# DEQM Group Improvement Notation Extension - Data Exchange For Quality Measures Implementation Guide v1.0.0-ballot

## Extension: DEQM Group Improvement Notation Extension 

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

**Context of Use**

### 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](StructureDefinition-deqm-individualmeasurereport.md), [DEQM Subject List MeasureReport](StructureDefinition-deqm-subjectlistmeasurereport.md) and [DEQM Summary MeasureReport Profile](StructureDefinition-deqm-summarymeasurereport.md)
* Examples for this Extension: [MeasureReport/SupportingEvidenceExample](MeasureReport-SupportingEvidenceExample.md), [MeasureReport/indv-measurereport-patient-level-linear](MeasureReport-indv-measurereport-patient-level-linear.md), [MeasureReport/indv-measurereport-weighted-composite](MeasureReport-indv-measurereport-weighted-composite.md), [MeasureReport/indv-measurereport02](MeasureReport-indv-measurereport02.md)... Show 2 more, [MeasureReport/summary-measurereport-patient-level-linear](MeasureReport-summary-measurereport-patient-level-linear.md) and [MeasureReport/summary-measurereport-weighted-composite](MeasureReport-summary-measurereport-weighted-composite.md)

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

### Formal Views of Extension 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-deqm-groupImprovementNotation.csv), [Excel](../StructureDefinition-deqm-groupImprovementNotation.xlsx), [Schematron](../StructureDefinition-deqm-groupImprovementNotation.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "deqm-groupImprovementNotation",
  "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/deqm/ImplementationGuide/hl7.fhir.uv.deqm"
      }]
    }
  },
  {
    "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/deqm/ImplementationGuide/hl7.fhir.uv.deqm"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation",
  "version" : "1.0.0-ballot",
  "name" : "DEQMGroupImprovementNotationExtension",
  "title" : "DEQM Group Improvement Notation Extension",
  "status" : "active",
  "date" : "2026-04-07T14:18:11+10:00",
  "publisher" : "HL7 International / Clinical Quality Information",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cqi"
    }]
  }],
  "description" : "Indicates whether improvement in the measure group is noted by an increase or decrease in the measure score.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001",
      "display" : "World"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "MeasureReport.group"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension"
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/uv/deqm/StructureDefinition/deqm-groupImprovementNotation"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "slicing" : {
        "discriminator" : [{
          "type" : "type",
          "path" : "$this"
        }],
        "ordered" : false,
        "rules" : "open"
      },
      "type" : [{
        "code" : "CodeableConcept"
      }]
    },
    {
      "id" : "Extension.valueCodeableConcept",
      "path" : "Extension.valueCodeableConcept",
      "min" : 0,
      "max" : "1",
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/ValueSet/measure-improvement-notation"
      }
    }]
  }
}

```
