The Measure resource provides the definition of a quality measure.

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.

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

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.

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.

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

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.

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 .

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

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.

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.

Support human navigation and 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.

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.

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

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

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

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

A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to no version of this resource will ever be used intended for genuine usage.

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

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.

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.

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.

The date (and optionally time) when the measure was published. 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.

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 .

The name of the organization or individual that published responsible for the release and ongoing maintenance of the measure.

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

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.

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

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

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

A 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).

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.

Assist in searching for appropriate content.

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

A legal or geographic region in which the measure authority that maintains the resource is intended to be used. 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.

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.)

Explanation 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.

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

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.

This metadata element was typically referred to as Guidance in HQMF

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

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

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).

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').

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

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.

The 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.

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

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

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.

If specified, this date follows the original approval date.

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

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

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.

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 .

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

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

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.

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.

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

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)

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

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

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

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

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

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

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

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.

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.

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

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

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

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.

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.

Describes how to combine the calculation 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 measure, including proportion, ratio, continuous-variable, entities’ aggregate data and cohort. summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The value set is extensible, allowing additional aggregated data are derived from the results of a specific measure scoring types 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 represented. applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).

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

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.

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

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

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.

A codeable representation of the defined term.

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

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

If this 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.

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

A group of population criteria for the measure.

An identifier that is unique within the scoring method used Measure allowing linkage to combine the component measures equivalent item in a MeasureReport resource.

MeasureReport does not require omitted groups to determine be included.

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

Indicates the composite score. title for the group.

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.

The human readable description of this population group.

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.

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).

A description The subject of the risk adjustment factors 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 may impact it limits what content is available based on its relationship to the resulting score 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.

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 how they may be accounted for when computing a population basis of Encounter, and reporting measure results. the population criteria all return lists of Encounters.

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

Describes the method of adjusting for clinical severity and conditions present at the start of care 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 can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether satisfies ANY basisRequirement. A data element satisfies a measure basisRequirement if the instance is subject of the type, conforms to ALL the statistical process for reducing, removing, specified profiles, and matches ALL the codeFilters. basisRequirements SHALL specify type, MAY specify profile and codeFilter, and SHALL NOT specify dateFilter, valueFilter, limit, or clarifying sort. If basis is specified, any basisRequirement SHALL be consistent with the influences specified basis (i.e. the type of confounding factors each basisRequirement SHALL be the same type as, or a subtype of the basis type).

Allows population basis to allow for be described with more useful comparisons. flexibility, including the use of a profile and a code filter.

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

The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes Defines the performance expected units of measure for the entity over measure score. This element SHOULD be specified as a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived UCUM unit.

When the unit cannot be inferred directly from the results calculation logic, this element allows the specification of a specific measure algorithm and, if appropriate, the application desired units of measure of specific risk adjustment models. Can also be used to describe how to risk adjust the data based on supplemental data elements described output.

When this element is specified, implementations are expected to report measure scores in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in specified units. Note that this may involve unit conversion if the ICU versus non-ICU and then expected units are different than the roll-up units of the two). This could resulting score calculation. In this case, unit conversions SHALL be applied performed according to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level). unit conversion semantics specified by UCUM.

Provides When the score is a succinct statement decimal value this should be used to specify the expected minimum number of digits after the need decimal point to use for the measure. Usually includes statements pertaining to importance criterion: impact, gap 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 care, and evidence. the units specified.

Measure developers need If this is a composite measure, the scoring method used to be able combine the component measures to provide determine the composite score.

If this is a detailed description composite measure, a component of the purpose composite.

The measure that contains the definition of the rationale. component calculation.

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

Provides When referencing a summary component of relevant clinical guidelines or other clinical recommendations supporting a composite measure, if the measure. referenced measure contains multiple rates, this element specifies which particular rate is to be used as the component.

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

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

Describes 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).

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.

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

Provides a description of an individual term used within Narrative text to explain the measure. improvement notation and how to interpret it.

Measure developers must be able This element allows explanation to provide precise definitions of terms used within measure descriptions and the improvementNotation be provided. In some cases, additional guidance is required to help clearly communicate the 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 measure. intent.

Additional guidance for the measure including how it can be used in A reference to a clinical context, and Library resource containing the intent of formal logic used by the measure. measure group.

A group of population criteria for the measure.

Indicates a meaning for the group. This can be as simple as a An identifier that is unique identifier, or it can establish meaning in a broader context by drawing from a terminology, within the Measure allowing groups linkage to be correlated across measures. the equivalent population in a MeasureReport resource.

MeasureReport does not require omitted populations to be included.

The human readable description of this population group. 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

A population criteria Indicates the title for the measure. group's population.

The type of population criteria.

The human readable description of this population criteria.

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

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

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 resource SHALL be a definitional (as opposed to an actual) group.

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.

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

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.

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

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

An identifier that is unique within the Measure allowing linkage to the equivalent item in a referenced library or MeasureReport resource.

MeasureReport does not require omitted stratifiers to be included.

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 FHIR Resource Path. XHTML element IDs, and should not directly embed them as such

Indicates the title for the stratifier of the group.

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.

The human readable description of this stratifier criteria.

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

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

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

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.

A component of the a value-based 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.

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

MeasureReport does not require omitted stratifier components to be included.

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

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.

The human readable description of this stratifier criteria component.

An expression that specifies returns the criteria for value of this component of the stratifier. 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. 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.

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

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

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.

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).

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.

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

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

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.

Note that supplemental data are reported as observations resources for each patient and included referenced in the evaluatedResources bundle. 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 or and the Quality Reporting topic for more information.

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

MeasureReport does not require omitted supplementalData to be included.

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

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.

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.

The human readable description of this supplemental data.

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.

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

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).

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.

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.

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.