R4 Ballot #1 #2 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.3.0: (v3.5.0: R4 Ballot 2). #2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

14.11 Resource Measure - Content

Clinical Quality Information Work Group Maturity Level : 2   Trial Use Compartments : Not linked to any defined compartments

The Measure resource provides the definition of a quality measure.

Note to balloters The Clinical Quality Information workgroup is seeking feedback on the name of this resource, as discussed in the GF#11305 . Specifically, the committee is seeking implementer community feedback on whether the resource should be named Measure or MeasureDefinition. The committee believes that the name Measure is a reasonable description of what the resource is doing, and the suggested name change to MeasureDefinition will likely not have much if any positive impact on the usability of the resource. The documentation for the resource is much more important in terms of communicating the intended use.

14.11.1 Scope and Usage

This resource is a definition resource from a FHIR workflow perspective - see Workflow , specifically Definition .

The Measure resource represents a structured 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 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.

14.11.2 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 CQL 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. 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.

This resource is referenced by measurereport CarePlan , Communication , FamilyMemberHistory , MeasureReport and Procedure

14.11.3 Resource Content

Structure

set Σ 0..1 string The measure set, e.g. Preventive Care and Screening path 0..1 string Path to the stratifier path 0..1 string Path to the supplemental data element
Name Flags Card. Type Description & Constraints doco
. . Measure I TU DomainResource A quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . url Σ 0..1 uri Canonical identifier for this measure, represented as a URI (globally unique)
. . . identifier Σ 0..* Identifier Additional identifier for the measure
. . . version Σ 0..1 string Business version of the measure
. . . name Σ I 0..1 string Name for this measure (computer friendly)
. . . title Σ 0..1 string Name for this measure (human friendly)
. . . subtitle 0..1 string Subordinate title of the measure
. . . status ?! Σ 1..1 code draft | active | retired | unknown
PublicationStatus ( Required )
. . . experimental ?! Σ 0..1 boolean For testing purposes, not real usage
. . . subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
SubjectType Subject type ( Extensible )
. . . . subjectCodeableConcept CodeableConcept
. . . . subjectReference Reference ( Group )
. . . date Σ 0..1 dateTime Date last changed
. . . publisher Σ 0..1 string Name of the publisher (organization or individual)
. . . contact Σ 0..* ContactDetail Contact details for the publisher
. . . description Σ 0..1 markdown Natural language description of the measure
. . . useContext Σ 0..* UsageContext The context that the content is intended to support
. . . jurisdiction Σ 0..* CodeableConcept Intended jurisdiction for measure (if applicable)
Jurisdiction ValueSet ( Extensible )
. . . purpose 0..1 markdown Why this measure is defined
. . . usage 0..1 string Describes the clinical usage of the measure
. . . copyright 0..1 markdown Use and/or publishing restrictions
. . . approvalDate 0..1 date When the measure was approved by publisher
. . . lastReviewDate 0..1 date When the measure was last reviewed
. . . effectivePeriod Σ 0..1 Period When the measure is expected to be used
. . . topic 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc.
DefinitionTopic ( Example )
. . . contributor author 0..* Contributor ContactDetail A Who authored the content
... editor 0..* ContactDetail Who edited the content
... reviewer 0..* ContactDetail Who reviewed the content
... endorser 0..* ContactDetail Who endorsed the content contributor
. . . relatedArtifact 0..* RelatedArtifact Additional documentation, citations, etc.
. . . library 0..* canonical ( Library ) Logic used by the measure
. . . disclaimer Σ 0..1 markdown Disclaimer for use of the measure or its referenced content
. . . scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort
MeasureScoring ( Extensible )
. . . compositeScoring Σ 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted
CompositeMeasureScoring ( Extensible )
. . . type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
MeasureType ( Extensible )
. . . riskAdjustment Σ 0..1 string How risk adjustment is applied for this measure
. . . rateAggregation Σ 0..1 string How is rate aggregation performed for this measure
. . . rationale Σ 0..1 markdown Why does this Detailed description of why the measure exist exists
. . . clinicalRecommendationStatement Σ 0..1 markdown Summary of clinical guidelines
. . . improvementNotation Σ 0..1 string code Improvement notation for the measure, e.g. higher score indicates better quality increase | decrease
MeasureImprovementNotation ( Required )
. . . definition Σ 0..* markdown Defined terms used in the measure documentation
. . . guidance Σ 0..1 markdown Additional guidance for implementers
. . . group 0..* BackboneElement Population criteria group
. . . . code 0..1 CodeableConcept Meaning of the group
. . . . description 0..1 string Summary description
. . . . population 0..* BackboneElement Population criteria
. . . . . code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
MeasurePopulationType ( Extensible )
. . . . . description 0..1 string The human readable description of this population criteria
. . . . . criteria 1..1 string Expression The name of a valid referenced CQL expression (may be namespaced) criteria that defines this population criteria
. . . . stratifier 0..* BackboneElement Stratifier criteria for the measure
. . . . . code 0..1 CodeableConcept Meaning of the stratifier
. . . . . description 0..1 string The human readable description of this stratifier
. . . . . criteria 0..1 1..1 string Expression How the measure should be stratified
. . . supplementalData 0..* BackboneElement What other data should be reported with the measure
. . . . code 0..1 CodeableConcept Meaning of the supplemental data
. . . . usage 0..* CodeableConcept supplemental-data | risk-adjustment-factor
MeasureDataUsage ( Extensible )
. . . . description 0..1 string The human readable description of this supplemental data
. . . . criteria 0..1 1..1 string Expression Expression describing additional data to be reported

doco Documentation for this format

UML Diagram ( Legend )

Measure ( DomainResource ) 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 published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers url : uri [0..1] 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 identifier : Identifier [0..*] 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 version : string [0..1] 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 name : string [0..1] A short, descriptive, user-friendly title for the measure title : string [0..1] An explanatory or alternate title for the measure giving additional information about its content subtitle : string [0..1] The status of this measure. Enables tracking the life-cycle of the content (this element modifies the meaning of other elements) status : code [1..1] « The lifecycle status of an artifact. (Strength=Required) PublicationStatus ! » A 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 (this element modifies the meaning of other elements) experimental : boolean [0..1] 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 subject[x] : Type [0..1] « CodeableConcept | Reference ( Group ); The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.) etc.). (Strength=Extensible) SubjectType + » The 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 date : dateTime [0..1] The name of the organization or individual that published the measure publisher : string [0..1] Contact details to assist a user in finding and communicating with the publisher contact : ContactDetail [0..*] A free text natural language description of the measure from a consumer's perspective description : markdown [0..1] The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching for appropriate measure instances useContext : UsageContext [0..*] A legal or geographic region in which the measure is intended to be used jurisdiction : CodeableConcept [0..*] « Countries and regions within which this artifact is targeted for use use. (Strength=Extensible) Jurisdiction ValueSet + » Explanation of why this measure is needed and why it has been designed as it has purpose : markdown [0..1] A detailed description, from a clinical perspective, of how the measure is used usage : string [0..1] A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure copyright : markdown [0..1] The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage approvalDate : date [0..1] The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date lastReviewDate : date [0..1] The period during which the measure content was or is planned to be in active use effectivePeriod : Period [0..1] 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 topic : CodeableConcept [0..*] « High-level categorization of the definition, used for searching, sorting, and filtering filtering. (Strength=Example) DefinitionTopic ?? » A contributor to An individiual or organization primarily involved in the creation and maintenance of the content author : ContactDetail [0..*] An individual or organization primarily responsible for internal coherence of the content editor : ContactDetail [0..*] An individual or organization primarily responsible for review of some aspect of the measure, including authors, editors, reviewers, and endorsers content contributor reviewer : Contributor ContactDetail [0..*] An individual or organization responsible for officially endorsing the content for use in some setting endorser : ContactDetail [0..*] Related artifacts such as additional documentation, justification, or bibliographic references relatedArtifact : RelatedArtifact [0..*] A reference to a Library resource containing the formal logic used by the measure library : canonical [0..*] « Library » Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure disclaimer : markdown [0..1] Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented scoring : CodeableConcept [0..1] « The scoring type of the measure measure. (Strength=Extensible) MeasureScoring + » If this is a composite measure, the scoring method used to combine the component measures to determine the composite score compositeScoring : CodeableConcept [0..1] « The composite scoring method of the measure measure. (Strength=Extensible) CompositeMeasureScoring + » 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 type : CodeableConcept [0..*] « The type of measure (includes codes from 2.16.840.1.113883.1.11.20368) 2.16.840.1.113883.1.11.20368). (Strength=Extensible) MeasureType + » 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 riskAdjustment : string [0..1] Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result rateAggregation : string [0..1] Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence rationale : markdown [0..1] Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure clinicalRecommendationStatement : markdown [0..1] 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) improvementNotation : string code [0..1] « Improvement notation for a measure (e.g. increase or decrease). (Strength=Required) MeasureImprovementNotation ! » Provides a description of an individual term used within the measure definition : markdown [0..*] Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure guidance : markdown [0..1] The measure set, e.g. Preventive Care and Screening set : string [0..1] 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 code : CodeableConcept [0..1] The human readable description of this population group description : string [0..1] Population The type of population criteria code : CodeableConcept [0..1] « The type of population population. (Strength=Extensible) MeasurePopulationType + » The human readable description of this population criteria description : string [0..1] The name of a valid referenced CQL An expression (may be namespaced) that defines this population specifies the criteria for the population, typically the name of an expression in a library criteria : string Expression [1..1] Stratifier 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 code : CodeableConcept [0..1] The human readable description of this stratifier criteria description : string [0..1] The An expression that specifies the criteria for the stratifier. This must be is typically the name of an expression defined within a referenced library criteria : string [0..1] The library, but it may also be a path to an element that defines the stratifier, specified as a valid FHIR resource path stratifier element path criteria : string Expression [0..1] [1..1] SupplementalData 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 code : CodeableConcept [0..1] 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 usage : CodeableConcept [0..*] « The intended usage for supplemental data elements in the measure measure. (Strength=Extensible) MeasureDataUsage + » The human readable description of this supplemental data description : string [0..1] The criteria for the supplemental data. This must be is typically the name of a valid expression defined within a referenced library. library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element criteria : string [0..1] The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Path path : string Expression [0..1] [1..1] A population criteria for the measure population [0..*] 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 stratifier [0..*] A group of population criteria for the measure group [0..*] 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 supplementalData [0..*]

XML Template 

<Measure xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <

 <url value="[uri]"/><!-- 0..1 Canonical identifier for this measure, represented as a URI (globally unique) -->

 <identifier><!-- 0..* Identifier Additional identifier for the measure --></identifier>
 <version value="[string]"/><!-- 0..1 Business version of the measure -->
 <

 <name value="[string]"/><!-- ?? 0..1 Name for this measure (computer friendly) -->

 <title value="[string]"/><!-- 0..1 Name for this measure (human friendly) -->
 <subtitle value="[string]"/><!-- 0..1 Subordinate title of the measure -->
 <status value="[code]"/><!-- 1..1 draft | active | retired | unknown -->
 <

 <experimental value="[boolean]"/><!-- 0..1 For testing purposes, not real usage -->

 <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
 <date value="[dateTime]"/><!-- 0..1 Date last changed -->
 <publisher value="[string]"/><!-- 0..1 Name of the publisher (organization or individual) -->
 <contact><!-- 0..* ContactDetail Contact details for the publisher --></contact>
 <description value="[markdown]"/><!-- 0..1 Natural language description of the measure -->
 <useContext><!-- 0..* UsageContext The context that the content is intended to support --></useContext>
 <jurisdiction><!-- 0..* CodeableConcept Intended jurisdiction for measure (if applicable) --></jurisdiction>
 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <usage value="[string]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Use and/or publishing restrictions -->
 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed -->
 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. --></topic>
 <</contributor>

 <author><!-- 0..* ContactDetail Who authored the content --></author>
 <editor><!-- 0..* ContactDetail Who edited the content --></editor>
 <reviewer><!-- 0..* ContactDetail Who reviewed the content --></reviewer>
 <endorser><!-- 0..* ContactDetail Who endorsed the content --></endorser>

 <relatedArtifact><!-- 0..* RelatedArtifact Additional documentation, citations, etc. --></relatedArtifact>
 <library><!-- 0..* canonical(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for use of the measure or its referenced content -->
 <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
 <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted --></compositeScoring>
 <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
 <riskAdjustment value="[string]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <

 <rationale value="[markdown]"/><!-- 0..1 Detailed description of why the measure exists -->

 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Summary of clinical guidelines -->
 <

 <improvementNotation value="[code]"/><!-- 0..1 increase | decrease -->

 <definition value="[markdown]"/><!-- 0..* Defined terms used in the measure documentation -->
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers -->
 <

 <group>  <!-- 0..* Population criteria group -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[string]"/><!-- 0..1 Summary description -->
  <population>  <!-- 0..* Population criteria -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <

   <criteria><!-- 1..1 Expression The criteria that defines this population --></criteria>

  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <code><!-- 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this stratifier -->
   <
   <

   <criteria><!-- 1..1 Expression How the measure should be stratified --></criteria>

  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor --></usage>
  <description value="[string]"/><!-- 0..1 The human readable description of this supplemental data -->
  <
  <

  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>

 </supplementalData>
</Measure>

JSON Template 

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "

  "url" : "<uri>", // Canonical identifier for this measure, represented as a URI (globally unique)

  "identifier" : [{ Identifier }], // Additional identifier for the measure
  "version" : "<string>", // Business version of the measure
  "

  "name" : "<string>", // C? Name for this measure (computer friendly)

  "title" : "<string>", // Name for this measure (human friendly)
  "subtitle" : "<string>", // Subordinate title of the measure
  "status" : "<code>", // R!  draft | active | retired | unknown
  "

  "experimental" : <boolean>, // For testing purposes, not real usage

  // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:
  "subjectCodeableConcept" : { CodeableConcept },
  "subjectReference" : { Reference(Group) },
  "date" : "<dateTime>", // Date last changed
  "publisher" : "<string>", // Name of the publisher (organization or individual)
  "contact" : [{ ContactDetail }], // Contact details for the publisher
  "description" : "<markdown>", // Natural language description of the measure
  "useContext" : [{ UsageContext }], // The context that the content is intended to support
  "jurisdiction" : [{ CodeableConcept }], // Intended jurisdiction for measure (if applicable)
  "purpose" : "<markdown>", // Why this measure is defined
  "usage" : "<string>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Use and/or publishing restrictions
  "approvalDate" : "<date>", // When the measure was approved by publisher
  "lastReviewDate" : "<date>", // When the measure was last reviewed
  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "topic" : [{ CodeableConcept }], // The category of the measure, such as Education, Treatment, Assessment, etc.
  "

  "author" : [{ ContactDetail }], // Who authored the content
  "editor" : [{ ContactDetail }], // Who edited the content
  "reviewer" : [{ ContactDetail }], // Who reviewed the content
  "endorser" : [{ ContactDetail }], // Who endorsed the content

  "relatedArtifact" : [{ RelatedArtifact }], // Additional documentation, citations, etc.
  "

  "library" : [{ canonical(Library) }], // Logic used by the measure

  "disclaimer" : "<markdown>", // Disclaimer for use of the measure or its referenced content
  "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
  "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted
  "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
  "riskAdjustment" : "<string>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "

  "rationale" : "<markdown>", // Detailed description of why the measure exists

  "clinicalRecommendationStatement" : "<markdown>", // Summary of clinical guidelines
  "

  "improvementNotation" : "<code>", // increase | decrease

  "definition" : ["<markdown>"], // Defined terms used in the measure documentation
  "guidance" : "<markdown>", // Additional guidance for implementers
  "

  "group" : [{ // Population criteria group
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<string>", // Summary description
    "population" : [{ // Population criteria
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      "description" : "<string>", // The human readable description of this population criteria
      "

      "criteria" : { Expression } // R!  The criteria that defines this population

    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "code" : { CodeableConcept }, // Meaning of the stratifier
      "description" : "<string>", // The human readable description of this stratifier
      "
      "

      "criteria" : { Expression } // R!  How the measure should be stratified

    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor
    "description" : "<string>", // The human readable description of this supplemental data
    "
    "

    "criteria" : { Expression } // R!  Expression describing additional data to be reported

  }]
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Measure;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:

  fhir:Measure.url [ uri ]; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)

  fhir:Measure.identifier [ Identifier ], ... ; # 0..* Additional identifier for the measure
  fhir:Measure.version [ string ]; # 0..1 Business version of the measure
  fhir:Measure.name [ string ]; # 0..1 Name for this measure (computer friendly)
  fhir:Measure.title [ string ]; # 0..1 Name for this measure (human friendly)
  fhir:Measure.subtitle [ string ]; # 0..1 Subordinate title of the measure
  fhir:Measure.status [ code ]; # 1..1 draft | active | retired | unknown
  fhir:

  fhir:Measure.experimental [ boolean ]; # 0..1 For testing purposes, not real usage

  # Measure.subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:Measure.subjectCodeableConcept [ CodeableConcept ]
    fhir:Measure.subjectReference [ Reference(Group) ]
  fhir:Measure.date [ dateTime ]; # 0..1 Date last changed
  fhir:Measure.publisher [ string ]; # 0..1 Name of the publisher (organization or individual)
  fhir:Measure.contact [ ContactDetail ], ... ; # 0..* Contact details for the publisher
  fhir:Measure.description [ markdown ]; # 0..1 Natural language description of the measure
  fhir:Measure.useContext [ UsageContext ], ... ; # 0..* The context that the content is intended to support
  fhir:Measure.jurisdiction [ CodeableConcept ], ... ; # 0..* Intended jurisdiction for measure (if applicable)
  fhir:Measure.purpose [ markdown ]; # 0..1 Why this measure is defined
  fhir:Measure.usage [ string ]; # 0..1 Describes the clinical usage of the measure
  fhir:Measure.copyright [ markdown ]; # 0..1 Use and/or publishing restrictions
  fhir:Measure.approvalDate [ date ]; # 0..1 When the measure was approved by publisher
  fhir:Measure.lastReviewDate [ date ]; # 0..1 When the measure was last reviewed
  fhir:Measure.effectivePeriod [ Period ]; # 0..1 When the measure is expected to be used
  fhir:Measure.topic [ CodeableConcept ], ... ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc.
  fhir:

  fhir:Measure.author [ ContactDetail ], ... ; # 0..* Who authored the content
  fhir:Measure.editor [ ContactDetail ], ... ; # 0..* Who edited the content
  fhir:Measure.reviewer [ ContactDetail ], ... ; # 0..* Who reviewed the content
  fhir:Measure.endorser [ ContactDetail ], ... ; # 0..* Who endorsed the content

  fhir:Measure.relatedArtifact [ RelatedArtifact ], ... ; # 0..* Additional documentation, citations, etc.
  fhir:Measure.library [ canonical(Library) ], ... ; # 0..* Logic used by the measure
  fhir:Measure.disclaimer [ markdown ]; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:Measure.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
  fhir:Measure.compositeScoring [ CodeableConcept ]; # 0..1 opportunity | all-or-nothing | linear | weighted
  fhir:Measure.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
  fhir:Measure.riskAdjustment [ string ]; # 0..1 How risk adjustment is applied for this measure
  fhir:Measure.rateAggregation [ string ]; # 0..1 How is rate aggregation performed for this measure
  fhir:

  fhir:Measure.rationale [ markdown ]; # 0..1 Detailed description of why the measure exists

  fhir:Measure.clinicalRecommendationStatement [ markdown ]; # 0..1 Summary of clinical guidelines
  fhir:

  fhir:Measure.improvementNotation [ code ]; # 0..1 increase | decrease

  fhir:Measure.definition [ markdown ], ... ; # 0..* Defined terms used in the measure documentation
  fhir:Measure.guidance [ markdown ]; # 0..1 Additional guidance for implementers
  fhir:

  fhir:Measure.group [ # 0..* Population criteria group
    fhir:Measure.group.code [ CodeableConcept ]; # 0..1 Meaning of the group
    fhir:Measure.group.description [ string ]; # 0..1 Summary description
    fhir:Measure.group.population [ # 0..* Population criteria
      fhir:Measure.group.population.code [ CodeableConcept ]; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:Measure.group.population.description [ string ]; # 0..1 The human readable description of this population criteria
      fhir:

      fhir:Measure.group.population.criteria [ Expression ]; # 1..1 The criteria that defines this population

    ], ...;
    fhir:Measure.group.stratifier [ # 0..* Stratifier criteria for the measure
      fhir:Measure.group.stratifier.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier
      fhir:Measure.group.stratifier.description [ string ]; # 0..1 The human readable description of this stratifier
      fhir:
      fhir:

      fhir:Measure.group.stratifier.criteria [ Expression ]; # 1..1 How the measure should be stratified

    ], ...;
  ], ...;
  fhir:Measure.supplementalData [ # 0..* What other data should be reported with the measure
    fhir:Measure.supplementalData.code [ CodeableConcept ]; # 0..1 Meaning of the supplemental data
    fhir:Measure.supplementalData.usage [ CodeableConcept ], ... ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:Measure.supplementalData.description [ string ]; # 0..1 The human readable description of this supplemental data
    fhir:
    fhir:

    fhir:Measure.supplementalData.criteria [ Expression ]; # 1..1 Expression describing additional data to be reported

  ], ...;
]

Changes since R3

Measure
Measure.subtitle
  • Added Element
Measure.experimental
  • No longer marked as Modifier
Measure.subject[x]
  • Added Element
Measure.author
  • Added Element
Measure.editor
  • Added Element
Measure.reviewer
  • Added Element
Measure.endorser
  • Added Element
Measure.library
  • Type changed from Reference(Library) to canonical
Measure.improvementNotation
  • Type changed from string to code
  • Add Binding http://hl7.org/fhir/ValueSet/measure-improvement-notation (required)
Measure.group.code
  • Added Element
Measure.group.population.criteria
  • Type changed from string to Expression
Measure.group.stratifier.code
  • Added Element
Measure.group.stratifier.description
  • Added Element
Measure.group.stratifier.criteria
  • Min Cardinality changed from 0 to 1
  • Type changed from string to Expression
Measure.supplementalData.code
  • Added Element
Measure.supplementalData.description
  • Added Element
Measure.supplementalData.criteria
  • Min Cardinality changed from 0 to 1
  • Type changed from string to Expression
Measure.contributor
  • deleted
Measure.set
  • deleted
Measure.group.identifier
  • deleted
Measure.group.name
  • deleted
Measure.group.population.identifier
  • deleted
Measure.group.population.name
  • deleted
Measure.group.stratifier.identifier
  • deleted
Measure.group.stratifier.path
  • deleted
Measure.supplementalData.identifier
  • deleted
Measure.supplementalData.path
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 6 tests of which 6 fail to execute .)

Structure

set Σ 0..1 string The measure set, e.g. Preventive Care and Screening path 0..1 string Path to the stratifier path 0..1 string Path to the supplemental data element
Name Flags Card. Type Description & Constraints doco
. . Measure I TU DomainResource A quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . url Σ 0..1 uri Canonical identifier for this measure, represented as a URI (globally unique)
. . . identifier Σ 0..* Identifier Additional identifier for the measure
. . . version Σ 0..1 string Business version of the measure
. . . name Σ I 0..1 string Name for this measure (computer friendly)
. . . title Σ 0..1 string Name for this measure (human friendly)
. . . subtitle 0..1 string Subordinate title of the measure
. . . status ?! Σ 1..1 code draft | active | retired | unknown
PublicationStatus ( Required )
. . . experimental ?! Σ 0..1 boolean For testing purposes, not real usage
. . . subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
SubjectType Subject type ( Extensible )
. . . . subjectCodeableConcept CodeableConcept
. . . . subjectReference Reference ( Group )
. . . date Σ 0..1 dateTime Date last changed
. . . publisher Σ 0..1 string Name of the publisher (organization or individual)
. . . contact Σ 0..* ContactDetail Contact details for the publisher
. . . description Σ 0..1 markdown Natural language description of the measure
. . . useContext Σ 0..* UsageContext The context that the content is intended to support
. . . jurisdiction Σ 0..* CodeableConcept Intended jurisdiction for measure (if applicable)
Jurisdiction ValueSet ( Extensible )
. . . purpose 0..1 markdown Why this measure is defined
. . . usage 0..1 string Describes the clinical usage of the measure
. . . copyright 0..1 markdown Use and/or publishing restrictions
. . . approvalDate 0..1 date When the measure was approved by publisher
. . . lastReviewDate 0..1 date When the measure was last reviewed
. . . effectivePeriod Σ 0..1 Period When the measure is expected to be used
. . . topic 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc.
DefinitionTopic ( Example )
. . . contributor author 0..* Contributor ContactDetail A Who authored the content
... editor 0..* ContactDetail Who edited the content
... reviewer 0..* ContactDetail Who reviewed the content
... endorser 0..* ContactDetail Who endorsed the content contributor
. . . relatedArtifact 0..* RelatedArtifact Additional documentation, citations, etc.
. . . library 0..* canonical ( Library ) Logic used by the measure
. . . disclaimer Σ 0..1 markdown Disclaimer for use of the measure or its referenced content
. . . scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort
MeasureScoring ( Extensible )
. . . compositeScoring Σ 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted
CompositeMeasureScoring ( Extensible )
. . . type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
MeasureType ( Extensible )
. . . riskAdjustment Σ 0..1 string How risk adjustment is applied for this measure
. . . rateAggregation Σ 0..1 string How is rate aggregation performed for this measure
. . . rationale Σ 0..1 markdown Why does this Detailed description of why the measure exist exists
. . . clinicalRecommendationStatement Σ 0..1 markdown Summary of clinical guidelines
. . . improvementNotation Σ 0..1 string code Improvement notation for the measure, e.g. higher score indicates better quality increase | decrease
MeasureImprovementNotation ( Required )
. . . definition Σ 0..* markdown Defined terms used in the measure documentation
. . . guidance Σ 0..1 markdown Additional guidance for implementers
. . . group 0..* BackboneElement Population criteria group
. . . . code 0..1 CodeableConcept Meaning of the group
. . . . description 0..1 string Summary description
. . . . population 0..* BackboneElement Population criteria
. . . . . code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
MeasurePopulationType ( Extensible )
. . . . . description 0..1 string The human readable description of this population criteria
. . . . . criteria 1..1 string Expression The name of a valid referenced CQL expression (may be namespaced) criteria that defines this population criteria
. . . . stratifier 0..* BackboneElement Stratifier criteria for the measure
. . . . . code 0..1 CodeableConcept Meaning of the stratifier
. . . . . description 0..1 string The human readable description of this stratifier
. . . . . criteria 0..1 1..1 string Expression How the measure should be stratified
. . . supplementalData 0..* BackboneElement What other data should be reported with the measure
. . . . code 0..1 CodeableConcept Meaning of the supplemental data
. . . . usage 0..* CodeableConcept supplemental-data | risk-adjustment-factor
MeasureDataUsage ( Extensible )
. . . . description 0..1 string The human readable description of this supplemental data
. . . . criteria 0..1 1..1 string Expression Expression describing additional data to be reported

doco Documentation for this format

UML Diagram ( Legend )

Measure ( DomainResource ) 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 published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers url : uri [0..1] 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 identifier : Identifier [0..*] 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 version : string [0..1] 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 name : string [0..1] A short, descriptive, user-friendly title for the measure title : string [0..1] An explanatory or alternate title for the measure giving additional information about its content subtitle : string [0..1] The status of this measure. Enables tracking the life-cycle of the content (this element modifies the meaning of other elements) status : code [1..1] « The lifecycle status of an artifact. (Strength=Required) PublicationStatus ! » A 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 (this element modifies the meaning of other elements) experimental : boolean [0..1] 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 subject[x] : Type [0..1] « CodeableConcept | Reference ( Group ); The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.) etc.). (Strength=Extensible) SubjectType + » The 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 date : dateTime [0..1] The name of the organization or individual that published the measure publisher : string [0..1] Contact details to assist a user in finding and communicating with the publisher contact : ContactDetail [0..*] A free text natural language description of the measure from a consumer's perspective description : markdown [0..1] The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching for appropriate measure instances useContext : UsageContext [0..*] A legal or geographic region in which the measure is intended to be used jurisdiction : CodeableConcept [0..*] « Countries and regions within which this artifact is targeted for use use. (Strength=Extensible) Jurisdiction ValueSet + » Explanation of why this measure is needed and why it has been designed as it has purpose : markdown [0..1] A detailed description, from a clinical perspective, of how the measure is used usage : string [0..1] A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure copyright : markdown [0..1] The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage approvalDate : date [0..1] The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date lastReviewDate : date [0..1] The period during which the measure content was or is planned to be in active use effectivePeriod : Period [0..1] 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 topic : CodeableConcept [0..*] « High-level categorization of the definition, used for searching, sorting, and filtering filtering. (Strength=Example) DefinitionTopic ?? » A contributor to An individiual or organization primarily involved in the creation and maintenance of the content author : ContactDetail [0..*] An individual or organization primarily responsible for internal coherence of the content editor : ContactDetail [0..*] An individual or organization primarily responsible for review of some aspect of the measure, including authors, editors, reviewers, and endorsers content contributor reviewer : Contributor ContactDetail [0..*] An individual or organization responsible for officially endorsing the content for use in some setting endorser : ContactDetail [0..*] Related artifacts such as additional documentation, justification, or bibliographic references relatedArtifact : RelatedArtifact [0..*] A reference to a Library resource containing the formal logic used by the measure library : canonical [0..*] « Library » Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure disclaimer : markdown [0..1] Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented scoring : CodeableConcept [0..1] « The scoring type of the measure measure. (Strength=Extensible) MeasureScoring + » If this is a composite measure, the scoring method used to combine the component measures to determine the composite score compositeScoring : CodeableConcept [0..1] « The composite scoring method of the measure measure. (Strength=Extensible) CompositeMeasureScoring + » 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 type : CodeableConcept [0..*] « The type of measure (includes codes from 2.16.840.1.113883.1.11.20368) 2.16.840.1.113883.1.11.20368). (Strength=Extensible) MeasureType + » 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 riskAdjustment : string [0..1] Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result rateAggregation : string [0..1] Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence rationale : markdown [0..1] Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure clinicalRecommendationStatement : markdown [0..1] 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) improvementNotation : string code [0..1] « Improvement notation for a measure (e.g. increase or decrease). (Strength=Required) MeasureImprovementNotation ! » Provides a description of an individual term used within the measure definition : markdown [0..*] Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure guidance : markdown [0..1] The measure set, e.g. Preventive Care and Screening set : string [0..1] 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 code : CodeableConcept [0..1] The human readable description of this population group description : string [0..1] Population The type of population criteria code : CodeableConcept [0..1] « The type of population population. (Strength=Extensible) MeasurePopulationType + » The human readable description of this population criteria description : string [0..1] The name of a valid referenced CQL An expression (may be namespaced) that defines this population specifies the criteria for the population, typically the name of an expression in a library criteria : string Expression [1..1] Stratifier 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 code : CodeableConcept [0..1] The human readable description of this stratifier criteria description : string [0..1] The An expression that specifies the criteria for the stratifier. This must be is typically the name of an expression defined within a referenced library criteria : string [0..1] The library, but it may also be a path to an element that defines the stratifier, specified as a valid FHIR resource path stratifier element path criteria : string Expression [0..1] [1..1] SupplementalData 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 code : CodeableConcept [0..1] 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 usage : CodeableConcept [0..*] « The intended usage for supplemental data elements in the measure measure. (Strength=Extensible) MeasureDataUsage + » The human readable description of this supplemental data description : string [0..1] The criteria for the supplemental data. This must be is typically the name of a valid expression defined within a referenced library. library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element criteria : string [0..1] The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Path path : string Expression [0..1] [1..1] A population criteria for the measure population [0..*] 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 stratifier [0..*] A group of population criteria for the measure group [0..*] 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 supplementalData [0..*]

XML Template 

<Measure xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <

 <url value="[uri]"/><!-- 0..1 Canonical identifier for this measure, represented as a URI (globally unique) -->

 <identifier><!-- 0..* Identifier Additional identifier for the measure --></identifier>
 <version value="[string]"/><!-- 0..1 Business version of the measure -->
 <

 <name value="[string]"/><!-- ?? 0..1 Name for this measure (computer friendly) -->

 <title value="[string]"/><!-- 0..1 Name for this measure (human friendly) -->
 <subtitle value="[string]"/><!-- 0..1 Subordinate title of the measure -->
 <status value="[code]"/><!-- 1..1 draft | active | retired | unknown -->
 <

 <experimental value="[boolean]"/><!-- 0..1 For testing purposes, not real usage -->

 <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
 <date value="[dateTime]"/><!-- 0..1 Date last changed -->
 <publisher value="[string]"/><!-- 0..1 Name of the publisher (organization or individual) -->
 <contact><!-- 0..* ContactDetail Contact details for the publisher --></contact>
 <description value="[markdown]"/><!-- 0..1 Natural language description of the measure -->
 <useContext><!-- 0..* UsageContext The context that the content is intended to support --></useContext>
 <jurisdiction><!-- 0..* CodeableConcept Intended jurisdiction for measure (if applicable) --></jurisdiction>
 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <usage value="[string]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Use and/or publishing restrictions -->
 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed -->
 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. --></topic>
 <</contributor>

 <author><!-- 0..* ContactDetail Who authored the content --></author>
 <editor><!-- 0..* ContactDetail Who edited the content --></editor>
 <reviewer><!-- 0..* ContactDetail Who reviewed the content --></reviewer>
 <endorser><!-- 0..* ContactDetail Who endorsed the content --></endorser>

 <relatedArtifact><!-- 0..* RelatedArtifact Additional documentation, citations, etc. --></relatedArtifact>
 <library><!-- 0..* canonical(Library) Logic used by the measure --></library>
 <disclaimer value="[markdown]"/><!-- 0..1 Disclaimer for use of the measure or its referenced content -->
 <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort --></scoring>
 <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted --></compositeScoring>
 <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite --></type>
 <riskAdjustment value="[string]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[string]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <

 <rationale value="[markdown]"/><!-- 0..1 Detailed description of why the measure exists -->

 <clinicalRecommendationStatement value="[markdown]"/><!-- 0..1 Summary of clinical guidelines -->
 <

 <improvementNotation value="[code]"/><!-- 0..1 increase | decrease -->

 <definition value="[markdown]"/><!-- 0..* Defined terms used in the measure documentation -->
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers -->
 <

 <group>  <!-- 0..* Population criteria group -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[string]"/><!-- 0..1 Summary description -->
  <population>  <!-- 0..* Population criteria -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this population criteria -->
   <

   <criteria><!-- 1..1 Expression The criteria that defines this population --></criteria>

  </population>
  <stratifier>  <!-- 0..* Stratifier criteria for the measure -->
   <code><!-- 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[string]"/><!-- 0..1 The human readable description of this stratifier -->
   <
   <

   <criteria><!-- 1..1 Expression How the measure should be stratified --></criteria>

  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor --></usage>
  <description value="[string]"/><!-- 0..1 The human readable description of this supplemental data -->
  <
  <

  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>

 </supplementalData>
</Measure>

JSON Template 

{doco
  "resourceType" : "Measure",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "

  "url" : "<uri>", // Canonical identifier for this measure, represented as a URI (globally unique)

  "identifier" : [{ Identifier }], // Additional identifier for the measure
  "version" : "<string>", // Business version of the measure
  "

  "name" : "<string>", // C? Name for this measure (computer friendly)

  "title" : "<string>", // Name for this measure (human friendly)
  "subtitle" : "<string>", // Subordinate title of the measure
  "status" : "<code>", // R!  draft | active | retired | unknown
  "

  "experimental" : <boolean>, // For testing purposes, not real usage

  // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:
  "subjectCodeableConcept" : { CodeableConcept },
  "subjectReference" : { Reference(Group) },
  "date" : "<dateTime>", // Date last changed
  "publisher" : "<string>", // Name of the publisher (organization or individual)
  "contact" : [{ ContactDetail }], // Contact details for the publisher
  "description" : "<markdown>", // Natural language description of the measure
  "useContext" : [{ UsageContext }], // The context that the content is intended to support
  "jurisdiction" : [{ CodeableConcept }], // Intended jurisdiction for measure (if applicable)
  "purpose" : "<markdown>", // Why this measure is defined
  "usage" : "<string>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Use and/or publishing restrictions
  "approvalDate" : "<date>", // When the measure was approved by publisher
  "lastReviewDate" : "<date>", // When the measure was last reviewed
  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "topic" : [{ CodeableConcept }], // The category of the measure, such as Education, Treatment, Assessment, etc.
  "

  "author" : [{ ContactDetail }], // Who authored the content
  "editor" : [{ ContactDetail }], // Who edited the content
  "reviewer" : [{ ContactDetail }], // Who reviewed the content
  "endorser" : [{ ContactDetail }], // Who endorsed the content

  "relatedArtifact" : [{ RelatedArtifact }], // Additional documentation, citations, etc.
  "

  "library" : [{ canonical(Library) }], // Logic used by the measure

  "disclaimer" : "<markdown>", // Disclaimer for use of the measure or its referenced content
  "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort
  "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted
  "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome | composite
  "riskAdjustment" : "<string>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<string>", // How is rate aggregation performed for this measure
  "

  "rationale" : "<markdown>", // Detailed description of why the measure exists

  "clinicalRecommendationStatement" : "<markdown>", // Summary of clinical guidelines
  "

  "improvementNotation" : "<code>", // increase | decrease

  "definition" : ["<markdown>"], // Defined terms used in the measure documentation
  "guidance" : "<markdown>", // Additional guidance for implementers
  "

  "group" : [{ // Population criteria group
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<string>", // Summary description
    "population" : [{ // Population criteria
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      "description" : "<string>", // The human readable description of this population criteria
      "

      "criteria" : { Expression } // R!  The criteria that defines this population

    }],
    "stratifier" : [{ // Stratifier criteria for the measure
      "code" : { CodeableConcept }, // Meaning of the stratifier
      "description" : "<string>", // The human readable description of this stratifier
      "
      "

      "criteria" : { Expression } // R!  How the measure should be stratified

    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor
    "description" : "<string>", // The human readable description of this supplemental data
    "
    "

    "criteria" : { Expression } // R!  Expression describing additional data to be reported

  }]
}

Turtle Template 

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Measure;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:

  fhir:Measure.url [ uri ]; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)

  fhir:Measure.identifier [ Identifier ], ... ; # 0..* Additional identifier for the measure
  fhir:Measure.version [ string ]; # 0..1 Business version of the measure
  fhir:Measure.name [ string ]; # 0..1 Name for this measure (computer friendly)
  fhir:Measure.title [ string ]; # 0..1 Name for this measure (human friendly)
  fhir:Measure.subtitle [ string ]; # 0..1 Subordinate title of the measure
  fhir:Measure.status [ code ]; # 1..1 draft | active | retired | unknown
  fhir:

  fhir:Measure.experimental [ boolean ]; # 0..1 For testing purposes, not real usage

  # Measure.subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:Measure.subjectCodeableConcept [ CodeableConcept ]
    fhir:Measure.subjectReference [ Reference(Group) ]
  fhir:Measure.date [ dateTime ]; # 0..1 Date last changed
  fhir:Measure.publisher [ string ]; # 0..1 Name of the publisher (organization or individual)
  fhir:Measure.contact [ ContactDetail ], ... ; # 0..* Contact details for the publisher
  fhir:Measure.description [ markdown ]; # 0..1 Natural language description of the measure
  fhir:Measure.useContext [ UsageContext ], ... ; # 0..* The context that the content is intended to support
  fhir:Measure.jurisdiction [ CodeableConcept ], ... ; # 0..* Intended jurisdiction for measure (if applicable)
  fhir:Measure.purpose [ markdown ]; # 0..1 Why this measure is defined
  fhir:Measure.usage [ string ]; # 0..1 Describes the clinical usage of the measure
  fhir:Measure.copyright [ markdown ]; # 0..1 Use and/or publishing restrictions
  fhir:Measure.approvalDate [ date ]; # 0..1 When the measure was approved by publisher
  fhir:Measure.lastReviewDate [ date ]; # 0..1 When the measure was last reviewed
  fhir:Measure.effectivePeriod [ Period ]; # 0..1 When the measure is expected to be used
  fhir:Measure.topic [ CodeableConcept ], ... ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc.
  fhir:

  fhir:Measure.author [ ContactDetail ], ... ; # 0..* Who authored the content
  fhir:Measure.editor [ ContactDetail ], ... ; # 0..* Who edited the content
  fhir:Measure.reviewer [ ContactDetail ], ... ; # 0..* Who reviewed the content
  fhir:Measure.endorser [ ContactDetail ], ... ; # 0..* Who endorsed the content

  fhir:Measure.relatedArtifact [ RelatedArtifact ], ... ; # 0..* Additional documentation, citations, etc.
  fhir:Measure.library [ canonical(Library) ], ... ; # 0..* Logic used by the measure
  fhir:Measure.disclaimer [ markdown ]; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:Measure.scoring [ CodeableConcept ]; # 0..1 proportion | ratio | continuous-variable | cohort
  fhir:Measure.compositeScoring [ CodeableConcept ]; # 0..1 opportunity | all-or-nothing | linear | weighted
  fhir:Measure.type [ CodeableConcept ], ... ; # 0..* process | outcome | structure | patient-reported-outcome | composite
  fhir:Measure.riskAdjustment [ string ]; # 0..1 How risk adjustment is applied for this measure
  fhir:Measure.rateAggregation [ string ]; # 0..1 How is rate aggregation performed for this measure
  fhir:

  fhir:Measure.rationale [ markdown ]; # 0..1 Detailed description of why the measure exists

  fhir:Measure.clinicalRecommendationStatement [ markdown ]; # 0..1 Summary of clinical guidelines
  fhir:

  fhir:Measure.improvementNotation [ code ]; # 0..1 increase | decrease

  fhir:Measure.definition [ markdown ], ... ; # 0..* Defined terms used in the measure documentation
  fhir:Measure.guidance [ markdown ]; # 0..1 Additional guidance for implementers
  fhir:

  fhir:Measure.group [ # 0..* Population criteria group
    fhir:Measure.group.code [ CodeableConcept ]; # 0..1 Meaning of the group
    fhir:Measure.group.description [ string ]; # 0..1 Summary description
    fhir:Measure.group.population [ # 0..* Population criteria
      fhir:Measure.group.population.code [ CodeableConcept ]; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:Measure.group.population.description [ string ]; # 0..1 The human readable description of this population criteria
      fhir:

      fhir:Measure.group.population.criteria [ Expression ]; # 1..1 The criteria that defines this population

    ], ...;
    fhir:Measure.group.stratifier [ # 0..* Stratifier criteria for the measure
      fhir:Measure.group.stratifier.code [ CodeableConcept ]; # 0..1 Meaning of the stratifier
      fhir:Measure.group.stratifier.description [ string ]; # 0..1 The human readable description of this stratifier
      fhir:
      fhir:

      fhir:Measure.group.stratifier.criteria [ Expression ]; # 1..1 How the measure should be stratified

    ], ...;
  ], ...;
  fhir:Measure.supplementalData [ # 0..* What other data should be reported with the measure
    fhir:Measure.supplementalData.code [ CodeableConcept ]; # 0..1 Meaning of the supplemental data
    fhir:Measure.supplementalData.usage [ CodeableConcept ], ... ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:Measure.supplementalData.description [ string ]; # 0..1 The human readable description of this supplemental data
    fhir:
    fhir:

    fhir:Measure.supplementalData.criteria [ Expression ]; # 1..1 Expression describing additional data to be reported

  ], ...;
]

Changes since DSTU2 Release 3

Measure
Measure.subtitle
  • Added Element
Measure.experimental
  • No longer marked as Modifier
Measure.subject[x]
  • Added Element
Measure.author
  • Added Element
Measure.editor
  • Added Element
Measure.reviewer
  • Added Element
Measure.endorser
  • Added Element
Measure.library
  • Type changed from Reference(Library) to canonical
Measure.improvementNotation
  • Type changed from string to code
  • Add Binding http://hl7.org/fhir/ValueSet/measure-improvement-notation (required)
Measure.group.code
  • Added Element
Measure.group.population.criteria
  • Type changed from string to Expression
Measure.group.stratifier.code
  • Added Element
Measure.group.stratifier.description
  • Added Element
Measure.group.stratifier.criteria
  • Min Cardinality changed from 0 to 1
  • Type changed from string to Expression
Measure.supplementalData.code
  • Added Element
Measure.supplementalData.description
  • Added Element
Measure.supplementalData.criteria
  • Min Cardinality changed from 0 to 1
  • Type changed from string to Expression
Measure.contributor
  • deleted
Measure.set
  • deleted
Measure.group.identifier
  • deleted
Measure.group.name
  • deleted
Measure.group.population.identifier
  • deleted
Measure.group.population.name
  • deleted
Measure.group.stratifier.identifier
  • deleted
Measure.group.stratifier.path
  • deleted
Measure.supplementalData.identifier
  • deleted
Measure.supplementalData.path
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON .

See R3 <--> R4 Conversion Maps (status = 6 tests of which 6 fail to execute .)

 

Alternate See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON , XML Schema / Schematron + JSON Schema , ShEx (for Turtle ) + see the extensions & the dependency analysis

14.11.3.1 Terminology Bindings

Path Definition Type Reference
Measure.status The lifecycle status of an artifact. Required PublicationStatus
Measure.subject[x] The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.) etc.). Extensible SubjectType
Measure.jurisdiction Countries and regions within which this artifact is targeted for use use. Extensible Jurisdiction ValueSet
Measure.topic High-level categorization of the definition, used for searching, sorting, and filtering filtering. Example DefinitionTopic
Measure.scoring The scoring type of the measure measure. Extensible MeasureScoring
Measure.compositeScoring The composite scoring method of the measure measure. Extensible CompositeMeasureScoring
Measure.type The type of measure (includes codes from 2.16.840.1.113883.1.11.20368) 2.16.840.1.113883.1.11.20368). Extensible MeasureType
Measure.improvementNotation Improvement notation for a measure (e.g. increase or decrease). Required MeasureImprovementNotation
Measure.group.population.code The type of population population. Extensible MeasurePopulationType
Measure.supplementalData.usage The intended usage for supplemental data elements in the measure measure. Extensible MeasureDataUsage

14.11.3.2 Constraints

id Level Location Description Expression
mea-0 Warning (base) Name should be usable as an identifier for the module by machine processing applications such as code generation name.matches('[A-Z]([A-Za-z0-9_]){0,254}')

14.11.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
composed-of reference What resource is being referenced Measure.relatedArtifact.where(type='composed-of').resource
(Any)
context token A use context assigned to the measure (Measure.useContext.value as CodeableConcept)
context-quantity quantity A quantity- or range-valued use context assigned to the measure (Measure.useContext.value as Quantity) | (Measure.useContext.value as Range)
context-type token A type of use context assigned to the measure Measure.useContext.code
context-type-quantity composite A use context type and quantity- or range-based value assigned to the measure On Measure.useContext:
  context-type: code
  context-quantity: value.as(Quantity) | value.as(Range)
context-type-value composite A use context type and value assigned to the measure On Measure.useContext:
  context-type: code
  context: value.as(CodeableConcept)
date date The measure publication date Measure.date
depends-on reference What resource is being referenced Measure.relatedArtifact.where(type='depends-on').resource | Measure.library
( Library ) , Any)
derived-from reference What resource is being referenced Measure.relatedArtifact.where(type='derived-from').resource
(Any)
description string The description of the measure Measure.description
effective date The time during which the measure is intended to be in use Measure.effectivePeriod
identifier token External identifier for the measure Measure.identifier
jurisdiction token Intended jurisdiction for the measure Measure.jurisdiction
name string Computationally friendly name of the measure Measure.name
predecessor reference What resource is being referenced Measure.relatedArtifact.where(type='predecessor').resource
(Any)
publisher string Name of the publisher of the measure Measure.publisher
status token The current status of the measure Measure.status
successor reference What resource is being referenced Measure.relatedArtifact.where(type='successor').resource
(Any)
title string The human-friendly name of the measure Measure.title
topic token Topics associated with the measure Measure.topic
url uri The uri that identifies the measure Measure.url
version token The business version of the measure Measure.version