) |

This structure is derived from CQMComputableMeasure

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 18 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Measure.relatedArtifact

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure | S C | 0..* | CQMComputableMeasure | A quality measure definition Constraints: mea-0, mea-1, comp-1, comp-2, comp-3, comp-4, comp-5, comp-6, comp-7
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Slices for extension |  |  |  | Content/Rules for all slices
extension:populationBasis | S C | 0..* | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:effectiveDataRequirements | S | 0..1 | canonical(CRMI Module Definition Library) | Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
subject[x] | S | 0..1 |  | E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept |  |  | CodeableConcept |
subjectReference |  |  | Reference(Group) |
usage | S | 0..1 | string | Describes the clinical usage of the measure
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S Σ | 1..1 | code | Component measure Binding: RelatedArtifactType (required): The type of relationship to the related artifact. Fixed Value: composed-of
display | S Σ | 0..1 | string | Brief description of the related artifact
resource | S Σ | 1..1 | canonical(Measure) | What resource is being referenced
library | S | 0..1 | canonical(CRMI Computable Library) | Logic used by the measure
scoring | S Σ C | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
compositeScoring | S Σ | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
type | S Σ C | 0..* | CodeableConcept | 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. Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
improvementNotation | S Σ C | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required)
group | S C | 0..* | BackboneElement | Population criteria group Constraints: comp-8, comp-9, cmp-10, cmp-11
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
extension:populationBasis | S C | 0..1 | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component"
extension:type | C | 0..* | CodeableConcept | Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
extension:riskAdjustment | C | 0..1 | string | How risk adjustment is applied for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment
extension:rateAggregation | C | 0..1 | string | How is rate aggregation performed for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation
extension:improvementNotation | S C | 0..1 | CodeableConcept | increase | decrease URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the group
description | S | 0..1 | string | Summary description
population | S C | 0..* | BackboneElement | Population criteria
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description | S | 0..1 | string | The human readable description of this population criteria
criteria |  | 1..1 | Expression | The criteria that defines this population
stratifier | S | 0..* | BackboneElement | Stratifier criteria for the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:appliesTo |  | 0..* | CodeableConcept | Which population does this stratifier apply to? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier
component | S | 0..* | BackboneElement | Stratifier criteria component for the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.component.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier component Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier component
criteria |  | 1..1 | Expression | Component of how the measure should be stratified
supplementalData | S | 0..* | BackboneElement | What other data should be reported with the measure
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the supplemental data
usage | S | 0..* | CodeableConcept | supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description | S | 0..1 | string | The human readable description of this supplemental data
criteria |  | 1..1 | Expression | Expression describing additional data to be reported
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Measure.status | required | PublicationStatus `http://hl7.org/fhir/ValueSet/publication-status|4.0.1` From the FHIR Standard
Measure.subject[x] | extensible | SubjectTypeValueSet `http://hl7.org/fhir/uv/cqm/ValueSet/subject-type` From this IG
Measure.relatedArtifact:component.type | required | Fixed Value: composed-of `http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1` From the FHIR Standard
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`
Measure.type | extensible | ObservationMeasureType `http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType`
Measure.improvementNotation | required | MeasureImprovementNotation `http://terminology.hl7.org/ValueSet/measure-improvement-notation`
Measure.group.population.code | extensible | MeasurePopulationType `http://hl7.org/fhir/ValueSet/measure-population|4.0.1` From the FHIR Standard
Measure.group.stratifier.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.group.stratifier.component.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.supplementalData.usage | extensible | MeasureDataUsage `http://hl7.org/fhir/ValueSet/measure-data-usage|4.0.1` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |
comp-1 | error | Measure | 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() |
comp-2 | error | Measure | Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. : (scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())) |
comp-3 | error | Measure | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists() |
comp-4 | error | Measure | If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. : scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists() |
comp-5 | error | Measure | If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse() |
comp-6 | error | Measure | If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse() |
comp-7 | error | Measure | If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse() |
comp-8 | error | Measure.group | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() |
comp-9 | error | Measure.group | If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. : 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 in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists() |
dom-2 | error | Measure | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Measure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Measure | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
mea-0 | warning | Measure | Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}') |
mea-1 | error | Measure | Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists()) |
popBasis-1 | error | Measure.extension:populationBasis, Measure.group.extension:populationBasis | If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. : value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()) |

Differential View

This structure is derived from CQMComputableMeasure

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure |  | 0..* | CQMComputableMeasure | A quality measure definition
Slices for extension |  |  |  | Content/Rules for all slices
extension:scoringUnit | S | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S | 1..1 | code | Component measure Fixed Value: composed-of
display | S | 0..1 | string | Brief description of the related artifact
resource | S | 1..1 | canonical(Measure) | What resource is being referenced
scoring | S | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
compositeScoring | S | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
group | S C | 0..* | BackboneElement | Population criteria group Constraints: cmp-10, cmp-11
Slices for extension |  |  |  | Content/Rules for all slices
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
Slices for extension |  |  |  | Content/Rules for all slices
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
population | S C | 0..* | BackboneElement | Population criteria
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet / Code | URI
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Measure | S C | 0..* | CQMComputableMeasure | A quality measure definition Constraints: mea-0, mea-1, comp-1, comp-2, comp-3, comp-4, comp-5, comp-6, comp-7
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:populationBasis | S C | 0..* | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:effectiveDataRequirements | S | 0..1 | canonical(CRMI Module Definition Library) | Effective required data for evaluation URL: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
url | Σ | 0..1 | uri | Canonical identifier for this measure, represented as a URI (globally unique)
identifier | Σ | 0..* | Identifier | Additional identifier for the measure
version | Σ | 0..1 | string | Business version of the measure
name | Σ C | 0..1 | string | Name for this measure (computer friendly)
title | Σ | 0..1 | string | Name for this measure (human friendly)
subtitle |  | 0..1 | string | Subordinate title of the measure
status | ?!Σ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact.
experimental | Σ | 0..1 | boolean | For testing purposes, not real usage
subject[x] | S | 0..1 |  | E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: Subject Type Value Set (extensible)
subjectCodeableConcept |  |  | CodeableConcept |
subjectReference |  |  | Reference(Group) |
date | Σ | 0..1 | dateTime | Date last changed
publisher | Σ | 0..1 | string | Name of the publisher (organization or individual)
contact | Σ | 0..* | ContactDetail | Contact details for the publisher
description | Σ | 0..1 | markdown | Natural language description of the measure
useContext | Σ | 0..* | UsageContext | The context that the content is intended to support
jurisdiction | Σ | 0..* | CodeableConcept | Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose |  | 0..1 | markdown | Why this measure is defined
usage | S | 0..1 | string | Describes the clinical usage of the measure
copyright |  | 0..1 | markdown | Use and/or publishing restrictions
approvalDate |  | 0..1 | date | When the measure was approved by publisher
lastReviewDate |  | 0..1 | date | When the measure was last reviewed
effectivePeriod | Σ | 0..1 | Period | When the measure is expected to be used
topic |  | 0..* | CodeableConcept | The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author |  | 0..* | ContactDetail | Who authored the content
editor |  | 0..* | ContactDetail | Who edited the content
reviewer |  | 0..* | ContactDetail | Who reviewed the content
endorser |  | 0..* | ContactDetail | Who endorsed the content
Slices for relatedArtifact | S | 0..* | RelatedArtifact | Additional documentation, citations, etc. Slice: Unordered, Open by value:type
relatedArtifact:component | S | 0..* | RelatedArtifact | Additional documentation, citations, etc.
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
type | S Σ | 1..1 | code | Component measure Binding: RelatedArtifactType (required): The type of relationship to the related artifact. Fixed Value: composed-of
label | Σ | 0..1 | string | Short label
display | S Σ | 0..1 | string | Brief description of the related artifact
citation | Σ | 0..1 | markdown | Bibliographic citation for the artifact
url | Σ | 0..1 | url | Where the artifact can be accessed
document | Σ | 0..1 | Attachment | What document is being referenced
resource | S Σ | 1..1 | canonical(Measure) | What resource is being referenced
library | S | 0..1 | canonical(CRMI Computable Library) | Logic used by the measure
disclaimer | Σ | 0..1 | markdown | Disclaimer for use of the measure or its referenced content
scoring | S Σ C | 0..1 | CodeableConcept | composite Binding: Measure Scoring (extensible) Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/measure-scoring
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: composite
display |  | 0..1 | string | Representation defined by the system
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
compositeScoring | S Σ | 0..1 | CodeableConcept | opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible)
type | S Σ C | 0..* | CodeableConcept | 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. Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
riskAdjustment | Σ C | 0..1 | string | How risk adjustment is applied for this measure
rateAggregation | Σ C | 0..1 | string | How is rate aggregation performed for this measure
rationale | Σ | 0..1 | markdown | Detailed description of why the measure exists
clinicalRecommendationStatement | Σ | 0..1 | markdown | Summary of clinical guidelines
improvementNotation | S Σ C | 0..1 | CodeableConcept | increase | decrease Binding: MeasureImprovementNotation (required)
definition | Σ | 0..* | markdown | Defined terms used in the measure documentation
guidance | Σ | 0..1 | markdown | Additional guidance for implementers
group | S C | 0..* | BackboneElement | Population criteria group Constraints: comp-8, comp-9, cmp-10, cmp-11
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId
extension:populationBasis | S C | 0..1 | code, DataRequirement | What type of population URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis Binding: FHIRAllTypes (required): The type of elements in the population Constraints: popBasis-1
extension:scoring | S C | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring Binding: Measure Scoring (extensible): How the measure calculation is performed
extension:scoringUnit | S C | 0..1 | CodeableConcept | What units? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
extension:scoringPrecision |  | 0..1 | positiveInt | Number of decimal places URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringPrecision
extension:compositeScoring | S | 0..1 | CodeableConcept | proportion | ratio | continuous-variable | cohort URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring Binding: CompositeMeasureScoring (extensible): How the composite measure calculation is performed
extension:component | S C | 0..* | (Complex) | What artifact URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:groupId | S | 0..1 | string | What group URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
extension:weight | S | 0..1 | decimal | Contribution? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component"
value[x] |  | 0..1 | RelatedArtifact | Value of extension
extension:type | C | 0..* | CodeableConcept | Extension URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type Binding: ObservationMeasureType (extensible): Indicates the type of quality measure based on the observation value.
extension:riskAdjustment | C | 0..1 | string | How risk adjustment is applied for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment
extension:rateAggregation | C | 0..1 | string | How is rate aggregation performed for this measure URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation
extension:improvementNotation | S C | 0..1 | CodeableConcept | increase | decrease URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the group
description | S | 0..1 | string | Summary description
population | S C | 0..* | BackboneElement | Population criteria
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
description | S | 0..1 | string | The human readable description of this population criteria
criteria |  | 1..1 | Expression | The criteria that defines this population
stratifier | S | 0..* | BackboneElement | Stratifier criteria for the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:appliesTo |  | 0..* | CodeableConcept | Which population does this stratifier apply to? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo Binding: MeasurePopulationType (extensible): Indicates the population
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier
criteria |  | 0..1 | Expression | How the measure should be stratified
component | S | 0..* | BackboneElement | Stratifier criteria component for the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.component.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the stratifier component Binding: Measure Stratifier Type (preferred)
description | S | 0..1 | string | The human readable description of this stratifier component
criteria |  | 1..1 | Expression | Component of how the measure should be stratified
supplementalData | S | 0..* | BackboneElement | What other data should be reported with the measure
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 1..* | Extension | Extension Slice: Unordered, Open by value:url
extension:linkId | S | 1..1 | string | Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId
extension:valueSet |  | 0..1 | canonical(ValueSet) | What stratum values? URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-valueSet
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | S | 0..1 | CodeableConcept | Meaning of the supplemental data
usage | S | 0..* | CodeableConcept | supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description | S | 0..1 | string | The human readable description of this supplemental data
criteria |  | 1..1 | Expression | Expression describing additional data to be reported
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Measure.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages|4.0.1` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Measure.status | required | PublicationStatus `http://hl7.org/fhir/ValueSet/publication-status|4.0.1` From the FHIR Standard
Measure.subject[x] | extensible | SubjectTypeValueSet `http://hl7.org/fhir/uv/cqm/ValueSet/subject-type` From this IG
Measure.jurisdiction | extensible | Jurisdiction ValueSet `http://hl7.org/fhir/ValueSet/jurisdiction|4.0.1` From the FHIR Standard
Measure.topic | example | DefinitionTopic `http://hl7.org/fhir/ValueSet/definition-topic|4.0.1` From the FHIR Standard
Measure.relatedArtifact:component.type | required | Fixed Value: composed-of `http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1` From the FHIR Standard
Measure.scoring | extensible | Pattern Value: composite `http://terminology.hl7.org/ValueSet/measure-scoring`
Measure.compositeScoring | extensible | CompositeMeasureScoring `http://terminology.hl7.org/ValueSet/composite-measure-scoring`
Measure.type | extensible | ObservationMeasureType `http://terminology.hl7.org/ValueSet/v3-ObservationMeasureType`
Measure.improvementNotation | required | MeasureImprovementNotation `http://terminology.hl7.org/ValueSet/measure-improvement-notation`
Measure.group.population.code | extensible | MeasurePopulationType `http://hl7.org/fhir/ValueSet/measure-population|4.0.1` From the FHIR Standard
Measure.group.stratifier.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.group.stratifier.component.code | preferred | MeasureStratifierType(a valid code from Measure Stratifier Type Codes) `http://terminology.hl7.org/ValueSet/measure-stratifier-type` From this IG
Measure.supplementalData.usage | extensible | MeasureDataUsage `http://hl7.org/fhir/ValueSet/measure-data-usage|4.0.1` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-10 | error | Measure.group | 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 | error | Measure.group | 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() |
comp-1 | error | Measure | 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() |
comp-2 | error | Measure | Scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. : (scoring.exists() and group.extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').empty()) xor (scoring.empty() and group.all(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists())) |
comp-3 | error | Measure | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies scoring.exists() |
comp-4 | error | Measure | If scoring is specified on the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required on the root. : scoring.exists() and (scoring.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists() |
comp-5 | error | Measure | If type is specified at the root, it may not be specified on any group : type.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-type').exists()).allFalse() |
comp-6 | error | Measure | If riskAdjustment is specified at the root, it may not be specified on any group : riskAdjustment.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-riskAdjustment').exists()).allFalse() |
comp-7 | error | Measure | If rateAggregation is specified at the root, it may not be specified on any group : rateAggregation.exists() implies group.select(extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-rateAggregation').exists()).allFalse() |
comp-8 | error | Measure.group | Scoring unit may only be specified at the root if the scoring is also specified at the root : extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit').exists() implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring').exists() |
comp-9 | error | Measure.group | If scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the improvementNotation element is required. : 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 in ('proportion' | 'ratio' | 'continuous-variable') implies extension('http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation').exists() |
dom-2 | error | Measure | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Measure | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Measure | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Measure | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
mea-0 | warning | Measure | Name should be usable as an identifier for the module by machine processing applications such as code generation : name.matches('[A-Z]([A-Za-z0-9_]){0,254}') |
mea-1 | error | Measure | Stratifier SHALL be either a single criteria or a set of criteria components : group.stratifier.all((code | description | criteria).exists() xor component.exists()) |
popBasis-1 | error | Measure.extension:populationBasis, Measure.group.extension:populationBasis | If DataRequirement.type is present, it may only contain the elements 'profile' and 'codeFilter'. : value.exists() and value.is(DataRequirement) implies ( value.as(DataRequirement).type.exists() and value.as(DataRequirement).limit.empty() and value.as(DataRequirement).sort.empty() and value.as(DataRequirement).dateFilter.empty() and value.as(DataRequirement).subject.empty() and value.as(DataRequirement).mustSupport.empty()) |

This structure is derived from CQMComputableMeasure

Summary

Mandatory: 0 element(2 nested mandatory elements)
Must-Support: 18 elements
Fixed: 1 element

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoringUnit
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-groupId
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-weight
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-compositeScoring
- http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-component

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Measure.relatedArtifact

Maturity: 4

Other representations of profile: CSV, Excel, Schematron