Resource type: measure

Description

The Measure resource provides the definition of a quality measure.

Elements

PathShortDefinitionComments
A quality measure definitionThe Measure resource provides the definition of a quality measure.
urlCanonical identifier for this measure, represented as a URI (globally unique)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 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.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](resource.html#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](resource.html#meta) element to indicate where the current master source of the resource can be found.
identifierAdditional identifier for the measureA 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.Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.
versionBusiness version of the measureThe 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.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].
nameName for this measure (computer friendly)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.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.
titleName for this measure (human friendly)A short, descriptive, user-friendly title for the measure.This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.
subtitleSubordinate title of the measureAn explanatory or alternate title for the measure giving additional information about its content.
statusdraft | active | retired | unknownThe status of this measure. Enables tracking the life-cycle of the content.Allows filtering of measures that are appropriate for use versus not.
experimentalFor testing purposes, not real usageA Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.Allows filtering of measures that are appropriate for use versus not.
subject[x]E.g. Patient, Practitioner, RelatedPerson, Organization, Location, DeviceThe 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.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.
dateDate last changedThe date (and optionally time) when the measure was published. 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.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.
publisherName of the publisher (organization or individual)The name of the organization or individual that published the measure.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.
contactContact details for the publisherContact details to assist a user in finding and communicating with the publisher.May be a web site, an email address, a telephone number, etc.
descriptionNatural language description of the measureA free text natural language description of the measure from a consumer's perspective.This description can be used to capture details such as why the measure was built, 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).
useContextThe context that the content is intended to supportThe 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.When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.
jurisdictionIntended jurisdiction for measure (if applicable)A legal or geographic region in which the measure is intended to be used.It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.
purposeWhy this measure is definedExplanation of why this measure is needed and why it has been designed as it has.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.
usageDescribes the clinical usage of the measureA detailed description, from a clinical perspective, of how the measure is used.
copyrightUse and/or publishing restrictionsA copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.
approvalDateWhen the measure was approved by publisherThe date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.
lastReviewDateWhen the measure was last reviewedThe date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.If specified, this date follows the original approval date.
effectivePeriodWhen the measure is expected to be usedThe period during which the measure content was or is planned to be in active use.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.
topicThe category of the measure, such as Education, Treatment, Assessment, etc.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.
authorWho authored the contentAn individiual or organization primarily involved in the creation and maintenance of the content.
editorWho edited the contentAn individual or organization primarily responsible for internal coherence of the content.
reviewerWho reviewed the contentAn individual or organization primarily responsible for review of some aspect of the content.
endorserWho endorsed the contentAn individual or organization responsible for officially endorsing the content for use in some setting.
relatedArtifactAdditional documentation, citations, etc.Related artifacts such as additional documentation, justification, or bibliographic references.Each related artifact is either an attachment, or a reference to another resource, but not both.
libraryLogic used by the measureA reference to a Library resource containing the formal logic used by the measure.
disclaimerDisclaimer for use of the measure or its referenced contentNotices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.
scoringproportion | ratio | continuous-variable | cohortIndicates 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.
compositeScoringopportunity | all-or-nothing | linear | weightedIf this is a composite measure, the scoring method used to combine the component measures to determine the composite score.
typeprocess | outcome | structure | patient-reported-outcome | compositeIndicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustmentHow risk adjustment is applied for this measureA 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.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.
rateAggregationHow is rate aggregation performed for this measureDescribes how to combine the information calculated, based on logic in each of several populations, into one summarized result.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).
rationaleDetailed description of why the measure existsProvides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.
clinicalRecommendationStatementSummary of clinical guidelinesProvides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.
improvementNotationincrease | decreaseInformation 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).
definitionDefined terms used in the measure documentationProvides a description of an individual term used within the measure.
guidanceAdditional guidance for implementersAdditional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.
groupPopulation criteria groupA group of population criteria for the measure.
group.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.codeMeaning of the groupIndicates 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.
group.descriptionSummary descriptionThe human readable description of this population group.
group.populationPopulation criteriaA population criteria for the measure.
group.population.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.population.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.population.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.population.codeinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observationThe type of population criteria.
group.population.descriptionThe human readable description of this population criteriaThe human readable description of this population criteria.
group.population.criteriaThe criteria that defines this populationAn expression that specifies the criteria for the population, typically the name of an expression in a library.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.
group.stratifierStratifier criteria for the measureThe stratifier criteria 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.
group.stratifier.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.stratifier.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.codeMeaning of the stratifierIndicates 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.
group.stratifier.descriptionThe human readable description of this stratifierThe human readable description of this stratifier criteria.
group.stratifier.criteriaHow the measure should be stratifiedAn expression that specifies the criteria for the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.
group.stratifier.componentStratifier criteria component for the measureA component of the stratifier criteria 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.Stratifiers are defined either as a single criteria, or as a set of component criteria.
group.stratifier.component.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.stratifier.component.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.component.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.component.codeMeaning of the stratifier componentIndicates 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.
group.stratifier.component.descriptionThe human readable description of this stratifier componentThe human readable description of this stratifier criteria component.
group.stratifier.component.criteriaComponent of how the measure should be stratifiedAn expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.
supplementalDataWhat other data should be reported with the measureThe 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.Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.
supplementalData.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
supplementalData.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplementalData.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplementalData.codeMeaning of the supplemental dataIndicates 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.
supplementalData.usagesupplemental-data | risk-adjustment-factorAn 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.
supplementalData.descriptionThe human readable description of this supplemental dataThe human readable description of this supplemental data.
supplementalData.criteriaExpression describing additional data to be reportedThe 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.

Scope and Usage

The Measure resource represents a structured, computable definition of a health-related measure such as a clinical quality measure, public health indicator, or population analytics measure. A quality measure is a quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.

Note that the Measure itself does not typically contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as population criteria, reference named expressions within that library (or libraries). In addition, if the Measure references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression.

For a detailed discussion of how to use the Measure and MeasureReport resources, refer to the Quality Reporting topic.

Boundaries and Relationships

The Measure resource describes a specific quality measure, or population analytic, providing the structure of the measure in terms of the calculation elements (the populations involved). The Group resource is also capable of describing a population, however, the complexity involved in specifying the criteria in the general case requires the use of a high-level query language such as Clinical Quality Language (CQL). As such, the Measure resource defines only the top-level populations and references expressions for the actual criteria. These expressions are typically provided using a Library resource containing CQL or ELM expressions. In addition, the individual members of a population may be cases such as encounters or procedures and in these cases, the Group resource would be unable to represent the population characteristics accurately.

A Measure is also similar to an Observation resource, with the exception that the Measure is purely definitional, it contains no actual measurements, only a description of how to calculate a particular measurement or set of measurements.

A Measure is also similar to a clinical document, but as with the relationship to Observation, a Document is specific to a particular subject.

Search Parameters

composed-ofWhat resource is being referencedMeasure.relatedArtifact.where(type='composed-of').resource
contextA use context assigned to the measure(Measure.useContext.value as CodeableConcept)
context-quantityA quantity- or range-valued use context assigned to the measure(Measure.useContext.value as Quantity) | (Measure.useContext.value as Range)
context-typeA type of use context assigned to the measureMeasure.useContext.code
dateThe measure publication dateMeasure.date
depends-onWhat resource is being referencedMeasure.relatedArtifact.where(type='depends-on').resource | Measure.library
derived-fromWhat resource is being referencedMeasure.relatedArtifact.where(type='derived-from').resource
descriptionThe description of the measureMeasure.description
effectiveThe time during which the measure is intended to be in useMeasure.effectivePeriod
identifierExternal identifier for the measureMeasure.identifier
jurisdictionIntended jurisdiction for the measureMeasure.jurisdiction
nameComputationally friendly name of the measureMeasure.name
predecessorWhat resource is being referencedMeasure.relatedArtifact.where(type='predecessor').resource
publisherName of the publisher of the measureMeasure.publisher
statusThe current status of the measureMeasure.status
successorWhat resource is being referencedMeasure.relatedArtifact.where(type='successor').resource
titleThe human-friendly name of the measureMeasure.title
topicTopics associated with the measureMeasure.topic
urlThe uri that identifies the measureMeasure.url
versionThe business version of the measureMeasure.version
context-type-quantityA use context type and quantity- or range-based value assigned to the measureMeasure.useContext
context-type-valueA use context type and value assigned to the measureMeasure.useContext

Extension Definitions

These are extension definitions for this resource defined by the spec

Profiles based on this resource

Shareable Measure

Enforces the minimum information set for the measure metadata required by HL7 and other organizations that share and publish measures

Elements

PathShortDefinitionComments
A quality measure definitionThe Measure resource provides the definition of a quality measure.
urlCanonical identifier for this measure, represented as a URI (globally unique)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 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.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](resource.html#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](resource.html#meta) element to indicate where the current master source of the resource can be found.
identifierAdditional identifier for the measureA 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.Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.
versionBusiness version of the measureThe 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.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].
nameName for this measure (computer friendly)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.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.
titleName for this measure (human friendly)A short, descriptive, user-friendly title for the measure.This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.
subtitleSubordinate title of the measureAn explanatory or alternate title for the measure giving additional information about its content.
statusdraft | active | retired | unknownThe status of this measure. Enables tracking the life-cycle of the content.Allows filtering of measures that are appropriate for use versus not.
experimentalFor testing purposes, not real usageA Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.Allows filtering of measures that are appropriate for use versus not.
subject[x]E.g. Patient, Practitioner, RelatedPerson, Organization, Location, DeviceThe 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.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.
dateDate last changedThe date (and optionally time) when the measure was published. 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.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.
publisherName of the publisher (organization or individual)The name of the organization or individual that published the measure.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.
contactContact details for the publisherContact details to assist a user in finding and communicating with the publisher.May be a web site, an email address, a telephone number, etc.
descriptionNatural language description of the measureA free text natural language description of the measure from a consumer's perspective.This description can be used to capture details such as why the measure was built, 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).
useContextThe context that the content is intended to supportThe 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.When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.
jurisdictionIntended jurisdiction for measure (if applicable)A legal or geographic region in which the measure is intended to be used.It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.
purposeWhy this measure is definedExplanation of why this measure is needed and why it has been designed as it has.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.
usageDescribes the clinical usage of the measureA detailed description, from a clinical perspective, of how the measure is used.
copyrightUse and/or publishing restrictionsA copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.
approvalDateWhen the measure was approved by publisherThe date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.
lastReviewDateWhen the measure was last reviewedThe date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.If specified, this date follows the original approval date.
effectivePeriodWhen the measure is expected to be usedThe period during which the measure content was or is planned to be in active use.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.
topicThe category of the measure, such as Education, Treatment, Assessment, etc.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.
authorWho authored the contentAn individiual or organization primarily involved in the creation and maintenance of the content.
editorWho edited the contentAn individual or organization primarily responsible for internal coherence of the content.
reviewerWho reviewed the contentAn individual or organization primarily responsible for review of some aspect of the content.
endorserWho endorsed the contentAn individual or organization responsible for officially endorsing the content for use in some setting.
relatedArtifactAdditional documentation, citations, etc.Related artifacts such as additional documentation, justification, or bibliographic references.Each related artifact is either an attachment, or a reference to another resource, but not both.
libraryLogic used by the measureA reference to a Library resource containing the formal logic used by the measure.
disclaimerDisclaimer for use of the measure or its referenced contentNotices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.
scoringproportion | ratio | continuous-variable | cohortIndicates 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.
compositeScoringopportunity | all-or-nothing | linear | weightedIf this is a composite measure, the scoring method used to combine the component measures to determine the composite score.
typeprocess | outcome | structure | patient-reported-outcome | compositeIndicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.
riskAdjustmentHow risk adjustment is applied for this measureA 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.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.
rateAggregationHow is rate aggregation performed for this measureDescribes how to combine the information calculated, based on logic in each of several populations, into one summarized result.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).
rationaleDetailed description of why the measure existsProvides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.
clinicalRecommendationStatementSummary of clinical guidelinesProvides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.
improvementNotationincrease | decreaseInformation 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).
definitionDefined terms used in the measure documentationProvides a description of an individual term used within the measure.
guidanceAdditional guidance for implementersAdditional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.
groupPopulation criteria groupA group of population criteria for the measure.
group.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.codeMeaning of the groupIndicates 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.
group.descriptionSummary descriptionThe human readable description of this population group.
group.populationPopulation criteriaA population criteria for the measure.
group.population.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.population.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.population.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.population.codeinitial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observationThe type of population criteria.
group.population.descriptionThe human readable description of this population criteriaThe human readable description of this population criteria.
group.population.criteriaThe criteria that defines this populationAn expression that specifies the criteria for the population, typically the name of an expression in a library.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.
group.stratifierStratifier criteria for the measureThe stratifier criteria 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.
group.stratifier.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.stratifier.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.codeMeaning of the stratifierIndicates 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.
group.stratifier.descriptionThe human readable description of this stratifierThe human readable description of this stratifier criteria.
group.stratifier.criteriaHow the measure should be stratifiedAn expression that specifies the criteria for the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.
group.stratifier.componentStratifier criteria component for the measureA component of the stratifier criteria 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.Stratifiers are defined either as a single criteria, or as a set of component criteria.
group.stratifier.component.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
group.stratifier.component.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.component.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
group.stratifier.component.codeMeaning of the stratifier componentIndicates 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.
group.stratifier.component.descriptionThe human readable description of this stratifier componentThe human readable description of this stratifier criteria component.
group.stratifier.component.criteriaComponent of how the measure should be stratifiedAn expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.
supplementalDataWhat other data should be reported with the measureThe 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.Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.
supplementalData.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
supplementalData.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplementalData.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplementalData.codeMeaning of the supplemental dataIndicates 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.
supplementalData.usagesupplemental-data | risk-adjustment-factorAn 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.
supplementalData.descriptionThe human readable description of this supplemental dataThe human readable description of this supplemental data.
supplementalData.criteriaExpression describing additional data to be reportedThe 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.