type: resource-definitionsresource: Measure

Measure Definitions

Measure

A quality measure definition

Definition: The Measure resource provides the definition of a quality measure.

Cardinality: 0..*

Constraints: cnl-0 | warning | Name should be usable as an identifier for the module by machine processing applications such as code generation | name.exists() implies name.matches('^A-Z{1,254}$'); mea-1 | error | Stratifier SHALL be either a single criteria or a set of criteria components | group.stratifier.all((code | description | criteria).exists() xor component.exists())

Mappings: workflow=Definition; rim=Observation[classCode=OBS, moodCode=DEFN]; w5=clinical.general

Measure.url

Canonical identifier for this measure, represented as a URI (globally unique)

Definition: An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers.

Comments: Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

Requirements: Allows the measure to be referenced by a single globally unique identifier.

Cardinality: 0..1

Type: uri

Summary: true

Mappings: workflow=Definition.url; w5=FiveWs.identifier; rim=.identifier[scope=BUSN;reliability=ISS]

Measure.identifier

Additional identifier for the measure

Definition: A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.

Requirements: Allows externally provided and/or usable business identifiers to be easily associated with the module.

Cardinality: 0..*

Type: Identifier

Summary: true

Mappings: workflow=Definition.identifier; w5=FiveWs.identifier; rim=.identifier; objimpl=no-gen-base

Measure.version

Business version of the measure

Definition: The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.

Comments: There may be different measure instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the measure with the format [url]|[version]. The version SHOULD NOT contain a '#' - see Business Version.

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Definition.version; w5=FiveWs.version; rim=N/A (to add?); objimpl=no-gen-base

Measure.versionAlgorithm[x]

How to compare versions

Definition: Indicates the mechanism used to compare versions to determine which is more current.

Comments: If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 and a 0 if the version ordering can't be successfully be determined.

Cardinality: 0..1

Type: string, Coding

Binding: extensible:version-algorithm

Summary: true

Mappings: workflow=Definition.versionAlgorithm; w5=FiveWs.version; rim=N/A (to add?); objimpl=no-gen-base

Measure.name

Name for this measure (computer friendly)

Definition: A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.

Comments: The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Requirements: Support human navigation and code generation.

Conditions: cnl-0

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Definition.name; rim=N/A

Measure.title

Name for this measure (human friendly)

Definition: A short, descriptive, user-friendly title for the measure.

Comments: This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Definition.title; rim=.title

Measure.subtitle

Subordinate title of the measure

Definition: An explanatory or alternate title for the measure giving additional information about its content.

Cardinality: 0..1

Type: string

Mappings: rim=N/A (to add?)

Measure.status

draft | active | retired | unknown

Definition: The status of this measure. Enables tracking the life-cycle of the content.

Comments: Allows filtering of measures that are appropriate for use versus not.

See guidance around (not) making local changes to elements here.

Cardinality: 1..1

Type: code

Binding: required:publication-status

Summary: true

Is Modifier: true (Reason: This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration)

Mappings: workflow=Definition.status; w5=FiveWs.status; rim=.status

Measure.experimental

For testing only - never for real usage

Definition: A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and no version of this resource will ever be intended for genuine usage.

Comments: Allows filtering of measures that are appropriate for use versus not. Experimental resources might include example instances in implementation guides, instances created solely for testing purposes, etc. If experimental is 'true' for any version of a resource, it should be true for all versions of the resource. (If experimental changes, then it is being misused or a resource that was never intended for real-world use has unexpectedly changed its purpose.).

Experimental resources are not expected to be stable and may well have breaking changes without a corresponding change to the 'version' element.

Requirements: Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.

Meaning if Missing: If absent, this resource is treated as though it is not experimental.

Cardinality: 0..1

Type: boolean

Summary: true

Mappings: workflow=Definition.experimental; w5=FiveWs.class; rim=N/A (to add?)

Measure.subject[x]

E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device

Definition: The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anything.

Comments: The subject of the measure is critical in interpreting the criteria definitions, as the logic in the measures is evaluated with respect to a particular subject. This corresponds roughly to the notion of a Compartment in that it limits what content is available based on its relationship to the subject. In CQL, this corresponds to the context declaration. If the subject is specified as a reference to a Group, it must be a definitional group.

Meaning if Missing: Patient

Cardinality: 0..1

Type: CodeableConcept, Reference(Group)

Binding: extensible:participant-resource-types

Mappings: rim=N/A (to add?) { only applies for subject Patient? }

Measure.date

Date last changed

Definition: The date (and optionally time) when the measure was last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.

Comments: The date is often not tracked until the resource is published, but may be present on draft content. Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

See guidance around (not) making local changes to elements here.

Aliases: Revision Date

Cardinality: 0..1

Type: dateTime

Summary: true

Mappings: workflow=Definition.date; w5=FiveWs.recorded; rim=.participation[typeCode=AUT].time

Measure.publisher

Name of the publisher/steward (organization or individual)

Definition: The name of the organization or individual responsible for the release and ongoing maintenance of the measure.

Comments: Usually an organization but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.

Requirements: Helps establish the "authority/credibility" of the measure. May also allow for contact.

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Definition.publisher; w5=FiveWs.witness; rim=participation[typeCode=AUT].role

Measure.contact

Contact details for the publisher

Definition: Contact details to assist a user in finding and communicating with the publisher.

Comments: May be a web site, an email address, a telephone number, etc.

See guidance around (not) making local changes to elements here.

Cardinality: 0..*

Type: ContactDetail

Summary: true

Mappings: workflow=Definition.contact; rim=.participation[typeCode=CALLBCK].role

Measure.description

Natural language description of the measure

Definition: A free text natural language description of the measure from a consumer's perspective.

Comments: This description can be used to capture details such as comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the measure is presumed to be the predominant language in the place the measure was created).

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: workflow=Definition.description; rim=.text

Measure.useContext

The context that the content is intended to support

Definition: The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.

Comments: When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Requirements: Assist in searching for appropriate content.

Cardinality: 0..*

Type: UsageContext

Summary: true

Mappings: workflow=Definition.useContext; rim=N/A (to add?)

Measure.jurisdiction

Jurisdiction of the authority that maintains the measure (if applicable)

Definition: A legal or geographic region in which the authority that maintains the resource is operating. In general, the jurisdiction is also found in the useContext. The useContext may reference additional jurisdictions because the defining jurisdiction does not necessarily limit the jurisdictions of use.

Comments: It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.

DEPRECATION NOTE: For consistency, implementations are encouraged to migrate to using the new 'jurisdiction' code in the useContext element. (I.e. useContext.code indicating http://terminology.hl7.org/CodeSystem/usage-context-type#jurisdiction and useContext.valueCodeableConcept indicating the jurisdiction.)

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:jurisdiction

Summary: true

Mappings: workflow=Definition.jurisdiction; rim=N/A (to add?)

Measure.purpose

Why this measure is defined

Definition: Explanation of why this measure is needed and why it has been designed as it has.

Comments: This element does not describe the usage of the measure. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this measure.

Cardinality: 0..1

Type: markdown

Mappings: workflow=Definition.purpose; w5=FiveWs.why[x]; rim=.reasonCode.text; objimpl=no-gen-base

Measure.usage

Describes the clinical usage of the measure

Definition: A detailed description, from a clinical perspective, of how the measure is used.

Comments: This metadata element was typically referred to as Guidance in HQMF

Requirements: Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the population criteria of the measure. This element provides detailed guidance, where the usage element provides a summary of the guidance.

Aliases: guidance

Cardinality: 0..1

Type: markdown

Mappings: rim=N/A (to add?)

Measure.copyright

Notice about intellectual property ownership, can include restrictions on use

Definition: A copyright statement relating to the measure and/or its contents. Copyright statements are notices of intellectual property ownership and can include restrictions on the use and publishing of the measure.

Comments: The short copyright declaration (e.g. (c) '2015+ xyz organization') should be sent in the copyrightLabel element without the copyright prefix (i.e., do not include '(c)' or the symbol).

Requirements: Consumers must be able to determine any legal restrictions on the use of the measure and/or its content.

Aliases: License, Restrictions

Cardinality: 0..1

Type: markdown

Mappings: workflow=Definition.copyright; rim=N/A (to add?); objimpl=no-gen-base

Measure.copyrightLabel

Definition: A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are restricted. (e.g. 'All rights reserved', 'Some rights reserved').

Comments: The copyright symbol and the '(c)' textual representation SHOULD NOT be included in this string. It will be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

Requirements: Defines the content expected to be rendered in all representations of the artifact.

Cardinality: 0..1

Type: string

Mappings: workflow=Definition.copyrightLabel; rim=N/A (to add?); objimpl=no-gen-base

Measure.approvalDate

When the measure was approved by publisher

Definition: The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

Comments: The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

See guidance around (not) making local changes to elements here.

Cardinality: 0..1

Type: date

Mappings: workflow=Definition.approvalDate; rim=.outboundRelationship[typeCode=SUBJ].act[classCode=CACT;moodCode=EVN;code="approval"].effectiveTime; objimpl=no-gen-base

Measure.lastReviewDate

When the measure was last reviewed by the publisher

Definition: The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

Comments: If specified, this date follows the original approval date.

See guidance around (not) making local changes to elements here.

Requirements: Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

Cardinality: 0..1

Type: date

Mappings: workflow=Definition.lastReviewDate; rim=.outboundRleationship[typeCode=SUBJ;subsetCode=RECENT].act[classCode=CACT;moodCode=EVN;code=review].effectiveTime; objimpl=no-gen-base

Measure.effectivePeriod

When the measure is expected to be used

Definition: The period during which the measure content was or is planned to be in active use.

Comments: The effective period for a measure determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

See guidance around (not) making local changes to elements here.

Requirements: Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the measure are or are expected to be used instead.

Cardinality: 0..1

Type: Period

Summary: true

Mappings: workflow=Definition.effectivePeriod; rim=.effectiveTime; objimpl=no-gen-base

Measure.reportingFrequency

The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)

Definition: The frequency that this measure should be reported, usually specified by the program it is being submitted to.

Comments: Note that reporting frequency is often specified by the expectations of a quality program or initiative that is making use of the measure, rather than on the measure directly.

Requirements: Allows the reporting frequency for the given program to be specified in the Measure itself.

Cardinality: 0..1

Type: Quantity

Binding: extensible:frequency-unit

Measure.topic

The category of the measure, such as Education, Treatment, Assessment, etc

Definition: Descriptive topics related to the content of the measure. Topics provide a high-level categorization grouping types of measures that can be useful for filtering and searching.

Comments: DEPRECATION NOTE: For consistency, implementations are encouraged to migrate to using the new 'topic' code in the useContext element. (I.e. useContext.code indicating http://terminology.hl7.org/CodeSystem/usage-context-type#topic and useContext.valueCodeableConcept indicating the topic)

Requirements: Repositories must be able to determine how to categorize the measure so that it can be found by topical searches.

Cardinality: 0..*

Type: CodeableConcept

Binding: example:definition-topic

Mappings: rim=N/A (to add?)

Measure.author

Who authored the content

Definition: An individiual or organization primarily involved in the creation and maintenance of the content.

Cardinality: 0..*

Type: ContactDetail

Mappings: rim=.participation[typeCode=AUT]

Measure.editor

Who edited the content

Definition: An individual or organization primarily responsible for internal coherence of the content.

Cardinality: 0..*

Type: ContactDetail

Mappings: rim=.participation[typeCode=AUT] { not a great match, but there does not appear to be an editor concept in V3 participation }

Measure.reviewer

Who reviewed the content

Definition: An individual or organization asserted by the publisher to be primarily responsible for review of some aspect of the content.

Comments: See guidance around (not) making local changes to elements here.

Cardinality: 0..*

Type: ContactDetail

Mappings: rim=.participation[typeCode=VRF] {not clear whether VRF best corresponds to reviewer or endorser}

Measure.endorser

Who endorsed the content

Definition: An individual or organization asserted by the publisher to be responsible for officially endorsing the content for use in some setting.

Comments: See guidance around (not) making local changes to elements here.

Cardinality: 0..*

Type: ContactDetail

Mappings: rim=.participation[typeCode=VRF] {not clear whether VRF best corresponds to reviewer or endorser}

Measure.relatedArtifact

Additional documentation, citations, etc

Definition: Related artifacts such as additional documentation, justification, or bibliographic references.

Comments: Each related artifact is either an attachment, or a reference to another resource, but not both. In addition, the successor or predecessor of a Measure SHOULD be a Measure, and dependencies and components of a Measure SHOULD reference a resource.

Requirements: Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.

Cardinality: 0..*

Type: RelatedArtifact

Constraints: mea-8 | warning | Dependencies and components of a Measure should reference a resource | type in ('depends-on' | 'composed-of' | 'part-of') implies ((resource.exists() xor resourceReference.exists()) or (artifact is canonical xor artifact is Reference))

Mappings: rim=.outboundRelationship[typeCode=DOC,RSON,PREV, DRIV, USE, COMP] {successor would be PREV w/ inversionInd=true; No support for citation}

Measure.library

Logic used by the measure

Definition: A reference to a Library resource containing the formal logic used by the measure.

Cardinality: 0..*

Type: canonical

Mappings: rim=N/A (to add?)

Measure.disclaimer

Disclaimer for use of the measure or its referenced content

Definition: Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.

Requirements: Some organizations require that notices and disclosures be included when publishing measures that reference their intellecutal property.

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.riskAdjustment

How risk adjustment is applied for this measure

Definition: A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.

Comments: Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.rateAggregation

How is rate aggregation performed for this measure

Definition: Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

Comments: The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.rationale

Justification for the measure in terms of impact, gap in care, and evidence

Definition: Provides a detailed justification of the need for the measure including statements pertaining to importance criterion: impact, gap in care, and evidence.

Requirements: Measure developers need to be able to provide a detailed description of the purpose of the measure. This element provides detailed rationale, where the purpose element provides a summary of the rationale.

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.clinicalRecommendationStatement

Summary of clinical guidelines

Definition: Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.term

Defined terms used in the measure documentation

Definition: Provides a description of an individual term used within the measure.

Requirements: Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=N/A

Measure.term.code

What term?

Definition: A codeable representation of the defined term.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-definition-example

Mappings: rim=N/A

Measure.term.definition

Meaning of the term

Definition: Provides a definition for the term as used within the measure.

Cardinality: 0..1

Type: markdown

Mappings: rim=N/A (to add?)

Measure.guidance

Additional guidance for implementers (deprecated)

Definition: Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.

Comments: NOTE: This element is deprecated in favor of the usage element

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.group

Population criteria group

Definition: A group of population criteria for the measure.

Conditions: mea-1

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.group.linkId

Unique id for group in measure

Definition: An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource.

Comments: This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

Requirements: MeasureReport does not require omitted groups to be included.

Cardinality: 0..1

Type: string

Constraints: mea-2 | warning | Link ids should be 255 characters or less | $this.length() <= 255

Mappings: rim=.id

Measure.group.title

Title of the group. This title is expected in the corresponding MeasureReport.group.title

Definition: Indicates the title for the group.

Cardinality: 0..1

Type: string

Measure.group.code

Meaning of the group

Definition: Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measures.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-group-example

Mappings: rim=.code

Measure.group.description

Summary description

Definition: The human readable description of this population group.

Cardinality: 0..1

Type: markdown

Mappings: rim=.text

Measure.group.type

process | outcome | structure | patient-reported-outcome

Definition: Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:measure-type

Summary: true

Mappings: rim=.typeCode

Measure.group.subject[x]

E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device

Definition: The intended subjects for the measure. If this element is not provided, there is no subject context (i.e. population criteria are evaluated from the perspective of the entire system, rather than from the perspective of a particular subject).

Meaning if Missing: Unfiltered context, i.e. population criteria are evaluated from the perspective of the entire system, rather than from the perspective of a particular subject.

Cardinality: 0..1

Type: CodeableConcept, Reference(Group)

Binding: extensible:participant-resource-types

Mappings: rim=N/A

Measure.group.basis

Population basis

Definition: The population basis specifies the type of elements in the population. For a subject-based measure, this is boolean (because the subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and a population basis of Encounter, and the population criteria all return lists of Encounters.

Requirements: Allows non-subject-based measures to be specified (i.e. encounter-based and procedure-based)

Meaning if Missing: boolean

Cardinality: 0..1

Type: code

Binding: required:fhir-types

Summary: true

Mappings: rim=N/A (to add?) { only applies for subject Patient? }

Measure.group.basisRequirement

Population basis requirements

Definition: Specifies population basis requirements (i.e. what constitutes a case, or what is being counted) as a DataRequirement. If multiple basisRequirements are specified, criteria expressions may return data that satisfies ANY basisRequirement. A data element satisfies a basisRequirement if the instance is of the type, conforms to ALL the specified profiles, and matches ALL the codeFilters. basisRequirements SHALL specify type, MAY specify profile and codeFilter, and SHALL NOT specify dateFilter, valueFilter, limit, or sort. If basis is specified, any basisRequirement SHALL be consistent with the specified basis (i.e. the type of each basisRequirement SHALL be the same type as, or a subtype of the basis type).

Requirements: Allows population basis to be described with more flexibility, including the use of a profile and a code filter.

Cardinality: 0..*

Type: DataRequirement

Constraints: mea-7 | error | Basis requirements SHALL have a type, MAY have profile and codeFilter elements, and SHALL NOT specify dateFilter, valueFilter, limit, or sort | dateFilter.exists().not() and valueFilter.exists().not() and limit.exists().not() and sort.exists().not()

Mappings: rim=N/A (to add?) { only applies for subject Patient? }

Measure.group.scoring

proportion | ratio | continuous-variable | cohort | composite

Definition: Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:measure-scoring

Summary: true

Mappings: rim=.methodCode { the aspect of how the calculation is performed }

Measure.group.scoringUnit

What units?

Definition: Defines the expected units of measure for the measure score. This element SHOULD be specified as a UCUM unit.

Comments: When this element is specified, implementations are expected to report measure scores in the specified units. Note that this may involve unit conversion if the expected units are different than the units of the resulting score calculation. In this case, unit conversions SHALL be performed according to the unit conversion semantics specified by UCUM.

Requirements: When the unit cannot be inferred directly from the calculation logic, this element allows the specification of the desired units of measure of the output.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-scoring-unit

Summary: true

Mappings: rim=.methodCode { the aspect of how the calculation is performed }

Measure.group.scoringPrecision

How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result)

Definition: When the score is a decimal value this should be used to specify the expected minimum number of digits after the decimal point to use for the precision of the value. When a scoringUnit is also specified, this value is the expected minimum number of digits after the decimal point when the score is expressed in the units specified.

Cardinality: 0..1

Type: positiveInt

Summary: true

Mappings: rim=.methodCode { the aspect of how the calculation is performed }

Measure.group.compositeScoring

opportunity | all-or-nothing | linear | weighted

Definition: If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:composite-measure-scoring

Summary: true

Mappings: rim=.methodCode { the aspect of how component measures are combined }

Measure.group.component

A component of a composite measure

Definition: If this is a composite measure, a component of the composite.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.group.component.measure

What measure?

Definition: The measure that contains the definition of the component calculation.

Cardinality: 0..1

Type: canonical

Measure.group.component.groupId

What group?

Definition: Specifies the id of a particular group within the measure referenced by the related artifact resource.

Comments: When referencing a component of a composite measure, if the referenced measure contains multiple rates, this element specifies which particular rate is to be used as the component.

Cardinality: 0..1

Type: string

Measure.group.component.weight

What weight?

Definition: What is the weight of the contribution of this measure to the overall score.

Comments: When computing weighted composite measures, the weight of each contribution must be specified.

Cardinality: 0..1

Type: decimal

Measure.group.rateAggregation

How is rate aggregation performed for this measure

Definition: Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.

Comments: The measure rate for an organization or clinician is based upon the entities' aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: rim=N/A (to add?)

Measure.group.improvementNotation

increase | decrease

Definition: 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). Exercise caution when using any values besides increase or decrease for improvementNotation.

Requirements: Measure consumers and implementers must be able to determine how to interpret a measure score.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:measure-improvement-notation

Summary: true

Mappings: rim=.methodCode { the aspect of how the calculation is performed }

Measure.group.improvementNotationGuidance

Explanation of improvement notation

Definition: Narrative text to explain the improvement notation and how to interpret it.

Comments: This element allows explanation to the improvementNotation be provided. In some cases, additional guidance is required to clearly communicate measure intent around improvement notation. For example, a measure looking at Ceasarean-section births may have an improvement notation of “decrease”, but it is critical to be able to communicate that a measure score of 0 is not the intent.

Cardinality: 0..1

Type: markdown

Summary: true

Is Modifier: false

Mappings: rim=.methodCode { the aspect of how the calculation is performed }

Measure.group.library

Logic used by the measure group

Definition: A reference to a Library resource containing the formal logic used by the measure group.

Cardinality: 0..*

Type: canonical

Mappings: rim=N/A (to add?)

Measure.group.population

Population criteria

Definition: A population criteria for the measure.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.group.population.linkId

Unique id for population in measure

Definition: An identifier that is unique within the Measure allowing linkage to the equivalent population in a MeasureReport resource.

Comments: This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

Requirements: MeasureReport does not require omitted populations to be included.

Cardinality: 0..1

Type: string

Constraints: mea-3 | warning | Link ids should be 255 characters or less | $this.length() <= 255

Mappings: rim=.id

Measure.group.population.title

Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title

Definition: Indicates the title for the group's population.

Cardinality: 0..1

Type: string

Measure.group.population.code

Definition: The type of population criteria.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:measure-population

Mappings: rim=.code

Measure.group.population.description

The human readable description of this population criteria

Definition: The human readable description of this population criteria.

Cardinality: 0..1

Type: markdown

Mappings: rim=.text

Measure.group.population.criteria

The criteria that defines this population

Definition: An expression that specifies the criteria for the population, typically the name of an expression in a library.

Comments: In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information. As with any expression-valued element, the cqf-alternativeExpression extension may be used to provide an expression in an alternate language.

Cardinality: 0..1

Type: Expression

Mappings: rim=N/A (to add?)

Measure.group.population.groupDefinition

A group resource that defines this population

Definition: A Group resource that defines this population as a set of characteristics.

Cardinality: 0..1

Type: Reference(Group)

Mappings: rim=N/A (to add?)

Measure.group.population.inputPopulationId

Which population

Definition: The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting point.

Requirements: For ratio and continuous variable measures, the source populations must be specified explicitly when they cannot be unambiguously determined from the scoring structure.

Cardinality: 0..1

Type: string

Mappings: rim=N/A (to add?)

Measure.group.population.aggregateMethod

Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)

Definition: Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculation.

Requirements: For continuous variable measures, specifications must be able to indicate the aggregation method to be used for tallying results from individual observations.

Cardinality: 0..1

Type: CodeableConcept

Binding: extensible:measure-aggregate-method

Mappings: rim=N/A (to add?)

Measure.group.stratifier

Stratifier criteria for the measure

Definition: A stratifier for the measure, specified as either a criteria expression, or a set of components that define value-based stratifier expressions.

Conditions: mea-1

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.group.stratifier.linkId

Unique id for stratifier in measure

Definition: An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource.

Comments: This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

Requirements: MeasureReport does not require omitted stratifiers to be included.

Cardinality: 0..1

Type: string

Constraints: mea-4 | warning | Link ids should be 255 characters or less | $this.length() <= 255

Mappings: rim=.id

Measure.group.stratifier.title

Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title

Definition: Indicates the title for the stratifier of the group.

Cardinality: 0..1

Type: string

Measure.group.stratifier.code

Meaning of the stratifier

Definition: Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

Conditions: mea-1

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-stratifier-example

Mappings: rim=.code

Measure.group.stratifier.description

The human readable description of this stratifier

Definition: The human readable description of this stratifier criteria.

Conditions: mea-1

Cardinality: 0..1

Type: markdown

Mappings: rim=.text

Measure.group.stratifier.criteria

How the measure should be stratified

Definition: An expression that specifies a criteria-based stratifier for the measure. This is typically the name of an expression defined within a referenced library, and SHALL use the same basis as other population criteria for the population group.

Comments: As with any expression-valued element, the cqf-alternativeExpression extension may be used to provide an expression in an alternate language.

Conditions: mea-1

Cardinality: 0..1

Type: Expression

Mappings: rim=N/A (to add?)

Measure.group.stratifier.groupDefinition

A group resource that defines this population

Definition: A Group resource that defines this population as a set of characteristics.

Comments: Note that this approach can only be used for measures where the basis is of the same type as the populations (e.g. a Patient-based measure, rather than an Encounter-based measure). In addition, the referenced Group SHALL be a definitional (as opposed to an actual) group. As with any expression-valued element, the cqf-alternativeExpression extension may be used to provide an expression in an alternate language.

Cardinality: 0..1

Type: Reference(Group)

Mappings: rim=N/A (to add?)

Measure.group.stratifier.component

Stratifier criteria component for the measure

Definition: A component of a value-based stratifier for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.

Comments: Stratifiers are defined either as a single criteria, or as a set of component criteria.

Conditions: mea-1

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.group.stratifier.component.linkId

Unique id for stratifier component in measure

Definition: An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource.

Comments: This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

Requirements: MeasureReport does not require omitted stratifier components to be included.

Cardinality: 0..1

Type: string

Constraints: mea-5 | warning | Link ids should be 255 characters or less | $this.length() <= 255

Mappings: rim=.id

Measure.group.stratifier.component.code

Meaning of the stratifier component

Definition: Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-stratifier-example

Mappings: rim=.code

Measure.group.stratifier.component.description

The human readable description of this stratifier component

Definition: The human readable description of this stratifier criteria component.

Cardinality: 0..1

Type: markdown

Mappings: rim=.text

Measure.group.stratifier.component.criteria

Component of how the measure should be stratified

Definition: An expression that returns the value of this component of the stratifier for a member of the population. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element, evaluated from the perspective of the measure subject. If this is a non-subject-based measure, the expression may be a reference to a function that takes an argument of the type of the measure basis, allowing the stratifier value to be determined for each member of the population.

Comments: As with any expression-valued element, the cqf-alternativeExpression extension may be used to provide an expression in an alternate language.

Cardinality: 0..1

Type: Expression

Mappings: rim=N/A (to add?)

Measure.group.stratifier.component.groupDefinition

A group resource that defines this population

Definition: A Group resource that defines this population as a set of characteristics.

Cardinality: 0..1

Type: Reference(Group)

Mappings: rim=N/A (to add?)

Measure.group.stratifier.component.valueSet

What stratum values?

Definition: A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

Comments: This element may be used to define a stratifier rather than requiring the stratifier be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example.

Cardinality: 0..1

Type: canonical

Measure.group.stratifier.component.unit

What units?

Definition: Indicates what units, if any, stratifier values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units.

Comments: This element may be used to define the expected units of stratum values, when that information cannot be inferred from the calculation logic directly.

Cardinality: 0..1

Type: string

Measure.supplementalData

What other data should be reported with the measure

Definition: The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.

Comments: Note that supplemental data are reported as resources for each patient and referenced in the supplementalData element of the MeasureReport. If the supplementalData expression results in a value other than a resource, it is reported using an Observation resource, typically contained in the resulting MeasureReport. See the MeasureReport resource and the Quality Reporting topic for more information.

Cardinality: 0..*

Type: BackboneElement

Mappings: rim=.outboundRelationship[typeCode=COMP]

Measure.supplementalData.linkId

Unique id for supplementalData in measure

Definition: An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource.

Comments: This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

Requirements: MeasureReport does not require omitted supplementalData to be included.

Cardinality: 0..1

Type: string

Constraints: mea-6 | warning | Link ids should be 255 characters or less | $this.length() <= 255

Mappings: rim=.id

Measure.supplementalData.code

Meaning of the supplemental data

Definition: Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:measure-supplemental-data-example

Mappings: rim=.code

Measure.supplementalData.usage

supplemental-data | risk-adjustment-factor

Definition: An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:measure-data-usage

Mappings: rim=.methodCode

Measure.supplementalData.description

The human readable description of this supplemental data

Definition: The human readable description of this supplemental data.

Cardinality: 0..1

Type: markdown

Mappings: rim=.text

Measure.supplementalData.criteria

Expression describing additional data to be reported

Definition: The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.

Comments: As with any expression-valued element, the cqf-alternativeExpression extension may be used to provide an expression in an alternate language.

Cardinality: 1..1

Type: Expression

Mappings: rim=N/A (to add?)

Measure.supplementalData.valueSet

What supplemental data values?

Definition: A value set defining the set of possible values for supplemental data in this element. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce supplemental data values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value 01Y--05Y with the system ignored).

Comments: This element may be used to define a supplemental data element rather than requiring the element to be defined with logic. For example, a measure may reference a value set defining possible age ranges, rather than (and potentially in addition to) embedding the calculation of the age ranges into measure logic. See the MeasureStratifierAgeRangeExample value set for an example.

Cardinality: 0..1

Type: canonical

Measure.supplementalData.unit

What units?

Definition: Indicates what units, if any, supplemental data values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units.

Comments: This element may be used to define the expected units of supplemental data values, when that information cannot be inferred from the calculation logic directly.

Cardinality: 0..1

Type: string