DSTU2 STU 3 Ballot
This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is

This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . For a full list of available versions, see the Directory of published versions . Page versions: . Page versions: R5 R4B R4 R3 R2

6.8.12.3.4 14.7.6 StructureDefinition: MeasureReport - Detailed Descriptions Resource MeasureReport - Detailed Descriptions Definitions for the measurereport Profile. Composition(MeasureReport) Definition A set of healthcare-related information that is assembled together into a single logical document that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. While a Composition defines the structure, it does not actually contain the content: rather the full content of a document is contained in a Bundle, of which the Composition is the first resource contained. Control 0..* Type Composition Comments While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

Detailed Descriptions for the elements in the MeasureReport resource.

Type Comments Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible. Alternate Names Alternate Names Comments Alternate Names extensions, user content Comments 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. Type Identifier Comments See discussion in resource definition for how these relate. Composition.date Definition The composition editing time, when the composition was last logically changed by the author. Control 1..1 Requirements Requirements Type Requirements Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents. Comments Comments Binding The workflow/clinical status of the composition. The codes SHALL be taken from CompositionStatus Requirements Need to be able to mark interim, amended, or withdrawn compositions or documents. Comments If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "withdrawn" is why this element is labeled as a modifier of other elements. Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required. Comments The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). Requirements For a mreasure report, the subject indicates who ior what is being measured? For example, the provider, hospital, or health plan that is being measured by the scores included in the report. Comments if a report contains the results of more than one measure, each measure should be measuring the same entity. Composition.author Definition Identifies who is responsible for the information in the composition. (Not necessarily who typed it in.). Control 1..* 0..* Type Requirements Identifies responsibility for the accuracy of the composition content. 0..* Type Alternate Names Alternate Names extensions, user content, modifiers Comments 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. 0..1 Type Requirements Identifies where to go to find the current version, where to report issues, etc. Comments This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However it is important that this information be known when working with a derived document, so providing a custodian is encouraged. Composition.event Definition The clinical service, such as a colonoscopy or an appendectomy, being documented. Requirements The report's results will typically span many cases that may each span many events. Comments The event needs to be consistent with the type element, though can provide further information if desired. Alternate Names Type Extension Alternate Names extensions, user content, modifiers Comments 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. Comments An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries. Requirements Provides context for the composition and supports searching. Type Invariants Alternate Names Type Extension Alternate Names extensions, user content, modifiers Comments 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. Requirements Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized. Alternate Names Binding Classification of a section of a composition/document. For example codes, see Document Section Codes 0..1 This element is affected by the following invariants: cmp-1 Type Binding The processing mode that applies to this section. The codes SHALL be taken from ListMode Type Requirements Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries. Comments Comments If there are no entries in the list, an emptyReason SHOULD be provided. Composition.section.emptyReason Definition If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason. Control 0..1 This element is affected by the following invariants: cmp-2 Binding If a section is empty, why it is empty. The codes SHOULD be taken from List Empty Reasons Type CodeableConcept Requirements Allows capturing things like "none exist" or "not asked" which can be important for most lists. Comments The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases. Composition.section.section Definition A nested sub-section within this section. © HL7.org 2011+. FHIR DSTU2 (v1.0.2-7202) generated on Sat, Oct 24, 2015 07:43+1100. Links: Search | Version History | Table of Contents | Compare to DSTU1
Composition.id MeasureReport
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The MeasureReport resource contains the results of evaluating a measure.

Control 0..1 1..1
id Summary Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID. true
Composition.meta MeasureReport.measure
Definition

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. A reference to the Measure that was evaluated to produce this report.

Control 0..1 1..1
Type Meta Composition.implicitRules Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Control 0..1 Type Reference uri ( Measure )
Is Modifier Summary true
Composition.language MeasureReport.type
Definition

The base language in which the resource is written. The type of measure report. This may be an individual report, which provides a single patient's score for the measure, a patient listing, which returns the list of patients that meet the various criteria in the measure, or a summary report, which returns a population count for each criteria in the measure.

Control 0..1 1..1
Binding A human language. The codes SHALL be taken from http://tools.ietf.org/html/bcp47 MeasureReportType: The type of the measure report ( Required )
Type code
Comments Summary Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). true
Composition.text MeasureReport.patient
Definition

A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Optional Patient if the report was requested for a single patient.

Control 0..1 This element is affected by the following invariants: dom-1
Type Narrative Reference ( Patient )
narrative, html, xhtml, display Summary Comments Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. true
Composition.contained MeasureReport.period
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. The reporting period for which the report was calculated.

Control 0..* 1..1
Type Resource Period
inline resources, anonymous resources, contained resources Summary Comments This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. true
Composition.extension MeasureReport.status
Definition

May be used to represent additional information that is not part of the basic definition of the resource. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. The report status. No data will be available until the report status is complete.

Control 0..* Type Extension Alternate Names extensions, user content 1..1
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. Binding Composition.modifierExtension Definition May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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. Control MeasureReportStatus: The status of the measure report ( Required 0..* )
Type Extension code
Is Modifier Summary true
Composition.identifier MeasureReport.date
Definition

Logical Identifier for the composition, assigned when created. This identifier stays constant as the composition is changed over time. The date this measure report was generated.

Control 0..1
Type dateTime
dateTime is used for tracking, organizing versions and searching. Summary Comments The Last Modified Date on the composition may be after the date of the document was attested without being changed. true
Composition.type MeasureReport.reportingOrganization
Definition

Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition. Reporting Organization.

Control 1..1 Binding Type of a composition. The codes SHOULD be taken from FHIR Document Type Codes 0..1
Type CodeableConcept Reference ( Organization )
Key metadata element describing the composition, used in searching/filtering. Summary Comments For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding. true
Composition.class MeasureReport.group
Definition

A categorization for the type of the composition. This may be implied by or derived from the code specified in the Composition Type. The results of the calculation, one for each population group in the measure.

Control 0..1 Binding High-level kind of a clinical document at a macro level. For example codes, see FHIR Document Class Codes 0..*
CodeableConcept Summary This is a metadata field from XDS/MHD . true
Composition.title MeasureReport.group.identifier
Definition

Official human-readable label for the composition. Control 1..1 Type string The identifier of the population group as defined in the measure definition.

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period. Composition.status Definition The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document. This is a business identifer, not a resource identifier (see discussion )
Control 1..1
Type code Identifier
Is Modifier Summary true
Composition.confidentiality MeasureReport.group.population
Definition

The code specifying the level of confidentiality of the Composition. The populations that make up the population group, one for each type of population appropriate for the measure.

Control 1..1 Binding Codes specifying the level of confidentiality of the composition. The codes SHALL be taken from v3 Code System Confidentiality Type code 0..*
Is Modifier Summary true
Composition.subject MeasureReport.group.population.type
Definition

Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (I.e. machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure). The type of the population.

Control 1..1
Type Binding Choice of: Reference ( Patient ), Reference ( Practitioner ), Reference ( Group ), Reference ( Device ), Reference ( Location MeasurePopulationType: The type of population (e.g. initial, numerator, denominator, etc.) ( Required )
Type Choice of: Reference ( Practitioner ), Reference ( Device ), Reference ( Patient ), Reference ( RelatedPerson ) Requirements Identifies who is responsible for the content. Composition.attester Definition A participant who has attested to the accuracy of the composition/document. Control code
BackboneElement Summary Comments Only list each attester once. true
Composition.attester.id MeasureReport.group.population.count
Definition

unique id for the element within a resource (for internal references). The number of members of the population.

Control 0..1
Type id Composition.attester.extension Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Control integer
Extension Summary extensions, user content Comments 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. true
Composition.attester.modifierExtension MeasureReport.group.population.patients
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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. This element refers to a List of patient level MeasureReport resources, one for each patient in this population.

Control 0..* 0..1
Type Extension Reference ( List )
Is Modifier Summary true
Composition.attester.mode MeasureReport.group.measureScore
Definition

The type of attestation the authenticator offers. The measure score.

Control 1..* Binding The way in which a person authenticated a composition. The codes SHALL be taken from CompositionAttestationMode 0..1
Type code Requirements Indicates the level of authority of the attestation. Comments Use more than one code where a single attester has more than one mode (professional and legal are often paired). Composition.attester.time Definition When composition was attested by the party. Control decimal
dateTime Summary Requirements Identifies when the information in the composition was deemed accurate. (Things may have changed since then.). true
Composition.attester.party MeasureReport.group.stratifier
Definition

Who attested the composition in the specified way. When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.

Control 0..1 0..*
Type Choice of: Reference ( Patient ), Reference ( Practitioner ), Reference ( Organization Summary ) Requirements Identifies who has taken on the responsibility for accuracy of the composition content. true
Composition.custodian MeasureReport.group.stratifier.identifier
Definition

Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information. Control 0..1 The identifier of this stratifier, as defined in the measure definition.

Type Note Reference ( Organization This is a business identifer, not a resource identifier (see discussion )
Control 0..0 1..1
Type BackboneElement Identifier
Must Support Summary true
Composition.event.id MeasureReport.group.stratifier.group
Definition

unique id for the element within a resource (for internal references). This element contains the results for a single stratum within the stratifier. For example, when stratifying on administrative gender, there will be four strata, one for each possible gender value.

Control 0..1 0..*
Type Summary id true
Composition.event.extension MeasureReport.group.stratifier.group.value
Definition

May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. The value for this stratum, expressed as a string. When defining stratifiers on complex values, the value must be rendered such that the value for each stratum within the stratifier is unique.

Control 0..* 1..1
Type Extension string
extensions, user content Summary Comments 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. true
Composition.event.modifierExtension MeasureReport.group.stratifier.group.population
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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. The populations that make up the stratum, one for each type of population appropriate to the measure.

Control 0..*
Is Modifier Summary true
Composition.event.code MeasureReport.group.stratifier.group.population.type
Definition

This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act. The type of the population.

Control 0..0 1..1
Binding This list of codes represents the main clinical acts being documented. For example codes, see v3 Code System ActCode MeasurePopulationType: The type of population (e.g. initial, numerator, denominator, etc.) ( Required )
Type CodeableConcept code
Must Support Summary true
Composition.event.period MeasureReport.group.stratifier.group.population.count
Definition

The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time. The number of members of the population in this stratum.

Control 0..0 0..1
Type Period integer
Must Support Summary true
Composition.event.detail MeasureReport.group.stratifier.group.population.patients
Definition

Full details for the event(s) the composition/documentation consents. This element refers to a List of patient level MeasureReport resources, one for each patient in this population in this stratum.

Control 0..0 0..1
Type Reference ( Resource List )
Must Support Summary true
Composition.encounter MeasureReport.group.stratifier.group.measureScore
Definition

Describes the clinical encounter or type of care this documentation is associated with. The measure score for this stratum.

Control 0..0 0..1
Type Reference ( Encounter decimal )
Must Support Summary true
Composition.section MeasureReport.group.supplementalData
Definition

The root of the contents that make up the composition. Supplemental data elements for the measure provide additional information requested by the measure for each patient involved in the populations.

Control 0..*
BackboneElement Summary Defined on this element cmp-1 : A section must at least one of text, entries, or sub-sections (xpath: exists(f:text) or exists(f:entry) or exists(f:section)) cmp-2 : A section can only have an emptyReason if it is empty (xpath: not(exists(f:emptyReason) and exists(f:entry))) true
Composition.section.id MeasureReport.group.supplementalData.identifier
Definition

unique id for the element within a resource (for internal references). Control 0..1 The identifier of the supplemental data element as defined in the measure.

Type Note id This is a business identifer, not a resource identifier (see discussion Composition.section.extension Definition May be used to represent additional information that is not part of the basic definition of the element. In order 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 is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. )
Control 0..* 1..1
Type Extension Identifier
extensions, user content Summary Comments 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. true
Composition.section.modifierExtension MeasureReport.group.supplementalData.group
Definition

May 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 that contains it. Usually modifier elements provide negation or qualification. In order 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 is allowed to 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. This element contains the results for a single value within the supplemental data. For example, when reporting supplemental data for administrative gender, there will be four groups, one for each possible gender value.

Control 0..*
Is Modifier Summary true
Composition.section.title MeasureReport.group.supplementalData.group.value
Definition

The heading for this particular section. This will be part of the rendered content for the document. The value for this supplemental data element, expressed as a string. When defining supplemental data on complex values, the value must be rendered such that the value for each group within the supplemental data element is unique.

Control 0..1 1..1
Type string
header, label, caption Summary Comments The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element. true
Composition.section.code MeasureReport.group.supplementalData.group.count
Definition

A code identifying the kind of content contained within the section. This must be consistent with the section title. The number of members in the supplemental data group.

Control 0..1
Type CodeableConcept Requirements Provides computable standardized labels to topics within the document. Comments The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document. If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code. Composition.section.text Definition A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Control integer
Narrative Summary Comments Document profiles may define what content should be represented in the narrative to ensure clinical safety. true
Composition.section.mode MeasureReport.group.supplementalData.group.patients
Definition

How the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted. This element refers to a List of patient level MeasureReport resources, one for each patient in this population.

Control 0..1
Type code Is Modifier true Requirements Sections are used in various ways, and it must be known in what way it is safe to use the entries in them. Composition.section.orderedBy Definition Specifies the order applied to the items in the section entries. Control 0..1 Binding Reference What order applies to the items in the entry. The codes SHOULD be taken from ( List Order Codes )
CodeableConcept Summary Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order. true
Composition.section.entry MeasureReport.evaluatedResources
Definition

The content (narrative and data) associated with the section. A reference to a Bundle containing the Resources that were used in the evaluation of this report.

Control 1..1 This element is affected by the following invariants: cmp-2 0..1
Type Reference ( Observation Bundle )
Control Summary 0..* This element is affected by the following invariants: cmp-1 Type See section Comments Nested sections are primarily used to help human readers navigate to particular portions of the document. true