R6 Ballot (1st Draft)

This page is part of the FHIR Specification v6.0.0-ballot1: Release 6 Ballot (1st Draft) (see Ballot Notes). The current version is 5.0.0. For a full list of available versions, see the Directory of published versions

14.18 Resource Measure - Content

Clinical Quality Information icon Work GroupMaturity Level: 4 Trial UseSecurity Category: Anonymous Compartments: No defined compartments

The Measure resource provides the definition of a quality measure.

14.18.1 Scope and Usage

The Measure resource represents a structured, computable definition of a health-related measure such as a clinical quality measure, public health indicator, or population analytics measure. A quality measure is a quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.

Note that the Measure itself does not typically contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as population criteria, reference named expressions within that library (or libraries). In addition, if the Measure references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression.

This resource is a definition resource from a FHIR workflow perspective - see Workflow, specifically Definition.

For a detailed discussion of how to use the Measure and MeasureReport resources, refer to the Quality Reporting topic.

14.18.2 Boundaries and Relationships

The Measure resource describes a specific quality measure, or population analytic, providing the structure of the measure in terms of the calculation elements (the populations involved). The Group resource is also capable of describing a population, however, the complexity involved in specifying the criteria in the general case requires the use of a high-level query language such as Clinical Quality Language (CQL). As such, the Measure resource defines only the top-level populations and references expressions for the actual criteria. These expressions are typically provided using a Library resource containing CQL or ELM expressions. In addition, the individual members of a population may be cases such as encounters or procedures and in these cases, the Group resource would be unable to represent the population characteristics accurately.

A Measure is also similar to an ObservationDefinition resource, in that it is purely definitional, it contains no actual measurements, only a description of how to calculate a particular measurement or set of measurements. Measure is different from ObservationDefinition in that Measure is intended to provide a computable specification.

A Measure is also similar to a clinical document, but as with the relationship to Observation, a Document is specific to a particular subject.

14.18.3 References to this Resource

14.18.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Measure TUDomainResourceA quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Interfaces Implemented: MetadataResource
... url ΣC0..1uriCanonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
... identifier Σ0..*IdentifierAdditional identifier for the measure

... version Σ0..1stringBusiness version of the measure
... versionAlgorithm[x] Σ0..1How to compare versions
Binding: Version Algorithm (Extensible)
.... versionAlgorithmStringstring
.... versionAlgorithmCodingCoding
... name ΣC0..1stringName for this measure (computer friendly)
... title ΣT0..1stringName for this measure (human friendly)
... subtitle T0..1stringSubordinate title of the measure
... status ?!Σ1..1codedraft | active | retired | unknown
Binding: PublicationStatus (Required)
... experimental Σ0..1booleanFor testing purposes, not real usage
... subject[x] 0..1E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types (Extensible)
.... subjectCodeableConceptCodeableConcept
.... subjectReferenceReference(Group)
... basis Σ0..1codePopulation basis
Binding: All FHIR Types (Required)
... date Σ0..1dateTimeDate last changed
... publisher ΣT0..1stringName of the publisher/steward (organization or individual)
... contact Σ0..*ContactDetailContact details for the publisher

... description ΣT0..1markdownNatural language description of the measure
... useContext Σ0..*UsageContextThe context that the content is intended to support

... jurisdiction ΣXD0..*CodeableConceptIntended jurisdiction for measure (if applicable)
Binding: Jurisdiction ValueSet (Extensible)

... purpose T0..1markdownWhy this measure is defined
... usage T0..1markdownDescribes the clinical usage of the measure
... copyright T0..1markdownUse and/or publishing restrictions
... copyrightLabel T0..1stringCopyright holder and year(s)
... approvalDate 0..1dateWhen the measure was approved by publisher
... lastReviewDate 0..1dateWhen the measure was last reviewed by the publisher
... effectivePeriod Σ0..1PeriodWhen the measure is expected to be used
... topic XD0..*CodeableConceptThe category of the measure, such as Education, Treatment, Assessment, etc
Binding: Definition Topic (Example)

... author 0..*ContactDetailWho authored the content

... editor 0..*ContactDetailWho edited the content

... reviewer 0..*ContactDetailWho reviewed the content

... endorser 0..*ContactDetailWho endorsed the content

... relatedArtifact 0..*RelatedArtifactAdditional documentation, citations, etc

... library 0..*canonical(Library)Logic used by the measure

... disclaimer Σ0..1markdownDisclaimer for use of the measure or its referenced content
... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring icon (Extensible)
... scoringUnit Σ0..1CodeableConceptWhat units?
Binding: Measure Scoring Unit (Example)
... compositeScoring Σ0..1CodeableConceptopportunity | all-or-nothing | linear | weighted
Binding: Composite Measure Scoring (Extensible)
... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: Measure Type (Extensible)

... riskAdjustment Σ0..1markdownHow risk adjustment is applied for this measure
... rateAggregation Σ0..1markdownHow is rate aggregation performed for this measure
... rationale Σ0..1markdownDetailed description of why the measure exists
... clinicalRecommendationStatement Σ0..1markdownSummary of clinical guidelines
... improvementNotation Σ0..1CodeableConceptincrease | decrease
Binding: Measure Improvement Notation (Required)
... term 0..*BackboneElementDefined terms used in the measure documentation

.... code 0..1CodeableConceptWhat term?
Binding: Measure Definition Example (Example)
.... definition 0..1markdownMeaning of the term
... guidance ΣXD0..1markdownAdditional guidance for implementers (deprecated)
... group C0..*BackboneElementPopulation criteria group

.... linkId C0..1stringUnique id for group in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1CodeableConceptMeaning of the group
Binding: Measure Group Example (Example)
.... description 0..1markdownSummary description
.... type Σ0..*CodeableConceptprocess | outcome | structure | patient-reported-outcome | composite
Binding: Measure Type (Extensible)

.... subject[x] 0..1E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types (Extensible)
..... subjectCodeableConceptCodeableConcept
..... subjectReferenceReference(Group)
.... basis Σ0..1codePopulation basis
Binding: All FHIR Types (Required)
.... scoring Σ0..1CodeableConceptproportion | ratio | continuous-variable | cohort
Binding: MeasureScoring icon (Extensible)
.... scoringUnit Σ0..1CodeableConceptWhat units?
Binding: Measure Scoring Unit (Example)
.... rateAggregation Σ0..1markdownHow is rate aggregation performed for this measure
.... improvementNotation Σ0..1CodeableConceptincrease | decrease
Binding: Measure Improvement Notation (Required)
.... library 0..*canonical(Library)Logic used by the measure group

.... population 0..*BackboneElementPopulation criteria

..... linkId C0..1stringUnique id for population in measure
+ Warning: Link ids should be 255 characters or less
..... code 0..1CodeableConceptinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: Measure Population Type (Extensible)
..... description 0..1markdownThe human readable description of this population criteria
..... criteria 0..1ExpressionThe criteria that defines this population
..... groupDefinition 0..1Reference(Group)A group resource that defines this population
..... inputPopulationId 0..1stringWhich population
..... aggregateMethod 0..1CodeableConceptAggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Binding: Measure Aggregate Method (Extensible)
.... stratifier C0..*BackboneElementStratifier criteria for the measure

..... linkId C0..1stringUnique id for stratifier in measure
+ Warning: Link ids should be 255 characters or less
..... code C0..1CodeableConceptMeaning of the stratifier
Binding: Measure Stratifier Example (Example)
..... description C0..1markdownThe human readable description of this stratifier
..... criteria C0..1ExpressionHow the measure should be stratified
..... groupDefinition 0..1Reference(Group)A group resource that defines this population
..... component C0..*BackboneElementStratifier criteria component for the measure

...... linkId C0..1stringUnique id for stratifier component in measure
+ Warning: Link ids should be 255 characters or less
...... code 0..1CodeableConceptMeaning of the stratifier component
Binding: Measure Stratifier Example (Example)
...... description 0..1markdownThe human readable description of this stratifier component
...... criteria 0..1ExpressionComponent of how the measure should be stratified
...... groupDefinition 0..1Reference(Group)A group resource that defines this population
... supplementalData 0..*BackboneElementWhat other data should be reported with the measure

.... linkId C0..1stringUnique id for supplementalData in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1CodeableConceptMeaning of the supplemental data
Binding: Measure Supplemental Data Example (Example)
.... usage 0..*CodeableConceptsupplemental-data | risk-adjustment-factor
Binding: Measure Data Usage (Extensible)

.... description 0..1markdownThe human readable description of this supplemental data
.... criteria 1..1ExpressionExpression describing additional data to be reported

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

Measure (DomainResource) +MetadataResourceAn absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different serversurl : uri [0..1]A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instanceidentifier : Identifier [0..*]The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifactsversion : string [0..1]Indicates the mechanism used to compare versions to determine which is more currentversionAlgorithm[x] : DataType [0..1] « string|Coding; null (Strength=Extensible) VersionAlgorithm+ »A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generationname : string [0..1] « This element has or is affected by some invariantsC »A short, descriptive, user-friendly title for the measuretitle : string [0..1]An explanatory or alternate title for the measure giving additional information about its contentsubtitle : string [0..1]The status of this measure. Enables tracking the life-cycle of the content (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)PublicationStatus! »A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usageexperimental : boolean [0..1]The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anythingsubject[x] : DataType [0..1] « CodeableConcept|Reference(Group); null (Strength=Extensible) ParticipantResourceTypes+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »The date (and optionally time) when the measure was last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changesdate : dateTime [0..1]The name of the organization or individual responsible for the release and ongoing maintenance of the measurepublisher : string [0..1]Contact details to assist a user in finding and communicating with the publishercontact : ContactDetail [0..*]A free text natural language description of the measure from a consumer's perspectivedescription : markdown [0..1]The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instancesuseContext : UsageContext [0..*]A legal or geographic region in which the measure is intended to be usedjurisdiction : CodeableConcept [0..*] « null (Strength=Extensible)JurisdictionValueSet+ »Explanation of why this measure is needed and why it has been designed as it haspurpose : markdown [0..1]A detailed description, from a clinical perspective, of how the measure is usedusage : markdown [0..1]A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measurecopyright : markdown [0..1]A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved')copyrightLabel : string [0..1]The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usageapprovalDate : date [0..1]The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval datelastReviewDate : date [0..1]The period during which the measure content was or is planned to be in active useeffectivePeriod : Period [0..1]Descriptive topics related to the content of the measure. Topics provide a high-level categorization grouping types of measures that can be useful for filtering and searchingtopic : CodeableConcept [0..*] « null (Strength=Example)DefinitionTopic?? »An individiual or organization primarily involved in the creation and maintenance of the contentauthor : ContactDetail [0..*]An individual or organization primarily responsible for internal coherence of the contenteditor : ContactDetail [0..*]An individual or organization asserted by the publisher to be primarily responsible for review of some aspect of the contentreviewer : ContactDetail [0..*]An individual or organization asserted by the publisher to be responsible for officially endorsing the content for use in some settingendorser : ContactDetail [0..*]Related artifacts such as additional documentation, justification, or bibliographic referencesrelatedArtifact : RelatedArtifact [0..*]A reference to a Library resource containing the formal logic used by the measurelibrary : canonical [0..*] « Library »Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measuredisclaimer : markdown [0..1]Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »If this is a composite measure, the scoring method used to combine the component measures to determine the composite scorecompositeScoring : CodeableConcept [0..1] « null (Strength=Extensible)CompositeMeasureScoring+ »Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)MeasureType+ »A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure resultsriskAdjustment : markdown [0..1]Describes how to combine the information calculated, based on logic in each of several populations, into one summarized resultrateAggregation : markdown [0..1]Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidencerationale : markdown [0..1]Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measureclinicalRecommendationStatement : markdown [0..1]Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measureguidance : markdown [0..1]TermA codeable representation of the defined termcode : CodeableConcept [0..1] « null (Strength=Example)MeasureDefinitionExample?? »Provides a definition for the term as used within the measuredefinition : markdown [0..1]GroupAn identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resourcelinkId : string [0..1]Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureGroupExample?? »The human readable description of this population groupdescription : markdown [0..1]Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilizationtype : CodeableConcept [0..*] « null (Strength=Extensible)MeasureType+ »The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anythingsubject[x] : DataType [0..1] « CodeableConcept|Reference(Group); null (Strength=Extensible) ParticipantResourceTypes+ »The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encountersbasis : code [0..1] « null (Strength=Required)FHIRTypes! »Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be representedscoring : CodeableConcept [0..1] « null (Strength=Extensible)MeasureScoring+ »Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unitscoringUnit : CodeableConcept [0..1] « null (Strength=Example)MeasureScoringUnit?? »Describes how to combine the information calculated, based on logic in each of several populations, into one summarized resultrateAggregation : markdown [0..1]Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range)improvementNotation : CodeableConcept [0..1] « null (Strength=Required) MeasureImprovementNotation! »A reference to a Library resource containing the formal logic used by the measure grouplibrary : canonical [0..*] « Library »PopulationAn identifier that is unique within the Measure allowing linkage to the equivalent population in a MeasureReport resourcelinkId : string [0..1]The type of population criteriacode : CodeableConcept [0..1] « null (Strength=Extensible)MeasurePopulationType+ »The human readable description of this population criteriadescription : markdown [0..1]An expression that specifies the criteria for the population, typically the name of an expression in a librarycriteria : Expression [0..1]A Group resource that defines this population as a set of characteristicsgroupDefinition : Reference [0..1] « Group »The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting pointinputPopulationId : string [0..1]Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculationaggregateMethod : CodeableConcept [0..1] « null (Strength=Extensible)MeasureAggregateMethod+ »StratifierAn identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resourcelinkId : string [0..1]Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? » « This element has or is affected by some invariantsC »The human readable description of this stratifier criteriadescription : markdown [0..1] « This element has or is affected by some invariantsC »An expression that specifies the criteria for the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier elementcriteria : Expression [0..1] « This element has or is affected by some invariantsC »A Group resource that defines this population as a set of characteristicsgroupDefinition : Reference [0..1] « Group »ComponentAn identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resourcelinkId : string [0..1]Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureStratifierExample?? »The human readable description of this stratifier criteria componentdescription : markdown [0..1]An expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier elementcriteria : Expression [0..1]A Group resource that defines this population as a set of characteristicsgroupDefinition : Reference [0..1] « Group »SupplementalDataAn identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resourcelinkId : string [0..1]Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measurescode : CodeableConcept [0..1] « null (Strength=Example)MeasureSupplementalDataExample?? »An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculationusage : CodeableConcept [0..*] « null (Strength=Extensible)MeasureDataUsage+ »The human readable description of this supplemental datadescription : markdown [0..1]The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this elementcriteria : Expression [1..1]Provides a description of an individual term used within the measureterm[0..*]A population criteria for the measurepopulation[0..*]A component of the stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Pathcomponent[0..*]The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Pathstratifier[0..*]A group of population criteria for the measuregroup[0..*]The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource PathsupplementalData[0..*]