This Implementation Guide defines a profile for Measure to be used for Public Health reporting for Situational Awareness, rather than Quality Reporting. The measures using this profile are intended to support reporting about the health system capacity to provide adequate care for patients during a health system emergency, whether it is regional, national or global. In this, the purpose and function of situational awareness measures have a different focus and intent than those used for quality reporting.

Describing and Identifying a Measure

Each measure has a Title, the name by which it is commonly known by people, and by which it can be readily found in an information system. Titles should not be overly long (to enable recall by people), but should be descriptive enough to distinguish different measures published by the same organization. A subtitle may be present to provide additional descriptive detail.

1. Measure.title should be less than 64 characters in length.
2. Measure.subtitle may be present.

Software Component Name

Computer friendly names enable developers to create software tools that facilitate measure implementation and automation. This profile recommends transforming the title into a name by removing spaces and special characters (any character other than A-Z, a-z and 0-9), using PascalCase to seperate boundaries between words. This allows the name to be used in most computing languages and as the id for the resource in systems where user defined identifiers are supported for id values.

1. Measure.name shall be present.
2. Measure.name should match the pattern [A-Z][A-Za-z0-9]+.
3. Measure.id should be equal to Measure.name.

Canonical URL

The canonical URL is a unique identifier which represents the Measure within MeasureReport resources defined by that Measure. Tooling for FHIR (e.g., the FHIR IG Publisher, SUSHI, Simplifier) follows a protocol for automatically constructing these URLs. This guide makes several recommendations for URLs used by a publisher. The example below is used to illustrate the recommendations

 https:\//example.com/saner/covid19/Measure/MyMeasureName

1. All Measure URLs for measures published by the same organization should have the same base URL. The Base URL part should be memorable. In the example above, https:\//example.com/saner is the base URL.
2. The base URL should be less than 40 characters in length.
3. The penultimate path part of the URL may be used to categorize measures in some way, e.g., by topic (e.g., COVID-19, Hurricane) or type of facility (e.g., Hospital, Ambulatory, LTC) to which they apply. In the example above, covid19 is the category. This category should also be encoded in Measure.useContext (see Classifying Measures below).
4. The last path part in the URL should be Measure. Following this recomendation simplifies the use of FHIR IG Development tools to generate Measure resources. In the example above, the last path part is Measure.
5. The computable name given in the Measure should be the last part of the URL. Again, this simplifies measure development using existing FHIR IG Development tools. In the example above, MyMeasureName is the name of the measure.
6. The URL should resolve to an HTML page that describes the measure, or provides access to it as a FHIR Resource and ideally, would return HTML, XML or JSON representations based on the requested mime type.

Versioning

Measures can change over time. This guide requires that the Measure version information recorded be performed as follows:

1. A measure shall do one of the following:
   • be recorded in the form defined by Semantic Versioning, e.g.: version 1.2.3 is the third patch to the second minor update of the first major release, or
   • be recorded by date using ISO 8601 format with hyphens and no time component, e.g.: 2020-07-25 for the measure released on July 25, 2020.
2. If versions can be updated more frequently than by day, a publisher shall use semantic versioning.

The use of semantic versioning is preferred because this is the form required in FHIR implementation guides, and it enables support for versioning of measures using FHIR Implementation Guide tools. This is also the format for versioning that has been the most widely adopted by the IT industry.

Meanings of Major, Minor and Patch with respect to Measures

Major

A major update adds one or more required elements to the Measure that shall be present in a MeasureReport to be considered valid by the receiving system. The definition of valid is defined by the measure developer, and need not be the same as that performed by FHIR validation tools. The FHIR Validator will fail a MeasureReport that does not include all the groups, populations and strata defined in the Measure, even though these components might otherwise be considered optional by the measure developer.

Minor

A minor update adds one or more recommended or optional elements to the Measure.

Patch

A patch can clarify or correct information that does not impact the interpretation of the measure.

Status of a Measure

This profile requires that the publication status of a measure be reported (this is a general requirement of all Measure resources), and furthermore, that it’s experimental status shall also be reported.

The usage of status values is described below:

draft

The measure is presently under development. Measures presently under development shall also be recorded as being experimental.

active

The measure is ready for, or being used, either in pilots or production. The experimental status for the measure shall be used to distinguish between measures that are being piloted (experimental=true) or in production (experimental=false).

retired

The measure should no longer be used in production. Measures which are retired before ever becoming active in production shall have experimental=true, while those which have been available for production use shall have experimental=false.

Measures which have been used in the past should remain available for access for use when data has been used in production to enable systems to interpret historical data recorded using the measure.

The Subject of Measurement

In quality measurement, the subject of a measure in FHIR describes to whom or what the measure applies. For situational awareness, this guide restricts the subject of measurement to locations, representing a specific facility, site within a facility, or a broader geographic region (which can be defined as a collection of facilities within that geographic region). These measures can also be used by an organization to manage sites and facilities based on other organizing criteria, but are generally intended to support geographic rather than organizational boundaries.

1. Measure.subjectCodeableConcept shall have the value http://hl7.org/fhir/resource-types#Location

Classifying Measures

Measures can be classified in different ways, e.g., by clinical venue, program, type of healthcare provider, et cetera.

In the following: shall indicates a required binding for the vocabulary, and should indicates a preferred binding.

Measures Focused on a Particular Disease

1. Measures focusing on a particular disease shall record that focus in Measure.useContext, where:
   Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#focus](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-focus)
   and
   
2. Measure.useContext.valueCodableConcept is an appropriate code from a vocabulary identifying the disease of interest. It should come from SNOMED CT codes descending from 64572001 Disease (disorder).

Measures Focused on a Particular Kind of Event

1. Measures focusing on a particular kind of event (e.g., Pandemic, Hurricane, Fire, Flood) shall record their focus in Measure.useContext, where:
   Measure.useContext.code = http://snomed.info/sct#272379006 Event
   and
   
2. Measure.useContext.valueCodableConcept should come from SNOMED CT Codes descending from 276746005 Environmental Event to classify the type of event. See Event Context for the Value Set for this classification.

Measures Focused on a Particular Specialty

1. Measures focusing on a particular specialty shall record the specialty in Measure.useContext, where:
   Measure.useContext.code = http://terminology.hl7.org/CodeSystem/usage-context-type#user
   and
   
2. Measure.useContext.valueCodableConcept shall be an appropriate code from a vocabulary identifying the provider specialty.
3. The value should come from SNOMED CT terms descending from 394658006 Clinical Specialty.

Measures Focused on a Clinical Venue (e.g., hospital, long-term care, ambulatory care)

1. Measures focused on a particular clinical venue shall record the type of venue in Measure.useContext, where
   Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#venue](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-venue)
   and
   
2. Measure.useContext.valueCodableConcept shall be an appropriate code from a vocabulary identifying the venue (e.g., hospitals, pharmacies, long term care facilities).
3. These codes should come from:
   • http://terminology.hl7.org/ValueSet/v3-ServiceDeliveryLocationRoleType OR
   • Terms descending from SNOMED CT 43741000 Environment

Measures from a Given Program

1. Measures developed to support a given program (e.g., the CDC National Healthcare Safety Network) shall identify the program in Measure.useContext, where
   Measure.useContext.code = [http://terminology.hl7.org/CodeSystem/usage-context-type#program](https://www.hl7.org/fhir/codesystem-usage-context-type.html#usage-context-type-program)
   and
   
2. Measure.useContext.valueCodableConcept.text is a string identifying the program of work (e.g., the CDC National Healthcare Safety Network).

Measure Publication

A measure is published by some appropriate authority, for example a governmental agency focused on public health or emergency response, or an organization working with such a governmental agency. Measures for situational awareness are not expected to endure a ballot process, but will instead be created by authorities using a well established governance process. The reason for this is that as the emergent situation progresses, new measures will be needed as the situation changes, or existing measures may need to be updated to address issues found during use.

Measures are published by organizations rather than individuals. This profile requires that the organization be identified in Measure.publisher, and furthermore, that there is at least one organizational e-mail address which can be used to contact that publisher about the Measure in Measure.contact

Use of Appropriate National Models

Many countries have developed national healthcare information models in various states of completion. This IG requires the use of national core standards or guides to localize the PublicHealthMeasure to ensure a consistent data model for automation.

1. A conforming PublicHealthMeasure shall specify a jurisdiction to enable support for validation against national requirements.
2. A measure defined for international use may specify an international juristiction, or multiple jurisdictions where that is feasible.

Setting the Measure jurisdiction ensures that resources referenced by the Measure or MeasureReport conform to appropriate national standards.

Measure Reporting Period

A measure shall suggest the approrpriate reporting frequency and period using the [ReportingPeriod](StructureDefinition-ReportingPeriod.html] extension.

Measure Requirements

A measure may indicate the requirements for sending the content of a measure group, population or stratum within a MeasureReport by using the MeasureExpection extension on the Measure.group, Measure.group.population or Measure.group.stratifier element. The MeasureExpectation extension works like the Expectation extension on CapabilityStatement resources, but applies to the requirements for the content of a MeasureReport.

Stratifiers

Stratifiers partition a measure so that it counts subsets of the measure population within the numerator or other measure population by some attribute that classifies the population. Common stratifications often used in healthcare settings include age, sex at birth¹ and race and ethnicity. Constraints on the Measure.group.stratifier component of a Measure and further describes the elements of that component to support strata.

Each stratifier has the following features:

name

The human readable name for the stratifier. This can be found in stratifier.code.coding.display

code

A code that uniquely identifies the stratifier (e.g., age, sex at birth, race, ethnicity). This can be found in stratifier.code.coding.code and stratifier.code.coding.system

1. Codes used in this attribute should descend from SNOMED CT 363787002 Observable Entity

description

A description of the purpose of the stratifier, explaining what function it serves. This can be found in stratifier.code.text

value set

A list of values that describe the different categories into which counted elements are classified for stratification. Individual values in this value set can be found in stratifier.component.code and an explaination of their function appears in stratifier.component.description.

1. Codes used in this attribute should descend from SNOMED CT 404684003 Clinical Finding

• Text Summary
• Differential Table
• Snapshot Table
• Snapshot Table (Must Support)
• All

This structure is derived from Measure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	Measure	A quality measure definition
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
ReportingPeriod	S	1..1	Timing	Enables specification of proposed measure reporting URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
url	S	1..1	uri	Each resource must have a url.
version	S	1..1	string	Resources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
name	S	1..1	string	Each resource must have a name.
status		1..1	code	draft | active | retired Binding: Measure Status Values (required)
experimental	S	1..1	boolean	A resource must indicate its experimental status
Slices for subject[x]		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Slice: Unordered, Open by type:$this
subjectCodeableConcept		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/resource-types
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Location
publisher	S	1..1	string	The name of the organization publishing this resource
contact	S	1..*	ContactDetail	The contact information for whom to contact about this resource
useContext	S	1..*	UsageContext	The ISO 3166 code for use context
author	S	1..1	ContactDetail	The original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
name	S	1..1	string	The author must be identified by name. Can be the name of an individual or an organization.
telecom	S	1..*	ContactPoint	There must be contact information for the author.
relatedArtifact	S	1..*	RelatedArtifact	There must be at least one artifact describing the measure in human readable form.
library	S	1..*	canonical(Public Health Measure Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
MeasureGroupAttributes	S	1..1	(Complex)	Describes the attributes of one or more sections of the measure (form) being reported URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
extension:scoring		0..1	Extension	Extension
value[x]		1..1	CodeableConcept	Value of extension
valueCodeableConcept	S	1..1	CodeableConcept	Measure must have a scoring
extension:type		0..1	Extension	Extension
value[x]		1..1	CodeableConcept	Value of extension
valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
extension:rateAggregation		0..1	Extension	Extension
valueString		0..1	string	count | point-in-time | cumulative Binding: Measure Rate Aggregation Value Set (required)
extension:improvementNotation		0..1	Extension	Extension
valueCodeableConcept	S	0..1	CodeableConcept	Value of extension Binding: MeasureImprovementNotation (required)
extension:subject		1..1	Extension	Extension
valueCodeableConcept		0..1	CodeableConcept	Concept - reference to a terminology or just text
population	S	0..*	BackboneElement	Population criteria
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
coding	S	1..*	Coding	The coding gives a 'name' for this population and must be supplied
text		0..1	string	A human readable description of what this population is
description	S	1..1	string	Human readable instructions for counting or measuring this population
criteria		1..1	MeasureCriteria	An expression that can be used to generate a value
stratifier	S	0..*	BackboneElement	A group may have none, some or many strata
code	S	1..1	CodeableConcept	Describes the purpose of this stratifier
coding	S	0..*	Coding	Optional code uniquely identifying the strata
display	S	1..1	string	Provides a human readable name for the strata
text	S	1..1	string	Describes the function of the stratifier.
description	S	1..1	string	Describes the overall function of the strata.
criteria	S	1..1	MeasureCriteria	An expression that can be used to generate a value
component		0..0
supplementalData
code		1..1	CodeableConcept	Resource type included in the supplementalData Binding: ResourceType (extensible)
description		1..1	string	The human readable description of this supplemental data
criteria		1..1	MeasureCriteria	An expression that can be used to generate a value
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Measure	I	0..*	Measure	A quality measure definition
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
ReportingPeriod	S	1..1	Timing	Enables specification of proposed measure reporting URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
url	SΣ	1..1	uri	Each resource must have a url.
identifier	Σ	0..*	Identifier	Additional identifier for the measure
version	SΣ	1..1	string	Resources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
name	SΣI	1..1	string	Each resource must have a name.
title	Σ	0..1	string	Name for this measure (human friendly)
subtitle		0..1	string	Subordinate title of the measure
status	?!Σ	1..1	code	draft | active | retired Binding: Measure Status Values (required)
experimental	SΣ	1..1	boolean	A resource must indicate its experimental status
Slices for subject[x]		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Slice: Unordered, Closed by type:$this Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).
subject[x]:subjectCodeableConcept		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.). Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/resource-types
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Location
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date	Σ	0..1	dateTime	Date last changed
publisher	SΣ	1..1	string	The name of the organization publishing this resource
contact	SΣ	1..*	ContactDetail	The contact information for whom to contact about this resource
description	Σ	0..1	markdown	Natural language description of the measure
useContext	SΣ	1..*	UsageContext	The ISO 3166 code for use context
jurisdiction	Σ	0..*	CodeableConcept	Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose		0..1	markdown	Why this measure is defined
usage		0..1	string	Describes the clinical usage of the measure
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the measure was approved by publisher
lastReviewDate		0..1	date	When the measure was last reviewed
effectivePeriod	Σ	0..1	Period	When the measure is expected to be used
topic		0..*	CodeableConcept	The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author	S	1..1	ContactDetail	The original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
name	SΣ	1..1	string	The author must be identified by name. Can be the name of an individual or an organization.
telecom	SΣ	1..*	ContactPoint	There must be contact information for the author.
editor		0..*	ContactDetail	Who edited the content
reviewer		0..*	ContactDetail	Who reviewed the content
endorser		0..*	ContactDetail	Who endorsed the content
relatedArtifact	S	1..*	RelatedArtifact	There must be at least one artifact describing the measure in human readable form.
library	S	1..*	canonical(Public Health Measure Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	Σ	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort Binding: MeasureScoring (extensible): The scoring type of the measure.
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	Σ	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome | composite Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
riskAdjustment	Σ	0..1	string	How risk adjustment is applied for this measure
rateAggregation	Σ	0..1	string	How is rate aggregation performed for this measure
rationale	Σ	0..1	markdown	Detailed description of why the measure exists
clinicalRecommendationStatement	Σ	0..1	markdown	Summary of clinical guidelines
improvementNotation	Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	S	0..*	BackboneElement	Population criteria group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
MeasureGroupAttributes	S	1..1	(Complex)	Describes the attributes of one or more sections of the measure (form) being reported URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:scoring	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"scoring"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Measure must have a scoring Binding: MeasureScoring (required)
extension:compositeScoring		0..1	Extension	Like Measure.compositeScoring, but applies to group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"compositeScoring"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept		0..1	CodeableConcept	Value of extension Binding: CompositeMeasureScoring (extensible)
extension:type	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"type"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension Binding: MeasureType (required)
extension:riskAdjustment		0..1	Extension	Like Measure.riskAdjustment, but applies to group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"riskAdjustment"
value[x]		0..1	string	Value of extension
extension:rateAggregation		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"rateAggregation"
value[x]		0..1	string	count | point-in-time | cumulative Binding: Measure Rate Aggregation Value Set (required)
extension:improvementNotation		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"improvementNotation"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	0..1	CodeableConcept	Value of extension Binding: MeasureImprovementNotation (required)
extension:subject	S	1..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"subject"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept		0..1	CodeableConcept	Concept - reference to a terminology or just text Binding: ResourceType (extensible)
extension:subjectValueSet	S	0..1	Extension	Identifies the ValueSet describing the subject elements to count based on a code.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"subjectValueSet"
value[x]		0..1	Reference(ValueSet)	Value of extension
url		1..1	uri	"http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the group
description		0..1	string	Summary description
population	S	0..*	BackboneElement	Population criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..*	Coding	The coding gives a 'name' for this population and must be supplied
text	Σ	0..1	string	A human readable description of what this population is
description	S	1..1	string	Human readable instructions for counting or measuring this population
criteria	I	1..1	MeasureCriteria	An expression that can be used to generate a value
stratifier	S	0..*	BackboneElement	A group may have none, some or many strata
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Describes the purpose of this stratifier
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	0..*	Coding	Optional code uniquely identifying the strata
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	SΣ	1..1	string	Provides a human readable name for the strata
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	1..1	string	Describes the function of the stratifier.
description	S	1..1	string	Describes the overall function of the strata.
criteria	SI	1..1	MeasureCriteria	An expression that can be used to generate a value
supplementalData		0..*	BackboneElement	What other data should be reported with the measure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Resource type included in the supplementalData Binding: ResourceType (extensible)
usage		0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description		1..1	string	The human readable description of this supplemental data
criteria	I	1..1	MeasureCriteria	An expression that can be used to generate a value
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Measure	I	0..*	Measure	A quality measure definition
ReportingPeriod		1..1	Timing	Enables specification of proposed measure reporting URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
url	Σ	1..1	uri	Each resource must have a url.
version	Σ	1..1	string	Resources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
name	ΣI	1..1	string	Each resource must have a name.
experimental	Σ	1..1	boolean	A resource must indicate its experimental status
publisher	Σ	1..1	string	The name of the organization publishing this resource
contact	Σ	1..*	ContactDetail	The contact information for whom to contact about this resource
useContext	Σ	1..*	UsageContext	The ISO 3166 code for use context
author		1..1	ContactDetail	The original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
name	Σ	1..1	string	The author must be identified by name. Can be the name of an individual or an organization.
telecom	Σ	1..*	ContactPoint	There must be contact information for the author.
relatedArtifact		1..*	RelatedArtifact	There must be at least one artifact describing the measure in human readable form.
library		1..*	canonical(Public Health Measure Library)	Logic used by the measure
group		0..*	BackboneElement	Population criteria group
MeasureGroupAttributes		1..1	(Complex)	Describes the attributes of one or more sections of the measure (form) being reported URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
extension:scoring		0..1	Extension	Extension
value[x]:valueCodeableConcept		1..1	CodeableConcept	Measure must have a scoring Binding: MeasureScoring (required)
extension:type		0..1	Extension	Extension
value[x]:valueCodeableConcept		1..1	CodeableConcept	Value of extension Binding: MeasureType (required)
extension:improvementNotation		0..1	Extension	Extension
value[x]:valueCodeableConcept		0..1	CodeableConcept	Value of extension Binding: MeasureImprovementNotation (required)
extension:subject		1..1	Extension	Extension
extension:subjectValueSet		0..1	Extension	Identifies the ValueSet describing the subject elements to count based on a code.
population		0..*	BackboneElement	Population criteria
code		1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
coding	Σ	1..*	Coding	The coding gives a 'name' for this population and must be supplied
description		1..1	string	Human readable instructions for counting or measuring this population
stratifier		0..*	BackboneElement	A group may have none, some or many strata
code		1..1	CodeableConcept	Describes the purpose of this stratifier
coding	Σ	0..*	Coding	Optional code uniquely identifying the strata
display	Σ	1..1	string	Provides a human readable name for the strata
text	Σ	1..1	string	Describes the function of the stratifier.
description		1..1	string	Describes the overall function of the strata.
criteria	I	1..1	MeasureCriteria	An expression that can be used to generate a value
Documentation for this format

This structure is derived from Measure

Summary

Mandatory: 14 elements (16 nested mandatory elements)
Must-Support: 29 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasureLibrary
• http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureCriteria

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
• http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes

Slices

This structure defines the following Slices:

• The element Measure.subject[x] is sliced based on the value of type:$this

Differential View

This structure is derived from Measure

Name	Flags	Card.	Type	Description & Constraints
Measure		0..*	Measure	A quality measure definition
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
ReportingPeriod	S	1..1	Timing	Enables specification of proposed measure reporting URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
url	S	1..1	uri	Each resource must have a url.
version	S	1..1	string	Resources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
name	S	1..1	string	Each resource must have a name.
status		1..1	code	draft | active | retired Binding: Measure Status Values (required)
experimental	S	1..1	boolean	A resource must indicate its experimental status
Slices for subject[x]		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Slice: Unordered, Open by type:$this
subjectCodeableConcept		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/resource-types
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Location
publisher	S	1..1	string	The name of the organization publishing this resource
contact	S	1..*	ContactDetail	The contact information for whom to contact about this resource
useContext	S	1..*	UsageContext	The ISO 3166 code for use context
author	S	1..1	ContactDetail	The original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
name	S	1..1	string	The author must be identified by name. Can be the name of an individual or an organization.
telecom	S	1..*	ContactPoint	There must be contact information for the author.
relatedArtifact	S	1..*	RelatedArtifact	There must be at least one artifact describing the measure in human readable form.
library	S	1..*	canonical(Public Health Measure Library)	Logic used by the measure
group	S	0..*	BackboneElement	Population criteria group
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
MeasureGroupAttributes	S	1..1	(Complex)	Describes the attributes of one or more sections of the measure (form) being reported URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
extension:scoring		0..1	Extension	Extension
value[x]		1..1	CodeableConcept	Value of extension
valueCodeableConcept	S	1..1	CodeableConcept	Measure must have a scoring
extension:type		0..1	Extension	Extension
value[x]		1..1	CodeableConcept	Value of extension
valueCodeableConcept	S	1..1	CodeableConcept	Value of extension
extension:rateAggregation		0..1	Extension	Extension
valueString		0..1	string	count | point-in-time | cumulative Binding: Measure Rate Aggregation Value Set (required)
extension:improvementNotation		0..1	Extension	Extension
valueCodeableConcept	S	0..1	CodeableConcept	Value of extension Binding: MeasureImprovementNotation (required)
extension:subject		1..1	Extension	Extension
valueCodeableConcept		0..1	CodeableConcept	Concept - reference to a terminology or just text
population	S	0..*	BackboneElement	Population criteria
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
coding	S	1..*	Coding	The coding gives a 'name' for this population and must be supplied
text		0..1	string	A human readable description of what this population is
description	S	1..1	string	Human readable instructions for counting or measuring this population
criteria		1..1	MeasureCriteria	An expression that can be used to generate a value
stratifier	S	0..*	BackboneElement	A group may have none, some or many strata
code	S	1..1	CodeableConcept	Describes the purpose of this stratifier
coding	S	0..*	Coding	Optional code uniquely identifying the strata
display	S	1..1	string	Provides a human readable name for the strata
text	S	1..1	string	Describes the function of the stratifier.
description	S	1..1	string	Describes the overall function of the strata.
criteria	S	1..1	MeasureCriteria	An expression that can be used to generate a value
component		0..0
supplementalData
code		1..1	CodeableConcept	Resource type included in the supplementalData Binding: ResourceType (extensible)
description		1..1	string	The human readable description of this supplemental data
criteria		1..1	MeasureCriteria	An expression that can be used to generate a value
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Measure	I	0..*	Measure	A quality measure definition
id	Σ	0..1	string	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred) Max Binding: AllLanguages: A human language.
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
ReportingPeriod	S	1..1	Timing	Enables specification of proposed measure reporting URL: http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
url	SΣ	1..1	uri	Each resource must have a url.
identifier	Σ	0..*	Identifier	Additional identifier for the measure
version	SΣ	1..1	string	Resources are versioned like IG's 0.1.0 = first development version, 0.2.0 - first published for review version, 1.0.0 first official version ...
name	SΣI	1..1	string	Each resource must have a name.
title	Σ	0..1	string	Name for this measure (human friendly)
subtitle		0..1	string	Subordinate title of the measure
status	?!Σ	1..1	code	draft | active | retired Binding: Measure Status Values (required)
experimental	SΣ	1..1	boolean	A resource must indicate its experimental status
Slices for subject[x]		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Slice: Unordered, Closed by type:$this Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.).
subject[x]:subjectCodeableConcept		0..1	CodeableConcept	E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device Binding: SubjectType (extensible): The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.). Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/resource-types
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: Location
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
date	Σ	0..1	dateTime	Date last changed
publisher	SΣ	1..1	string	The name of the organization publishing this resource
contact	SΣ	1..*	ContactDetail	The contact information for whom to contact about this resource
description	Σ	0..1	markdown	Natural language description of the measure
useContext	SΣ	1..*	UsageContext	The ISO 3166 code for use context
jurisdiction	Σ	0..*	CodeableConcept	Intended jurisdiction for measure (if applicable) Binding: Jurisdiction ValueSet (extensible): Countries and regions within which this artifact is targeted for use.
purpose		0..1	markdown	Why this measure is defined
usage		0..1	string	Describes the clinical usage of the measure
copyright		0..1	markdown	Use and/or publishing restrictions
approvalDate		0..1	date	When the measure was approved by publisher
lastReviewDate		0..1	date	When the measure was last reviewed
effectivePeriod	Σ	0..1	Period	When the measure is expected to be used
topic		0..*	CodeableConcept	The category of the measure, such as Education, Treatment, Assessment, etc. Binding: DefinitionTopic (example): High-level categorization of the definition, used for searching, sorting, and filtering.
author	S	1..1	ContactDetail	The original author of the measure content, may be same as publisher, when otherwise, must include a relatedArtifact for the original author's publication
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
name	SΣ	1..1	string	The author must be identified by name. Can be the name of an individual or an organization.
telecom	SΣ	1..*	ContactPoint	There must be contact information for the author.
editor		0..*	ContactDetail	Who edited the content
reviewer		0..*	ContactDetail	Who reviewed the content
endorser		0..*	ContactDetail	Who endorsed the content
relatedArtifact	S	1..*	RelatedArtifact	There must be at least one artifact describing the measure in human readable form.
library	S	1..*	canonical(Public Health Measure Library)	Logic used by the measure
disclaimer	Σ	0..1	markdown	Disclaimer for use of the measure or its referenced content
scoring	Σ	0..1	CodeableConcept	proportion | ratio | continuous-variable | cohort Binding: MeasureScoring (extensible): The scoring type of the measure.
compositeScoring	Σ	0..1	CodeableConcept	opportunity | all-or-nothing | linear | weighted Binding: CompositeMeasureScoring (extensible): The composite scoring method of the measure.
type	Σ	0..*	CodeableConcept	process | outcome | structure | patient-reported-outcome | composite Binding: MeasureType (extensible): The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).
riskAdjustment	Σ	0..1	string	How risk adjustment is applied for this measure
rateAggregation	Σ	0..1	string	How is rate aggregation performed for this measure
rationale	Σ	0..1	markdown	Detailed description of why the measure exists
clinicalRecommendationStatement	Σ	0..1	markdown	Summary of clinical guidelines
improvementNotation	Σ	0..1	CodeableConcept	increase | decrease Binding: MeasureImprovementNotation (required): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.
definition	Σ	0..*	markdown	Defined terms used in the measure documentation
guidance	Σ	0..1	markdown	Additional guidance for implementers
group	S	0..*	BackboneElement	Population criteria group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
MeasureGroupAttributes	S	1..1	(Complex)	Describes the attributes of one or more sections of the measure (form) being reported URL: http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:scoring	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"scoring"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Measure must have a scoring Binding: MeasureScoring (required)
extension:compositeScoring		0..1	Extension	Like Measure.compositeScoring, but applies to group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"compositeScoring"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept		0..1	CodeableConcept	Value of extension Binding: CompositeMeasureScoring (extensible)
extension:type	S	0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"type"
Slices for value[x]		1..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	1..1	CodeableConcept	Value of extension Binding: MeasureType (required)
extension:riskAdjustment		0..1	Extension	Like Measure.riskAdjustment, but applies to group
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"riskAdjustment"
value[x]		0..1	string	Value of extension
extension:rateAggregation		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"rateAggregation"
value[x]		0..1	string	count | point-in-time | cumulative Binding: Measure Rate Aggregation Value Set (required)
extension:improvementNotation		0..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"improvementNotation"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept	S	0..1	CodeableConcept	Value of extension Binding: MeasureImprovementNotation (required)
extension:subject	S	1..1	Extension	Extension
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"subject"
Slices for value[x]		0..1	CodeableConcept	Value of extension Slice: Unordered, Closed by type:$this
value[x]:valueCodeableConcept		0..1	CodeableConcept	Concept - reference to a terminology or just text Binding: ResourceType (extensible)
extension:subjectValueSet	S	0..1	Extension	Identifies the ValueSet describing the subject elements to count based on a code.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..0
url		1..1	uri	"subjectValueSet"
value[x]		0..1	Reference(ValueSet)	Value of extension
url		1..1	uri	"http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes"
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		0..1	CodeableConcept	Meaning of the group
description		0..1	string	Summary description
population	S	0..*	BackboneElement	Population criteria
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation Binding: MeasurePopulationType (extensible): The type of population.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	1..*	Coding	The coding gives a 'name' for this population and must be supplied
text	Σ	0..1	string	A human readable description of what this population is
description	S	1..1	string	Human readable instructions for counting or measuring this population
criteria	I	1..1	MeasureCriteria	An expression that can be used to generate a value
stratifier	S	0..*	BackboneElement	A group may have none, some or many strata
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	S	1..1	CodeableConcept	Describes the purpose of this stratifier
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	SΣ	0..*	Coding	Optional code uniquely identifying the strata
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system
display	SΣ	1..1	string	Provides a human readable name for the strata
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	SΣ	1..1	string	Describes the function of the stratifier.
description	S	1..1	string	Describes the overall function of the strata.
criteria	SI	1..1	MeasureCriteria	An expression that can be used to generate a value
supplementalData		0..*	BackboneElement	What other data should be reported with the measure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Resource type included in the supplementalData Binding: ResourceType (extensible)
usage		0..*	CodeableConcept	supplemental-data | risk-adjustment-factor Binding: MeasureDataUsage (extensible): The intended usage for supplemental data elements in the measure.
description		1..1	string	The human readable description of this supplemental data
criteria	I	1..1	MeasureCriteria	An expression that can be used to generate a value
Documentation for this format