Quality Measure Implementation Guide
2.0.0-ballot - STU 2 Ballot

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

## Extension: CQM Improvement Notation

Official URL: http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation | Version: 1.0.0 | Highlight text changes?
Standards status: Trial-use Active as of 2026-04-07 | Maturity Level: 4 | Computable Name: CQMImprovementNotation
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.42.16

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).

Additional Guidance: improvementNotation

`Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Context of Use

This extension may be used on the following element(s)

- Element ID: `Measure.group`

Usage info

Usages:

- Use this Extension: CQM Computable Measure
- Examples for this Extension: MultiRateExample

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

Description Differentials, Snapshots, and other representations.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..1 | Extension | increase | decrease
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | required | MeasureImprovementNotation | 📦1.0.1 | THO v7.1

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..1 | Extension | increase | decrease
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | required | MeasureImprovementNotation | 📦1.0.1 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`

Summary

Simple Extension with the type CodeableConcept: 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).

Additional Guidance: improvementNotation

`Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Maturity: 4

Differential ViewDifferential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..1 | Extension | increase | decrease
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | required | MeasureImprovementNotation | 📦1.0.1 | THO v7.1

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..1 | Extension | increase | decrease
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (required): Indicates how to interpret the calculated score of the measure
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x] | Base | required | MeasureImprovementNotation | 📦1.0.1 | THO v7.1

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`

Summary

Simple Extension with the type CodeableConcept: 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).

Additional Guidance: improvementNotation

`Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set.

Maturity: 4

Other representations of profile: CSV, Excel, Schematron