# CQM Ratio Measure - Quality Measure Implementation Guide v2.0.0-ballot

## Resource Profile: CQM Ratio Measure 

 
The CQM Ratio Measure Profile describes a ratio scoring measure. 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: [EXMRatioMeasure](Measure-EXMRatio-FHIR.md)
* CapabilityStatements using this Profile: [CQF Measures Shareable Measure Repository Capability Statement](CapabilityStatement-shareable-measure-repository.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.uv.cqm|current/StructureDefinition/cqm-ratiomeasure)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](../StructureDefinition-cqm-ratiomeasure.csv), [Excel](../StructureDefinition-cqm-ratiomeasure.xlsx), [Schematron](../StructureDefinition-cqm-ratiomeasure.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "cqm-ratiomeasure",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cqi"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 4,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/uv/cqm/ImplementationGuide/hl7.fhir.uv.cqm"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/uv/cqm/ImplementationGuide/hl7.fhir.uv.cqm"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-ratiomeasure",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.61.42.25"
  }],
  "version" : "1.0.0",
  "name" : "CQMRatioMeasure",
  "title" : "CQM Ratio Measure",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-04-07T02:06:45+10:00",
  "publisher" : "HL7 International / Clinical Quality Information",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cqi"
    }]
  }],
  "description" : "The CQM Ratio Measure Profile describes a ratio scoring measure. For more information on the usage of this profile, refer to the Profiles and Packaging pages in this implementation guide.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "objimpl",
    "uri" : "http://hl7.org/fhir/object-implementation",
    "name" : "Object Implementation Information"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Measure",
  "baseDefinition" : "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Measure",
      "path" : "Measure"
    },
    {
      "id" : "Measure.scoring",
      "path" : "Measure.scoring",
      "short" : "ratio",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "code" : "ratio"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group",
      "path" : "Measure.group",
      "min" : 1,
      "max" : "*",
      "constraint" : [{
        "key" : "cmp-13",
        "severity" : "error",
        "human" : "Ratio measures may not have other than initial population, denominator, numerator, denominator-exclusion, numerator-exclusion, and measure-observation criteria",
        "expression" : "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 'ratio' implies population.select(code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/measure-population').code in ('initial-population' | 'numerator' | 'denominator' | 'denominator-exclusion' | 'measure-observation' | 'numerator-exclusion')).allTrue()"
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.extension:scoring",
      "path" : "Measure.group.extension",
      "sliceName" : "scoring",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-scoring"]
      }],
      "condition" : ["cmp-13"],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population",
      "path" : "Measure.group.population",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "code"
        }],
        "rules" : "open"
      },
      "min" : 4,
      "max" : "8",
      "condition" : ["cmp-13"],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:initialPopulation",
      "path" : "Measure.group.population",
      "sliceName" : "initialPopulation",
      "short" : "Initial Population",
      "min" : 1,
      "max" : "2",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:initialPopulation.extension:populationBasis",
      "path" : "Measure.group.population.extension",
      "sliceName" : "populationBasis",
      "short" : "Allows the populationBasis for that population to be overridden. If not present, the populationBasis of the measure (or group) is used. If present, it specifies the population basis for all the expressions that use it as the initial population in the ratio measure.",
      "min" : 0,
      "max" : "*",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis"]
      }],
      "mustSupport" : false
    },
    {
      "id" : "Measure.group.population:initialPopulation.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominator",
      "path" : "Measure.group.population",
      "sliceName" : "denominator",
      "short" : "Denominator",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominator.extension:criteriaReference",
      "path" : "Measure.group.population.extension",
      "sliceName" : "criteriaReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominator.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominatorExclusion",
      "path" : "Measure.group.population",
      "sliceName" : "denominatorExclusion",
      "short" : "Denominator Exclusion",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominatorExclusion.extension:criteriaReference",
      "path" : "Measure.group.population.extension",
      "sliceName" : "criteriaReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:denominatorExclusion.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator-exclusion"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numerator",
      "path" : "Measure.group.population",
      "sliceName" : "numerator",
      "short" : "Numerator",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numerator.extension:criteriaReference",
      "path" : "Measure.group.population.extension",
      "sliceName" : "criteriaReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numerator.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numeratorExclusion",
      "path" : "Measure.group.population",
      "sliceName" : "numeratorExclusion",
      "short" : "Numerator Exclusion",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numeratorExclusion.extension:criteriaReference",
      "path" : "Measure.group.population.extension",
      "sliceName" : "criteriaReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:numeratorExclusion.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator-exclusion"
        }]
      },
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:measureObservation",
      "path" : "Measure.group.population",
      "sliceName" : "measureObservation",
      "short" : "Measure Observation",
      "min" : 0,
      "max" : "2",
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:measureObservation.extension:criteriaReference",
      "path" : "Measure.group.population.extension",
      "sliceName" : "criteriaReference",
      "min" : 0,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:measureObservation.extension:aggregateMethod",
      "path" : "Measure.group.population.extension",
      "sliceName" : "aggregateMethod",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Measure.group.population:measureObservation.code",
      "path" : "Measure.group.population.code",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "CodeableConcept"
      }],
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "measure-observation"
        }]
      },
      "mustSupport" : true
    }]
  }
}

```
