Quality Measure Implementation Guide (STU5)
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This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v5.0.0-ballot: STU5 (v5.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 4.0.0. For a full list of available versions, see the Directory of published versions

: EXM55 - Median Emergency Department Visit Duration - JSON Representation

Active as of 2022-02-22

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{
  "resourceType" : "Measure",
  "id" : "EXM55-FHIR",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cv-measure-cqfm"🔗 ,
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">EXM55-FHIR</td>\n            </tr>\n            \n            \n            <tr>\n                <th scope=\"row\"><b>Download cql: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Library-EXM55-FHIR.cql\">EXM55-FHIR.cql</a></td>\n            </tr>\n            \n\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-EXM55-FHIR.html\">EXM55 - Median Emergency Department Visit Duration</a></td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">5.0.0-ballot</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Identifier: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>value: </b> <span>55</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Name: </b></th>\n                <td style=\"padding-left: 4px;\">EXM55</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">EXM55 - Median Emergency Department Visit Duration</td>\n            </tr>\n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">active</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Experimental: </b></th>\n                <td style=\"padding-left: 4px;\">true</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Scoring: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                                <span>Continuous Variable </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Improvement Notation: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                             <span>Decreased score indicates improvement </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Type: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                            <span>process </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Date: </b></th>\n                <td style=\"padding-left: 4px;\">2022-02-22</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">HL7 International / Clinical Quality Information</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>This example illustrates a continuous variable measure represented as a FHIR eCQM</p>\n</div></td>\n            </tr>\n        \n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Use Context: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        <tr><th><b>code</b></th><th><b>value</b></th></tr>\n                        \n                            <tr>\n                                <td>program</td>\n                                <td></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Jurisdiction: </b></th>\n                <td style=\"padding-left: 25px;\">US</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Topic: </b></th>\n                <td style=\"padding-left: 25px;\">57024-2</td>\n            </tr>\n        \n        \n        \n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Approval Date: </b></th>\n                <td style=\"padding-left: 4px;\">2019-03-08</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Last Review Date: </b></th>\n                <td style=\"padding-left: 4px;\">2019-03-08</td>\n            </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2018-01-01..2018-12-31</td>\n            </tr>\n        \n        \n            \n        \n        \n        \n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr><td><a href=\"Library-EXM55-FHIR.html\">EXM55 - Median Emergency Department Visit Duration (Example Continuous Variable Measure Library)</a></td></tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Related Artifact Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><a href=\"http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1\">http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.4.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.299/expansion\">Psychiatric/Mental Health Diagnosis</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.126/expansion\">Hospital Settings</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr><th><b>name</b></th><th><b>use</b></th><th><b>min</b></th><th><b>max</b></th><th><b>type</b></th></tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>in</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 3</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 2</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Measure Population Exclusion</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Stratification 1</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Measure Population</td>\n                                    <td>out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Encounter</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr><th><b>Type</b></th><th><b>Must Support</b></th><th><b>Valueset Name</b></th><th><b>Valueset</b></th></tr>\n                            \n                                <tr>\n                                    <td>Encounter</td>\n                                    <td>\n                                        \n                                            period\n                                        \n                                            hospitalization\n                                        \n                                            hospitalization.admitSource\n                                        \n                                            type\n                                        \n                                            status\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Emergency Department Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion\">Emergency Department Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter</td>\n                                    <td>\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition</td>\n                                    <td>\n                                        \n                                            id\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td></td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr><th><b>display</b></th><th><b>code</b></th><th><b>system</b></th></tr>\n                                \n                                    <tr>\n                                        <td>Billing</td>\n                                        <td>billing</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.4.0/CodeSystem-diagnosis-role.html\">Diagnosis Role</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n                \n                    <tr>\n                        <th scope=\"row\"><b>Logic Definitions:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            \n                                <table class=\"grid-dict\">\n                                    <tr>\n                                        <th><b>Group</b></th><th><b>Scoring</b></th><th><b>Population Criteria</b></th><th><b>Expression</b></th>\n                                    </tr>\n                                    <tr>\n                                        \n                                            <td>  </td>\n                                            <td>\n                                                \n                                                \n                                                    <b>Measure scoring:</b>\n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                        <span>Continuous Variable</span>\n                                                        </p>\n                                                    \n                                                \n                                            </td>\n                                            \n                                                <tr>\n                                                    <td/>\n                                                    <td/>\n                                                    <td>Initial Population</td>\n                                                    <td>\n                                                        \n                                                        <pre><code class=\"language-cql\">define &quot;Initial Population&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED\n     such that ED.status = 'finished'\n       and ED.period ends 1 hour or less before start of Encounter.period</code></pre>\n                                                        \n                                                    </td>\n                                                </tr>\n                                            \n                                                <tr>\n                                                    <td/>\n                                                    <td/>\n                                                    <td>Measure Population</td>\n                                                    <td>\n                                                        \n                                                        <pre><code class=\"language-cql\">define &quot;Measure Population&quot; :\n  &quot;Initial Population&quot;</code></pre>\n                                                        \n                                                    </td>\n                                                </tr>\n                                            \n                                                <tr>\n                                                    <td/>\n                                                    <td/>\n                                                    <td>Measure Population Exclusion</td>\n                                                    <td>\n                                                        \n                                                        <pre><code class=\"language-cql\">define &quot;Measure Population Exclusion&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED\n      such that ED.period ends 1 hour or less before start of Encounter.period\n        and ED.status = 'finished'\n        and ED.hospitalization.admitSource in &quot;Hospital Settings&quot;</code></pre>\n                                                        \n                                                    </td>\n                                                </tr>\n                                            \n                                                <tr>\n                                                    <td/>\n                                                    <td/>\n                                                    <td>Measure Observation</td>\n                                                    <td>\n                                                        \n                                                        <pre><code class=\"language-cql\"></code></pre>\n                                                        \n                                                    </td>\n                                                </tr>\n                                            \n\n                                    \n                                    </tr>\n                                </table>\n                            \n                            <table class=\"grid-dict\">\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Inpatient Encounter</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Inpatient Encounter&quot; :\n  [&quot;Encounter&quot;] Encounter\n    where LengthInDays(Encounter.period) &lt;= 120\n      and Encounter.period ends during &quot;Measurement Period&quot;</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Stratification 3</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 3&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    where PrincipalDiagnosis(Encounter) is null</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Stratification 2</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 2&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Measure Population Exclusion</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population Exclusion&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED\n      such that ED.period ends 1 hour or less before start of Encounter.period\n        and ED.status = 'finished'\n        and ED.hospitalization.admitSource in &quot;Hospital Settings&quot;</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Stratification 1</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Stratification 1&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Initial Population</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot; :\n  &quot;Inpatient Encounter&quot; Encounter\n    with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED\n     such that ED.status = 'finished'\n       and ED.period ends 1 hour or less before start of Encounter.period</code></pre></td>\n                                        \n                                    </tr>\n                                \n                                    <tr><th><b>Library Name</b></th><th><b>Name</b></th></tr>\n                                    <tr>\n                                        \n                                            <td>EXM55-FHIR</td>\n                                        \n                                        \n                                            <td>Measure Population</td>\n                                        \n                                    </tr>\n                                    <tr>\n                                        \n                                            <td></td>\n                                        <td><pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot; :\n  &quot;Initial Population&quot;</code></pre></td>\n                                        \n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n            \n        \n    </table>\n</div>"
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      "date" : "2022-02-22T10:37:03-07:00",
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        {
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        {
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          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Hospital Settings",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126"
        }
      ],
      "parameter" : [
        {
          "name" : "Measurement Period",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "type" : "Period"
        },
        {
          "name" : "Stratification 3",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        },
        {
          "name" : "Stratification 2",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        },
        {
          "name" : "Measure Population Exclusion",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        },
        {
          "name" : "Stratification 1",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        },
        {
          "name" : "Initial Population",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        },
        {
          "name" : "Measure Population",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Encounter"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport" : [
            "period",
            "hospitalization",
            "hospitalization.admitSource",
            "type",
            "status"
          ],
          "codeFilter" : [
            {
              "path" : "type",
              "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            }
          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            🔗 "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport" : [
            "period"
          ]
        },
        {
          "type" : "Condition",
          "profile" : [
            🔗 "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport" : [
            "id"
          ],
          "codeFilter" : [
            {
              "path" : "id"
            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
      "valueCode" : "Encounter"
    },
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference" : {
        🔗 "reference" : "Device/software-system-example"
      }
    },
    {
      "id" : "effective-data-requirements",
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference" : {
        "reference" : "#effective-data-requirements"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "cqi"
    }
  ],
  "url" : "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM55-FHIR",
  "identifier" : [
    {
      "use" : "official",
      "system" : "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm",
      "value" : "55"
    }
  ],
  "version" : "5.0.0-ballot",
  "name" : "EXM55",
  "title" : "EXM55 - Median Emergency Department Visit Duration",
  "status" : "active",
  "experimental" : true,
  "date" : "2022-02-22",
  "publisher" : "HL7 International / Clinical Quality Information",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/cqi"
        }
      ]
    }
  ],
  "description" : "This example illustrates a continuous variable measure represented as a FHIR eCQM",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "program"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs",
            "code" : "eh-cah",
            "display" : "EH/CAH"
          }
        ]
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "approvalDate" : "2019-03-08",
  "lastReviewDate" : "2019-03-08",
  "effectivePeriod" : {
    "start" : "2018-01-01",
    "end" : "2018-12-31"
  },
  "topic" : [
    {
      "coding" : [
        {
          "system" : "http://loinc.org",
          "code" : "57024-2",
          "display" : "Health Quality Measure Document"
        }
      ]
    }
  ],
  "library" : [
    🔗 "http://hl7.org/fhir/us/cqfmeasures/Library/EXM55-FHIR"
  ],
  "scoring" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "continuous-variable",
        "display" : "Continuous Variable"
      }
    ]
  },
  "type" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
          "code" : "process"
        }
      ]
    }
  ],
  "improvementNotation" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
        "code" : "decrease",
        "display" : "Decreased score indicates improvement"
      }
    ]
  },
  "group" : [
    {
      "population" : [
        {
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "initial-population",
                "display" : "Initial Population"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Initial Population"
          }
        },
        {
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-population",
                "display" : "Measure Population"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Population"
          }
        },
        {
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-population-exclusion",
                "display" : "Measure Population Exclusion"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Population Exclusion"
          }
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString" : "measure-population-identifier"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueCode" : "median"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-observation",
                "display" : "Measure Observation"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Observation"
          }
        }
      ],
      "stratifier" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "display" : "Stratification 1"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Stratification 1"
          }
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "display" : "Stratification 2"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Stratification 2"
          }
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-appliesTo",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "display" : "Stratification 3"
              }
            ]
          },
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Stratification 3"
          }
        }
      ]
    }
  ]
}