Data Exchange For Quality Measures Implementation Guide
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## Extension: DEQM Group Improvement Notation Extension

Official URL: http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation | Version: 1.0.0-ballot | Highlight text changes?
Standards status: Trial-use Active as of 2026-04-07 | Maturity Level: 4 | Computable Name: DEQMGroupImprovementNotationExtension

Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score.

Context of Use

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

- Element ID: `MeasureReport.group`

### Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present).

Each Extension Must Have:

1. url: identifies the meaning of the extension

### Introduction

This extension allows improvement notation to be specified at the group level rather than the measure level. However, it should be noted that if you specify improvement notation at the measure level it cannot be specified at the group level and if you specify it at the group level you must specify it for all groups and not at the measure level.

Usage info

Usages:

- Use this Extension: DEQM Individual MeasureReport Profile, DEQM Subject List MeasureReport and DEQM Summary MeasureReport Profile
- Examples for this Extension: MeasureReport/SupportingEvidenceExample, MeasureReport/indv-measurereport-patient-level-linear, MeasureReport/indv-measurereport-weighted-composite, MeasureReport/indv-measurereport02... Show 2 more, MeasureReport/summary-measurereport-patient-level-linear and MeasureReport/summary-measurereport-weighted-composite

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..* | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Open by type:$this
valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.valueCodeableConcept | Base | extensible | MeasureImprovementNotation | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation"
Slices for value[x] |  | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (extensible)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x]:valueCodeableConcept | Base | extensible | MeasureImprovementNotation | 📦4.0.1 | FHIR Std.

#### 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: Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score.

Maturity: 4

Differential ViewDifferential View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation"
value[x] |  | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Open by type:$this
valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Extension.valueCodeableConcept | Base | extensible | MeasureImprovementNotation | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | Extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation"
Slices for value[x] |  | 0..1 | CodeableConcept | Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept |  | 0..1 | CodeableConcept | Value of extension Binding: MeasureImprovementNotation (extensible)
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Extension.value[x]:valueCodeableConcept | Base | extensible | MeasureImprovementNotation | 📦4.0.1 | FHIR Std.

#### 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: Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score.

Maturity: 4

Other representations of profile: CSV, Excel, Schematron