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14.14 17.15 Resource Measure - Content

Responsible Owner: Clinical Quality Information icon Work Group Maturity Level : 2   Trial Use Normative Security Category : Anonymous Compartments : Not linked to any No defined compartments

The Measure resource provides the definition of a quality measure.

14.14.1 17.15.1 Scope and Usage

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

Note that the Measure itself does not typically contain any logic; rather a Library resource is referenced that contains the logic required by the measure, and the various expression elements, such as population criteria, reference named expressions within that library (or libraries). In addition, if the Measure references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression. Different measure types will contain different population criteria. Some measures may contain multiple rates. Measures can also specify stratifications to subdivide the measure population and/or supplemental data to communicate additional information about a population.

The data of interest for a measure is described as a set of data requirements, and include the specific data type, as well as any constraints. If the measure is specified computably, this information may be inferred by static analysis of the logic used to defined the population criteria. This capability is exposed via the $data-requirements operation.

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

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

14.14.2 17.15.2 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 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 ObservationDefinition resource, with the exception in that the Measure it is purely definitional, it contains no actual measurements, only a description of how to calculate a particular measurement or set of measurements. Measure is different from ObservationDefinition in that Measure is intended to provide a computable specification.

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

This resource is referenced by CarePlan Mappings from the V3 to the FHIR terminologies can be found in the Quality Measure IG icon.

17.15.3 References to this Resource

14.14.3 17.15.4 Resource Content

Structure

0..1 Intended jurisdiction for Use and/or publishing 0..1 markdown Summary increase markdown markdown 0..* Population criteria group BackboneElement 1..1 BackboneElement 1..1 BackboneElement
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Measure I TU N DomainResource A quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
Interfaces Implemented: MetadataResource
. . . url Σ C 0..1 uri Canonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
. . . identifier Σ 0..* Identifier Additional identifier for the measure

. . . version Σ 0..1 string Business version of the measure
. . name . versionAlgorithm[x] Σ I 0..1 How to compare versions
Binding: Version Algorithm ( Extensible )
. . . . versionAlgorithmString string
. . . . versionAlgorithmCoding Coding
... name Σ C 0..1 string Name for this measure (computer friendly)
. . . title Σ T 0..1 string Name for this measure (human friendly)
. . . subtitle T 0..1 string Subordinate title of the measure
. . . status ?! Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus ( Required )
. . . experimental Σ 0..1 boolean For testing purposes, not only - never for real usage
. . . subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Subject type Binding: Participant Resource Types ( Extensible )
. . . . subjectCodeableConcept CodeableConcept
. . . . subjectReference Reference ( Group )
. . . date Σ 0..1 dateTime Date last changed
. . . publisher Σ T 0..1 string Name of the publisher publisher/steward (organization or individual)
. . . contact Σ 0..* ContactDetail Contact details for the publisher

. . . description Σ T 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 Jurisdiction of the authority that maintains the measure (if applicable)
Binding: Jurisdiction ValueSet icon ( Extensible )

. . . purpose T 0..1 markdown Why this measure is defined
. . . usage T 0..1 string markdown Describes the clinical usage of the measure
. . . copyright T 0..1 markdown Notice about intellectual property ownership, can include restrictions on use
. . approvalDate . copyrightLabel T 0..1 string Copyright holder and year(s)
... approvalDate 0..1 date When the measure was approved by publisher
. . . lastReviewDate 0..1 date When the measure was last reviewed by the publisher
. . . effectivePeriod Σ 0..1 Period When the measure is expected to be used
. . . topic reportingFrequency 0..1 Quantity The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
Binding: Frequency Unit ( Extensible )
0..*
. . . topic 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. etc
DefinitionTopic Binding: Definition Topic ( Example )

. . . author 0..* ContactDetail 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

. . . relatedArtifact C 0..* RelatedArtifact Additional documentation, citations, etc. etc
+ Warning: Dependencies and components of a Measure should reference a resource

. . . 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 . riskAdjustment Σ 0..1 markdown How risk adjustment is applied for this measure
... rateAggregation Σ 0..1 markdown How is rate aggregation performed for this measure
... rationale Σ 0..1 markdown CodeableConcept Justification for the measure in terms of impact, gap in care, and evidence
... clinicalRecommendationStatement proportion | ratio | continuous-variable | cohort Σ 0..1 markdown Summary of clinical guidelines
MeasureScoring
. . . term 0..* BackboneElement Defined terms used in the measure documentation

.... code 0..1 CodeableConcept What term?
Binding: Measure Definition Example ( Extensible Example )
. . compositeScoring . . definition 0..1 markdown Meaning of the term
... guidance Σ 0..1 markdown Additional guidance for implementers (deprecated)
... group C 0..* BackboneElement Population criteria group

.... linkId C 0..1 string CodeableConcept Unique id for group in measure
+ Warning: Link ids should be 255 characters or less
.... title opportunity | all-or-nothing | linear | weighted 0..1 string Title of the group. This title is expected in the corresponding MeasureReport.group.title
CompositeMeasureScoring
. . . . code 0..1 CodeableConcept Meaning of the group
Binding: Measure Group Example ( Extensible Example )
. . . . description 0..1 markdown Summary description
.. . . type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType icon ( Extensible )

. . riskAdjustment . . subject[x] 0..1 Σ E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types ( Extensible )
. . . . . subjectCodeableConcept string CodeableConcept How risk adjustment is applied for this measure
. . . . . subjectReference Reference ( Group )
.. . . rateAggregation basis Σ 0..1 string code Population basis
Binding: All FHIR Types ( Required )
How is rate aggregation performed for this measure
. . . rationale . basisRequirement C Σ 0..* DataRequirement Population basis requirements
+ Rule: Basis requirements SHALL have a type, MAY have profile and codeFilter elements, and SHALL NOT specify dateFilter, valueFilter, limit, or sort

0..1
. . . . scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite
Binding: Measure Scoring icon ( Extensible )
Detailed description of why the measure exists
. . . clinicalRecommendationStatement . scoringUnit Σ 0..1 CodeableConcept markdown What units?
Binding: Measure Scoring Unit ( Example )
. . . . scoringPrecision Σ 0..1 positiveInt How many decimals (The number of clinical guidelines decimal places to include in the score when the score is a decimal-valued result)
. . . . improvementNotation compositeScoring Σ 0..1 CodeableConcept opportunity | decrease all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring icon MeasureImprovementNotation ( Required Extensible )
. . definition . . component 0..* Σ BackboneElement A component of a composite measure

0..*
. . . . . measure Defined terms used in the measure documentation 0..1 canonical () What measure?
. . . . guidance . groupId 0..1 Σ string What group?
0..1
. . . . . weight 0..1 decimal What weight?
Additional guidance for implementers
. . . group . rateAggregation Σ 0..1 BackboneElement markdown How is rate aggregation performed for this measure
. . . . code improvementNotation Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation icon ( Extensible )
Meaning of the group
. . . . description improvementNotationGuidance Σ 0..1 string markdown Explanation of improvement notation
Summary description
. . . population . library 0..* canonical ( Library ) Logic used by the measure group

0..*
. . . . population 0..* BackboneElement Population criteria

. . . . code . linkId C 0..1 string Unique id for population in measure
+ Warning: Link ids should be 255 characters or less
..... title 0..1 string Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
..... code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType icon ( Extensible )
. . . . . description 0..1 string markdown The human readable description of this population criteria
. . . . . criteria 0..1 Expression The criteria that defines this population
. . . . . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
..... inputPopulationId 0..1 string Which population
. . . . . aggregateMethod 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Binding: Measure Aggregate Method icon ( Extensible )
... . stratifier C 0..* BackboneElement Stratifier criteria for the measure

. . . . code . linkId C 0..1 string Unique id for stratifier in measure
+ Warning: Link ids should be 255 characters or less
..... title 0..1 string Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
..... code C 0..1 CodeableConcept Meaning of the stratifier
Binding: Measure Stratifier Example ( Example )
. . . . . description C 0..1 string markdown The human readable description of this stratifier
. . . . . criteria C 0..1 Expression How the measure should be stratified
. . . . component . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
0..*
. . . . . component C 0..* BackboneElement Stratifier criteria component for the measure

. . . . . code . linkId C 0..1 string Unique id for stratifier component in measure
+ Warning: Link ids should be 255 characters or less
...... code 0..1 CodeableConcept Meaning of the stratifier component
Binding: Measure Stratifier Example ( Example )
. . . . . . description 0..1 string markdown The human readable description of this stratifier component
. . . . . . criteria 0..1 Expression Component of how the measure should be stratified
. . . . . . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
. . . . . . valueSet 0..1 canonical ( ValueSet ) What stratum values?
.... . supplementalData . unit 0..1 string What units?
0..*
. . . supplementalData 0..* BackboneElement What other data should be reported with the measure

. . . code . linkId C 0..1 string Unique id for supplementalData in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1 CodeableConcept Meaning of the supplemental data
Binding: Measure Supplemental Data Example ( Example )
. . . . usage 0..* CodeableConcept supplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage icon ( Extensible )

. . . . description 0..1 string markdown The human readable description of this supplemental data
. . . . criteria 1..1 Expression Expression describing additional data to be reported
. . . . valueSet 0..1 canonical ( ValueSet ) What supplemental data values?
.... unit 0..1 string What units?

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Measure ( DomainResource ) + MetadataResource An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers 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] Indicates the mechanism used to compare versions to determine which is more current versionAlgorithm[x] : DataType [0..1] « string | Coding ; null (Strength=Extensible) VersionAlgorithm + » 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] « This element has or is affected by some invariants C » 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. null (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 no version of this resource will ever be used intended for genuine usage 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 DataType [0..1] « CodeableConcept | Reference ( Group ); The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.). null (Strength=Extensible) SubjectType ParticipantResourceTypes + » The date (and optionally time) when the measure was published. last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes date : dateTime [0..1] The name of the organization or individual that published responsible for the release and ongoing maintenance of 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 contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances useContext : UsageContext [0..*] A legal or geographic region in which the measure authority that maintains the resource is intended to be used operating. In general, the jurisdiction is also found in the useContext. The useContext may reference additional jurisdictions because the defining jurisdiction does not necessarily limit the jurisdictions of use jurisdiction : CodeableConcept [0..*] « Countries and regions within which this artifact is targeted for use. null (Strength=Extensible) Jurisdiction ValueSet JurisdictionValueSet + » 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 markdown [0..1] A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal notices of intellectual property ownership and can include restrictions on the use and publishing of the measure copyright : markdown [0..1] A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are restricted. (e.g. 'All rights reserved', 'Some rights reserved') copyrightLabel : string [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] The frequency that this measure should be reported, usually specified by the program it is being submitted to reportingFrequency : Quantity [0..1] « null (Strength=Extensible) FrequencyUnit + » 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. null (Strength=Example) DefinitionTopic ?? » 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 asserted by the publisher to be primarily responsible for review of some aspect of the content reviewer : ContactDetail [0..*] An individual or organization asserted by the publisher to be 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 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 : markdown [0..1] Describes how to combine the calculation is performed information calculated, based on logic in each of several populations, into one summarized result rateAggregation : markdown [0..1] Provides a detailed justification of the need for the measure, measure including proportion, ratio, continuous-variable, statements pertaining to importance criterion: impact, gap in care, and cohort. The value set is extensible, allowing additional evidence rationale : markdown [0..1] Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure scoring types to clinicalRecommendationStatement : markdown [0..1] Additional guidance for the measure including how it can be represented used in a clinical context, and the intent of the measure scoring guidance : CodeableConcept markdown [0..1] « The scoring type Term A codeable representation of the measure. (Strength=Extensible) defined term MeasureScoring code + : CodeableConcept [0..1] « null (Strength=Example) MeasureDefinitionExample ?? » If this is Provides a composite measure, definition for the scoring method term as used to combine within the component measures measure definition : markdown [0..1] Group An identifier that is unique within the Measure allowing linkage to determine the composite score equivalent item in a MeasureReport resource compositeScoring linkId : string [0..1] Indicates the title for the group title : string [0..1] 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] « null (Strength=Example) MeasureGroupExample ?? » The composite scoring method human readable description of the measure. (Strength=Extensible) this population group CompositeMeasureScoring description + » : markdown [0..1] 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..*] « null (Strength=Extensible) MeasureType + » The type intended subjects for the measure. If this element is not provided, there is no subject context (i.e. population criteria are evaluated from the perspective of measure (includes codes the entire system, rather than from 2.16.840.1.113883.1.11.20368). the perspective of a particular subject) subject[x] : DataType [0..1] « CodeableConcept | Reference ( Group ); null (Strength=Extensible) MeasureType ParticipantResourceTypes + » A description The population basis specifies the type of elements in the risk adjustment factors that may impact population. For a subject-based measure, this is boolean (because the resulting score subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and how they a population basis of Encounter, and the population criteria all return lists of Encounters basis : code [0..1] « null (Strength=Required) FHIRTypes ! » Specifies population basis requirements (i.e. what constitutes a case, or what is being counted) as a DataRequirement. If multiple basisRequirements are specified, criteria expressions may return data that satisfies ANY basisRequirement. A data element satisfies a basisRequirement if the instance `is` of the type, conforms to ALL the specified profiles, and matches ALL the codeFilters. basisRequirements SHALL specify type, MAY specify profile and codeFilter, and SHALL NOT specify dateFilter, valueFilter, limit, or sort. If basis is specified, any basisRequirement SHALL be accounted consistent with the specified basis (i.e. the type of each basisRequirement SHALL be the same type as, or a subtype of the basis type) basisRequirement : DataRequirement [0..*] Indicates how the calculation is performed for when computing the measure, including proportion, ratio, continuous-variable, and reporting cohort. The value set is extensible, allowing additional measure results scoring types to be represented riskAdjustment scoring : string CodeableConcept [0..1] « null (Strength=Extensible) MeasureScoring + » Describes how to combine Defines the information calculated, based on logic in each expected units of several populations, into one summarized result measure for the measure score. This element SHOULD be specified as a UCUM unit rateAggregation scoringUnit : string CodeableConcept [0..1] « null (Strength=Example) MeasureScoringUnit ?? » Provides When the score is a succinct statement decimal value this should be used to specify the expected minimum number of digits after the need decimal point to use for the measure. Usually includes statements pertaining to importance criterion: impact, gap precision of the value. When a scoringUnit is also specified, this value is the expected minimum number of digits after the decimal point when the score is expressed in care, and evidence the units specified rationale scoringPrecision : markdown positiveInt [0..1] Provides If this is a summary of relevant clinical guidelines or other clinical recommendations supporting composite measure, the measure scoring method used to combine the component measures to determine the composite score clinicalRecommendationStatement compositeScoring : CodeableConcept [0..1] « null (Strength=Extensible) CompositeMeasureScoring + » Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result rateAggregation : 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) range). Exercise caution when using any values besides increase or decrease for improvementNotation improvementNotation : CodeableConcept [0..1] « Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. (Strength=Required) null (Strength=Extensible) MeasureImprovementNotation ! + » Provides a description of an individual term used within Narrative text to explain the measure improvement notation and how to interpret it definition improvementNotationGuidance : markdown [0..*] [0..1] Additional guidance for the measure including how it can be used in A reference to a clinical context, and Library resource containing the intent of formal logic used by the measure group guidance library : markdown canonical [0..1] [0..*] « Library » Group Component Indicates a meaning for The measure that contains the group. This can be as simple as a unique identifier, or it can establish meaning in definition of the component calculation measure : canonical [0..1] « » Specifies the id of a broader context particular group within the measure referenced by drawing from a terminology, allowing groups to be correlated across measures the related artifact resource code groupId : CodeableConcept string [0..1] The human readable description What is the weight of the contribution of this population group measure to the overall score description weight : string decimal [0..1] Population An identifier that is unique within the Measure allowing linkage to the equivalent population in a MeasureReport resource linkId : string [0..1] Indicates the title for the group's population title : string [0..1] The type of population criteria code : CodeableConcept [0..1] « The type of population. null (Strength=Extensible) MeasurePopulationType + » The human readable description of this population criteria description : string markdown [0..1] An expression that specifies the criteria for the population, typically the name of an expression in a library criteria : Expression [1..1] [0..1] A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting point inputPopulationId : string [0..1] Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculation aggregateMethod : CodeableConcept [0..1] « null (Strength=Extensible) MeasureAggregateMethod + » Stratifier An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] Indicates the title for the stratifier of the group title : string [0..1] 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] « null (Strength=Example) MeasureStratifierExample ?? » « This element has or is affected by some invariants C » The human readable description of this stratifier criteria description : string markdown [0..1] « This element has or is affected by some invariants C » An expression that specifies the criteria a criteria-based stratifier for the stratifier. measure. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element and SHALL use the same basis as other population criteria for the population group criteria : Expression [0..1] « This element has or is affected by some invariants C » A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » Component An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures code : CodeableConcept [0..1] « null (Strength=Example) MeasureStratifierExample ?? » The human readable description of this stratifier criteria component description : string markdown [0..1] An expression that specifies returns the criteria for value of this component of the stratifier. stratifier for a member of the population. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element element, evaluated from the perspective of the measure subject. If this is a non-subject-based measure, the expression may be a reference to a function that takes an argument of the type of the measure basis, allowing the stratifier value to be determined for each member of the population criteria : Expression [1..1] [0..1] A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value `01Y--05Y` with the system ignored) valueSet : canonical [0..1] « ValueSet » Indicates what units, if any, stratifier values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units unit : string [0..1] SupplementalData An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] 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] « null (Strength=Example) MeasureSupplementalDataExample ?? » 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. null (Strength=Extensible) MeasureDataUsage + » The human readable description of this supplemental data description : string markdown [0..1] The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element criteria : Expression [1..1] A value set defining the set of possible values for supplemental data in this element. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce supplemental data values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value `01Y--05Y` with the system ignored) valueSet : canonical [0..1] « ValueSet » Indicates what units, if any, supplemental data values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units unit : string [0..1] Provides a description of an individual term used within the measure term [0..*] If this is a composite measure, a component of the composite component [0..*] A population criteria for the measure population [0..*] The A component of a value-based stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path component [0..*] A stratifier for the measure, specified as either a criteria expression, or a set of components that define value-based stratifier expressions 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 -->
 <

 <versionAlgorithm[x]><!-- 0..1 string|Coding How to compare versions --></versionAlgorithm[x]>
 <name value="[string]"/><!-- I 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 -->
 <
 <</subject[x]>
 <
 <

 <experimental value="[boolean]"/><!-- 0..1 For testing only - never for 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/steward (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>

 <jurisdiction><!-- 0..* CodeableConcept Jurisdiction of the authority that maintains the measure (if applicable) icon --></jurisdiction>

 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <
 <

 <usage value="[markdown]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Notice about intellectual property ownership, can include restrictions on use -->
 <copyrightLabel value="[string]"/><!-- 0..1 Copyright holder and year(s) -->

 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <

 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed by the publisher -->

 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <</topic>

 <reportingFrequency><!-- 0..1 Quantity The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly) --></reportingFrequency>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc --></topic>

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

 <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>
 <</compositeScoring>
 <</type>
 <
 <
 <

 <riskAdjustment value="[markdown]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[markdown]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Justification for the measure in terms of impact, gap in care, and evidence -->

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

 <term>  <!-- 0..* Defined terms used in the measure documentation -->
  <code><!-- 0..1 CodeableConcept What term? --></code>
  <definition value="[markdown]"/><!-- 0..1 Meaning of the term -->
 </term>
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers (deprecated) -->
 <group>  <!-- I 0..* Population criteria group -->
  <linkId value="[string]"/><!-- 0..1 Unique id for group in measure -->
  <title value="[string]"/><!-- 0..1 Title of the group. This title is expected in the corresponding MeasureReport.group.title -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[markdown]"/><!-- 0..1 Summary description -->
  <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome icon --></type>
  <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
  <basis value="[code]"/><!-- 0..1 Population basis -->
  <basisRequirement><!-- 0..* DataRequirement Population basis requirements --></basisRequirement>
  <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite icon --></scoring>
  <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
  <scoringPrecision value="[positiveInt]"/><!-- 0..1 How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result) -->
  <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted icon --></compositeScoring>
  <component>  <!-- 0..* A component of a composite measure -->
   <measure value="[canonical]"/><!-- 0..1 What measure? -->
   <groupId value="[string]"/><!-- 0..1 What group? -->
   <weight value="[decimal]"/><!-- 0..1 What weight? -->
  </component>
  <rateAggregation value="[markdown]"/><!-- 0..1 How is rate aggregation performed for this measure -->
  <improvementNotation><!-- 0..1 CodeableConcept increase | decrease icon --></improvementNotation>
  <improvementNotationGuidance value="[markdown]"/><!-- 0..1 Explanation of improvement notation -->
  <library><!-- 0..* canonical(Library) Logic used by the measure group --></library>

  <population>  <!-- 0..* Population criteria -->
   <</code>
   <
   <</criteria>

   <linkId value="[string]"/><!-- 0..1 Unique id for population in measure -->
   <title value="[string]"/><!-- 0..1 Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation icon --></code>
   <description value="[markdown]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria><!-- 0..1 Expression The criteria that defines this population --></criteria>
   <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
   <inputPopulationId value="[string]"/><!-- 0..1 Which population -->
   <aggregateMethod><!-- 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) icon --></aggregateMethod>

  </population>
  <
   <</code>
   <
   <</criteria>
   <
    <</code>
    <
    <</criteria>

  <stratifier>  <!-- I 0..* Stratifier criteria for the measure -->
   <linkId value="[string]"/><!-- 0..1 Unique id for stratifier in measure -->
   <title value="[string]"/><!-- 0..1 Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title -->
   <code><!-- I 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[markdown]"/><!-- I 0..1 The human readable description of this stratifier -->
   <criteria><!-- I 0..1 Expression How the measure should be stratified --></criteria>
   <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
   <component>  <!-- I 0..* Stratifier criteria component for the measure -->
    <linkId value="[string]"/><!-- 0..1 Unique id for stratifier component in measure -->
    <code><!-- 0..1 CodeableConcept Meaning of the stratifier component --></code>
    <description value="[markdown]"/><!-- 0..1 The human readable description of this stratifier component -->
    <criteria><!-- 0..1 Expression Component of how the measure should be stratified --></criteria>
    <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
    <valueSet><!-- 0..1 canonical(ValueSet) What stratum values? --></valueSet>
    <unit value="[string]"/><!-- 0..1 What units? -->

   </component>
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <</code>
  <</usage>
  <

  <linkId value="[string]"/><!-- 0..1 Unique id for supplementalData in measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor icon --></usage>
  <description value="[markdown]"/><!-- 0..1 The human readable description of this supplemental data -->

  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>
  <valueSet><!-- 0..1 canonical(ValueSet) What supplemental data values? --></valueSet>
  <unit value="[string]"/><!-- 0..1 What units? -->

 </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
  "

  // versionAlgorithm[x]: How to compare versions. One of these 2:
  "versionAlgorithmString" : "<string>",
  "versionAlgorithmCoding" : { Coding },
  "name" : "<string>", // I 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 only - never for 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/steward (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 }], // Jurisdiction of the authority that maintains the measure (if applicable) icon

  "purpose" : "<markdown>", // Why this measure is defined
  "
  "

  "usage" : "<markdown>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Notice about intellectual property ownership, can include restrictions on use
  "copyrightLabel" : "<string>", // Copyright holder and year(s)

  "approvalDate" : "<date>", // When the measure was approved by publisher
  "

  "lastReviewDate" : "<date>", // When the measure was last reviewed by the publisher

  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "

  "reportingFrequency" : { Quantity }, // The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
  "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
  "
  "
  "
  "
  "
  "

  "riskAdjustment" : "<markdown>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<markdown>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Justification for the measure in terms of impact, gap in care, and evidence

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

  "term" : [{ // Defined terms used in the measure documentation
    "code" : { CodeableConcept }, // What term?
    "definition" : "<markdown>" // Meaning of the term
  }],
  "guidance" : "<markdown>", // Additional guidance for implementers (deprecated)
  "group" : [{ // I Population criteria group
    "linkId" : "<string>", // Unique id for group in measure
    "title" : "<string>", // Title of the group. This title is expected in the corresponding MeasureReport.group.title
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<markdown>", // Summary description
    "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome icon
    // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:

    "subjectCodeableConcept" : { CodeableConcept },
    "subjectReference" : { Reference(Group) },
    "basis" : "<code>", // Population basis
    "basisRequirement" : [{ DataRequirement }], // Population basis requirements
    "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort | composite icon
    "scoringUnit" : { CodeableConcept }, // What units?
    "scoringPrecision" : "<positiveInt>", // How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result)
    "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted icon
    "component" : [{ // A component of a composite measure
      "measure" : "<canonical>", // What measure?
      "groupId" : "<string>", // What group?
      "weight" : <decimal> // What weight?
    }],
    "rateAggregation" : "<markdown>", // How is rate aggregation performed for this measure
    "improvementNotation" : { CodeableConcept }, // increase | decrease icon
    "improvementNotationGuidance" : "<markdown>", // Explanation of improvement notation
    "library" : ["<canonical(Library)>"], // Logic used by the measure group

    "population" : [{ // Population criteria
      "
      "
      "

      "linkId" : "<string>", // Unique id for population in measure
      "title" : "<string>", // Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation icon
      "description" : "<markdown>", // The human readable description of this population criteria
      "criteria" : { Expression }, // The criteria that defines this population
      "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
      "inputPopulationId" : "<string>", // Which population
      "aggregateMethod" : { CodeableConcept } // Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) icon

    }],
    "
      "
      "
      "
      "
        "
        "
        "

    "stratifier" : [{ // I Stratifier criteria for the measure
      "linkId" : "<string>", // Unique id for stratifier in measure
      "title" : "<string>", // Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
      "code" : { CodeableConcept }, // I Meaning of the stratifier
      "description" : "<markdown>", // I The human readable description of this stratifier
      "criteria" : { Expression }, // I How the measure should be stratified
      "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
      "component" : [{ // I Stratifier criteria component for the measure
        "linkId" : "<string>", // Unique id for stratifier component in measure
        "code" : { CodeableConcept }, // Meaning of the stratifier component
        "description" : "<markdown>", // The human readable description of this stratifier component
        "criteria" : { Expression }, // Component of how the measure should be stratified
        "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
        "valueSet" : "<canonical(ValueSet)>", // What stratum values?
        "unit" : "<string>" // What units?

      }]
    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "
    "
    "
    "

    "linkId" : "<string>", // Unique id for supplementalData in measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor icon
    "description" : "<markdown>", // The human readable description of this supplemental data
    "criteria" : { Expression }, // R!  Expression describing additional data to be reported
    "valueSet" : "<canonical(ValueSet)>", // What supplemental data values?
    "unit" : "<string>" // What units?

  }]
}

Turtle Template 

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


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

  # from 
  # from 
  fhir:
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  fhir:
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  fhir:
  fhir:
  # . One of these 2
    fhir: ]
    fhir:) ]
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
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  fhir:
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  fhir:
  fhir:
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  fhir:
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  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
      fhir:
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      fhir:
    ], ...;
    fhir:
      fhir:
      fhir:
      fhir:
      fhir:
        fhir:
        fhir:
        fhir:
      ], ...;
    ], ...;
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:url [ uri ] ; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Additional identifier for the measure
  fhir:version [ string ] ; # 0..1 Business version of the measure
  # versionAlgorithm[x] : 0..1 How to compare versions. One of these 2
    fhir:versionAlgorithm [  a fhir:String ; string ]
    fhir:versionAlgorithm [  a fhir:Coding ; Coding ]
  fhir:name [ string ] ; # 0..1 I Name for this measure (computer friendly)
  fhir:title [ string ] ; # 0..1 Name for this measure (human friendly)
  fhir:subtitle [ string ] ; # 0..1 Subordinate title of the measure
  fhir:status [ code ] ; # 1..1 draft | active | retired | unknown
  fhir:experimental [ boolean ] ; # 0..1 For testing only - never for real usage
  # subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:subject [  a fhir:CodeableConcept ; CodeableConcept ]
    fhir:subject [  a fhir:Reference ; Reference(Group) ]
  fhir:date [ dateTime ] ; # 0..1 Date last changed
  fhir:publisher [ string ] ; # 0..1 Name of the publisher/steward (organization or individual)
  fhir:contact  ( [ ContactDetail ] ... ) ; # 0..* Contact details for the publisher
  fhir:description [ markdown ] ; # 0..1 Natural language description of the measure
  fhir:useContext  ( [ UsageContext ] ... ) ; # 0..* The context that the content is intended to support
  fhir:jurisdiction  ( [ CodeableConcept ] ... ) ; # 0..* Jurisdiction of the authority that maintains the measure (if applicable)
  fhir:purpose [ markdown ] ; # 0..1 Why this measure is defined
  fhir:usage [ markdown ] ; # 0..1 Describes the clinical usage of the measure
  fhir:copyright [ markdown ] ; # 0..1 Notice about intellectual property ownership, can include restrictions on use
  fhir:copyrightLabel [ string ] ; # 0..1 Copyright holder and year(s)
  fhir:approvalDate [ date ] ; # 0..1 When the measure was approved by publisher
  fhir:lastReviewDate [ date ] ; # 0..1 When the measure was last reviewed by the publisher
  fhir:effectivePeriod [ Period ] ; # 0..1 When the measure is expected to be used
  fhir:reportingFrequency [ Quantity ] ; # 0..1 The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
  fhir:topic  ( [ CodeableConcept ] ... ) ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc
  fhir:author  ( [ ContactDetail ] ... ) ; # 0..* Who authored the content
  fhir:editor  ( [ ContactDetail ] ... ) ; # 0..* Who edited the content
  fhir:reviewer  ( [ ContactDetail ] ... ) ; # 0..* Who reviewed the content
  fhir:endorser  ( [ ContactDetail ] ... ) ; # 0..* Who endorsed the content
  fhir:relatedArtifact  ( [ RelatedArtifact ] ... ) ; # 0..* Additional documentation, citations, etc
  fhir:library  ( [ canonical(Library) ] ... ) ; # 0..* Logic used by the measure
  fhir:disclaimer [ markdown ] ; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:riskAdjustment [ markdown ] ; # 0..1 How risk adjustment is applied for this measure
  fhir:rateAggregation [ markdown ] ; # 0..1 How is rate aggregation performed for this measure
  fhir:rationale [ markdown ] ; # 0..1 Justification for the measure in terms of impact, gap in care, and evidence
  fhir:clinicalRecommendationStatement [ markdown ] ; # 0..1 Summary of clinical guidelines
  fhir:term ( [ # 0..* Defined terms used in the measure documentation
    fhir:code [ CodeableConcept ] ; # 0..1 What term?
    fhir:definition [ markdown ] ; # 0..1 Meaning of the term
  ] ... ) ;
  fhir:guidance [ markdown ] ; # 0..1 Additional guidance for implementers (deprecated)
  fhir:group ( [ # 0..* I Population criteria group
    fhir:linkId [ string ] ; # 0..1 Unique id for group in measure
    fhir:title [ string ] ; # 0..1 Title of the group. This title is expected in the corresponding MeasureReport.group.title
    fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the group
    fhir:description [ markdown ] ; # 0..1 Summary description
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* process | outcome | structure | patient-reported-outcome
    # subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
      fhir:subject [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:subject [  a fhir:Reference ; Reference(Group) ]
    fhir:basis [ code ] ; # 0..1 Population basis
    fhir:basisRequirement  ( [ DataRequirement ] ... ) ; # 0..* Population basis requirements
    fhir:scoring [ CodeableConcept ] ; # 0..1 proportion | ratio | continuous-variable | cohort | composite
    fhir:scoringUnit [ CodeableConcept ] ; # 0..1 What units?
    fhir:scoringPrecision [ positiveInt ] ; # 0..1 How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result)
    fhir:compositeScoring [ CodeableConcept ] ; # 0..1 opportunity | all-or-nothing | linear | weighted
    fhir:component ( [ # 0..* A component of a composite measure
      fhir:measure [ canonical ] ; # 0..1 What measure?
      fhir:groupId [ string ] ; # 0..1 What group?
      fhir:weight [ decimal ] ; # 0..1 What weight?
    ] ... ) ;
    fhir:rateAggregation [ markdown ] ; # 0..1 How is rate aggregation performed for this measure
    fhir:improvementNotation [ CodeableConcept ] ; # 0..1 increase | decrease
    fhir:improvementNotationGuidance [ markdown ] ; # 0..1 Explanation of improvement notation
    fhir:library  ( [ canonical(Library) ] ... ) ; # 0..* Logic used by the measure group
    fhir:population ( [ # 0..* Population criteria
      fhir:linkId [ string ] ; # 0..1 Unique id for population in measure
      fhir:title [ string ] ; # 0..1 Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
      fhir:code [ CodeableConcept ] ; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:description [ markdown ] ; # 0..1 The human readable description of this population criteria
      fhir:criteria [ Expression ] ; # 0..1 The criteria that defines this population
      fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
      fhir:inputPopulationId [ string ] ; # 0..1 Which population
      fhir:aggregateMethod [ CodeableConcept ] ; # 0..1 Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    ] ... ) ;
    fhir:stratifier ( [ # 0..* I Stratifier criteria for the measure
      fhir:linkId [ string ] ; # 0..1 Unique id for stratifier in measure
      fhir:title [ string ] ; # 0..1 Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
      fhir:code [ CodeableConcept ] ; # 0..1 I Meaning of the stratifier
      fhir:description [ markdown ] ; # 0..1 I The human readable description of this stratifier
      fhir:criteria [ Expression ] ; # 0..1 I How the measure should be stratified
      fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
      fhir:component ( [ # 0..* I Stratifier criteria component for the measure
        fhir:linkId [ string ] ; # 0..1 Unique id for stratifier component in measure
        fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the stratifier component
        fhir:description [ markdown ] ; # 0..1 The human readable description of this stratifier component
        fhir:criteria [ Expression ] ; # 0..1 Component of how the measure should be stratified
        fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
        fhir:valueSet [ canonical(ValueSet) ] ; # 0..1 What stratum values?
        fhir:unit [ string ] ; # 0..1 What units?
      ] ... ) ;
    ] ... ) ;
  ] ... ) ;
  fhir:supplementalData ( [ # 0..* What other data should be reported with the measure
    fhir:linkId [ string ] ; # 0..1 Unique id for supplementalData in measure
    fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the supplemental data
    fhir:usage  ( [ CodeableConcept ] ... ) ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:description [ markdown ] ; # 0..1 The human readable description of this supplemental data
    fhir:criteria [ Expression ] ; # 1..1 Expression describing additional data to be reported
    fhir:valueSet [ canonical(ValueSet) ] ; # 0..1 What supplemental data values?
    fhir:unit [ string ] ; # 0..1 What units?
  ] ... ) ;

]

Changes since R3 from R5 to R6

Measure
Measure.jurisdiction
Measure.subtitle Measure.reportingFrequency
  • Added Element
Measure.group.title
  • Added Element
Measure.status Measure.group.type
  • Change value set from http://hl7.org/fhir/ValueSet/publication-status http://hl7.org/fhir/ValueSet/measure-type to http://hl7.org/fhir/ValueSet/publication-status|4.0.1 MeasureType icon
Measure.experimental Measure.group.basis
  • No longer marked as Modifier Remove codes Element , BackboneElement , DataType , Address , Annotation , Attachment , Availability , BackboneType , Dosage , ElementDefinition , MarketingStatus , ProductShelfLife , Timing , CodeableConcept , CodeableReference , Coding , ContactDetail , ContactPoint , Contributor , DataRequirement , Expression , ExtendedContactDetail , Extension , HumanName , Identifier , Meta , MonetaryComponent , Money , Narrative , ParameterDefinition , Period , PrimitiveType , base64Binary , boolean , date , dateTime , decimal , instant , integer , positiveInt , unsignedInt , integer64 , string , code , id , markdown , time , uri , canonical , oid , url , uuid , Quantity , Age , Count , Distance , Duration , Range , Ratio , RatioRange , Reference , RelatedArtifact , SampledData , Signature , TriggerDefinition , UsageContext , VirtualServiceDetail , xhtml , Resource , Binary , Bundle , DomainResource , Account , ActivityDefinition , ActorDefinition , AdministrableProductDefinition , AdverseEvent , AllergyIntolerance , Appointment , AppointmentResponse , ArtifactAssessment , AuditEvent , Basic , BiologicallyDerivedProduct , BiologicallyDerivedProductDispense , BodyStructure , CanonicalResource , CapabilityStatement , CarePlan , CareTeam , ChargeItem , ChargeItemDefinition , Citation , Claim , ClaimResponse , ClinicalImpression , ClinicalUseDefinition , CodeSystem , Communication , CommunicationRequest , CompartmentDefinition , Composition , ConceptMap , Condition , ConditionDefinition , Consent , Contract , Coverage , CoverageEligibilityRequest , CoverageEligibilityResponse , DetectedIssue , Device , DeviceAssociation , DeviceDefinition , DeviceDispense , DeviceMetric , DeviceRequest , DeviceUsage , DiagnosticReport , DocumentReference , Encounter , EncounterHistory , Endpoint , EnrollmentRequest , EnrollmentResponse , EpisodeOfCare , EventDefinition , Evidence , EvidenceReport , EvidenceVariable , ExampleScenario , ExplanationOfBenefit , FamilyMemberHistory , Flag , FormularyItem , GenomicStudy , Goal , GraphDefinition , Group , GuidanceResponse , HealthcareService , ImagingSelection , ImagingStudy , Immunization , ImmunizationEvaluation , ImmunizationRecommendation , ImplementationGuide , Ingredient , InsurancePlan , InventoryItem , InventoryReport , Invoice , Library , Linkage , List , Location , ManufacturedItemDefinition , Measure , MeasureReport , Medication , MedicationAdministration , MedicationDispense , MedicationKnowledge , MedicationRequest , MedicationStatement , MedicinalProductDefinition , MessageDefinition , MessageHeader , MetadataResource , MolecularSequence , NamingSystem , NutritionIntake , NutritionOrder , NutritionProduct , Observation , ObservationDefinition , OperationDefinition , OperationOutcome , Organization , OrganizationAffiliation , PackagedProductDefinition , Patient , PaymentNotice , PaymentReconciliation , Permission , Person , PlanDefinition , Practitioner , PractitionerRole , Procedure , Provenance , Questionnaire , QuestionnaireResponse , RegulatedAuthorization , RelatedPerson , RequestOrchestration , Requirements , ResearchStudy , ResearchSubject , RiskAssessment , Schedule , SearchParameter , ServiceRequest , Slot , Specimen , SpecimenDefinition , StructureDefinition , StructureMap , Subscription , SubscriptionStatus , SubscriptionTopic , Substance , SubstanceDefinition , SubstanceNucleicAcid , SubstancePolymer , SubstanceProtein , SubstanceReferenceInformation , SubstanceSourceMaterial , SupplyDelivery , SupplyRequest , Task , TerminologyCapabilities , TestPlan , TestReport , TestScript , Transport , ValueSet , VerificationResult , VisionPrescription , Parameters
Measure.subject[x] Measure.group.basisRequirement
  • Added Element
Measure.author Measure.group.scoringPrecision
  • Added Element
Measure.editor Measure.group.compositeScoring
  • Added Element
Measure.reviewer Measure.group.component
  • Added Element
Measure.endorser Measure.group.component.measure
  • Added Element
Measure.group.component.groupId
  • Added Element
Measure.group.component.weight
  • Added Element
Measure.library Measure.group.improvementNotation
  • Type changed Change binding strength from Reference(Library) required to canonical(Library) extensible
  • Change value set from http://hl7.org/fhir/ValueSet/measure-improvement-notation|5.0.0 to MeasureImprovementNotation icon
Measure.group.improvementNotationGuidance
  • Added Element
Measure.group.population.title
  • Added Element
Measure.scoring Measure.group.population.code
  • Change code system for extensibly bound codes value set from "http://hl7.org/fhir/measure-scoring" http://hl7.org/fhir/ValueSet/measure-population to "http://terminology.hl7.org/CodeSystem/measure-scoring" MeasurePopulationType icon
Measure.compositeScoring Measure.group.population.aggregateMethod
  • Change value set from http://hl7.org/fhir/ValueSet/measure-aggregate-method to Measure Aggregate Method icon
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/composite-measure-scoring" "http://hl7.org/fhir/CodeSystem/measure-aggregate-method" to "http://terminology.hl7.org/CodeSystem/composite-measure-scoring" "http://terminology.hl7.org/CodeSystem/measure-aggregate-method"
Measure.group.stratifier.title
  • Added Element
Measure.group.stratifier.component.valueSet
  • Added Element
Measure.group.stratifier.component.unit
  • Added Element
Measure.supplementalData.usage
  • Change value set from http://hl7.org/fhir/ValueSet/measure-data-usage to MeasureDataUsage icon
Measure.supplementalData.valueSet
  • Added Element
Measure.supplementalData.unit
  • Added Element
Measure.basis
  • Deleted
Measure.scoring
  • Deleted
Measure.scoringUnit
  • Deleted
Measure.compositeScoring
  • Deleted
Measure.type
  • Deleted
Measure.improvementNotation
  • Deleted

Changes from R4 and R4B to R6

Measure
Measure.versionAlgorithm[x]
  • Added Element
Measure.subject[x]
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to Participant Resource Types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/measure-type" "http://hl7.org/fhir/resource-types" to "http://terminology.hl7.org/CodeSystem/measure-type" "http://hl7.org/fhir/fhir-types"
Measure.improvementNotation Measure.jurisdiction
Measure.usage
  • Type changed from string to CodeableConcept markdown
Measure.copyrightLabel
  • Add Binding http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 (required) Added Element
Measure.group.code Measure.reportingFrequency
  • Added Element
Measure.group.population.code Measure.riskAdjustment
  • Change code system for extensibly bound codes Type changed from "http://hl7.org/fhir/measure-population" string to "http://terminology.hl7.org/CodeSystem/measure-population" markdown
Measure.group.population.criteria Measure.rateAggregation
  • Type changed from string to Expression markdown
Measure.group.stratifier.code Measure.term
  • Added Element
Measure.group.stratifier.description Measure.term.code
  • Added Element
Measure.term.definition
  • Added Element
Measure.group.linkId
  • Added Element
Measure.group.title
  • Added Element
Measure.group.stratifier.criteria Measure.group.description
  • Type changed from string to Expression markdown
Measure.group.stratifier.component Measure.group.type
  • Added Element
Measure.group.stratifier.component.code Measure.group.subject[x]
  • Added Element
Measure.group.stratifier.component.description Measure.group.basis
  • Added Element
Measure.group.stratifier.component.criteria Measure.group.basisRequirement
  • Added Mandatory Element
Measure.supplementalData.code Measure.group.scoring
  • Added Element
Measure.group.scoringUnit
  • Added Element
Measure.group.scoringPrecision
  • Added Element
Measure.group.compositeScoring
  • Added Element
Measure.group.component
  • Added Element
Measure.group.component.measure
  • Added Element
Measure.group.component.groupId
  • Added Element
Measure.group.component.weight
  • Added Element
Measure.group.rateAggregation
  • Added Element
Measure.group.improvementNotation
  • Added Element
Measure.group.improvementNotationGuidance
  • Added Element
Measure.group.library
  • Added Element
Measure.group.population.linkId
  • Added Element
Measure.group.population.title
  • Added Element
Measure.supplementalData.usage Measure.group.population.code
  • Change code system for extensibly bound codes value set from "http://hl7.org/fhir/measure-data-usage" http://hl7.org/fhir/ValueSet/measure-population to "http://terminology.hl7.org/CodeSystem/measure-data-usage" MeasurePopulationType icon
Measure.supplementalData.description Measure.group.population.description
  • Added Element Type changed from string to markdown
Measure.supplementalData.criteria Measure.group.population.criteria
  • Min Cardinality changed from 1 to 0
Measure.group.population.groupDefinition
  • Added Element
Measure.group.population.inputPopulationId
  • Added Element
Measure.group.population.aggregateMethod
  • Added Element
Measure.group.stratifier.linkId
  • Added Element
Measure.group.stratifier.title
  • Added Element
Measure.group.stratifier.description
  • Type changed from string to 1 markdown
Measure.group.stratifier.groupDefinition
  • Added Element
Measure.group.stratifier.component.linkId
  • Added Element
Measure.group.stratifier.component.description
  • Type changed from string to Expression markdown
Measure.contributor Measure.group.stratifier.component.criteria
  • deleted Min Cardinality changed from 1 to 0
Measure.set Measure.group.stratifier.component.groupDefinition
  • deleted Added Element
Measure.group.identifier Measure.group.stratifier.component.valueSet
  • deleted Added Element
Measure.group.name Measure.group.stratifier.component.unit
  • deleted Added Element
Measure.group.population.identifier Measure.supplementalData.linkId
  • deleted Added Element
Measure.supplementalData.usage
  • Change value set from http://hl7.org/fhir/ValueSet/measure-data-usage to MeasureDataUsage icon
Measure.supplementalData.description
  • Type changed from string to markdown
Measure.supplementalData.valueSet
  • Added Element
Measure.supplementalData.unit
  • Added Element
Measure.group.population.name Measure.scoring
  • deleted Deleted
Measure.group.stratifier.identifier Measure.compositeScoring
  • deleted Deleted
Measure.group.stratifier.path Measure.type
  • deleted Deleted
Measure.supplementalData.identifier Measure.improvementNotation
  • deleted Deleted
Measure.supplementalData.path Measure.definition
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON . See R3 <--> R4 Conversion Maps (status = 6 tests that all execute ok. All tests pass round-trip testing and 6 r3 resources are invalid (0 errors). ) for R4B as XML or JSON .

Structure

0..1 Intended jurisdiction for Use and/or publishing 0..* 0..1 markdown Summary increase markdown markdown 0..* Population criteria group BackboneElement 1..1 BackboneElement 1..1 BackboneElement
Name Flags Card. Type Description & Constraints      Filter: Filters doco
. . Measure I TU N DomainResource A quality measure definition
+ Warning: Name should be usable as an identifier for the module by machine processing applications such as code generation
+ Rule: Stratifier SHALL be either a single criteria or a set of criteria components

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
Interfaces Implemented: MetadataResource
. . . url Σ C 0..1 uri Canonical identifier for this measure, represented as a URI (globally unique)
+ Warning: URL should not contain | or # - these characters make processing canonical references problematic
. . . identifier Σ 0..* Identifier Additional identifier for the measure

. . . version Σ 0..1 string Business version of the measure
. . name . versionAlgorithm[x] Σ I 0..1 How to compare versions
Binding: Version Algorithm ( Extensible )
. . . . versionAlgorithmString string
. . . . versionAlgorithmCoding Coding
... name Σ C 0..1 string Name for this measure (computer friendly)
. . . title Σ T 0..1 string Name for this measure (human friendly)
. . . subtitle T 0..1 string Subordinate title of the measure
. . . status ?! Σ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus ( Required )
. . . experimental Σ 0..1 boolean For testing purposes, not only - never for real usage
. . . subject[x] 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Subject type Binding: Participant Resource Types ( Extensible )
. . . . subjectCodeableConcept CodeableConcept
. . . . subjectReference Reference ( Group )
. . . date Σ 0..1 dateTime Date last changed
. . . publisher Σ T 0..1 string Name of the publisher publisher/steward (organization or individual)
. . . contact Σ 0..* ContactDetail Contact details for the publisher

. . . description Σ T 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 Jurisdiction of the authority that maintains the measure (if applicable)
Binding: Jurisdiction ValueSet icon ( Extensible )

. . . purpose T 0..1 markdown Why this measure is defined
. . . usage T 0..1 string markdown Describes the clinical usage of the measure
. . . copyright T 0..1 markdown Notice about intellectual property ownership, can include restrictions on use
. . approvalDate . copyrightLabel T 0..1 string Copyright holder and year(s)
... approvalDate 0..1 date When the measure was approved by publisher
. . . lastReviewDate 0..1 date When the measure was last reviewed by the publisher
. . . effectivePeriod Σ 0..1 Period When the measure is expected to be used
. . . topic reportingFrequency 0..1 Quantity The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
Binding: Frequency Unit ( Extensible )
. . . topic 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc. etc
DefinitionTopic Binding: Definition Topic ( Example )

. . . author 0..* ContactDetail 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

. . . relatedArtifact C 0..* RelatedArtifact Additional documentation, citations, etc. etc
+ Warning: Dependencies and components of a Measure should reference a resource

. . . 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 . riskAdjustment Σ 0..1 markdown How risk adjustment is applied for this measure
... rateAggregation Σ 0..1 markdown How is rate aggregation performed for this measure
... rationale Σ 0..1 markdown CodeableConcept Justification for the measure in terms of impact, gap in care, and evidence
... clinicalRecommendationStatement proportion | ratio | continuous-variable | cohort Σ 0..1 markdown Summary of clinical guidelines
MeasureScoring
. . . term 0..* BackboneElement Defined terms used in the measure documentation

.... code 0..1 CodeableConcept What term?
Binding: Measure Definition Example ( Extensible Example )
. . compositeScoring . . definition 0..1 markdown Meaning of the term
... guidance Σ 0..1 markdown Additional guidance for implementers (deprecated)
... group C 0..* BackboneElement Population criteria group

.... linkId C 0..1 string CodeableConcept Unique id for group in measure
+ Warning: Link ids should be 255 characters or less
.... title opportunity | all-or-nothing | linear | weighted 0..1 string Title of the group. This title is expected in the corresponding MeasureReport.group.title
CompositeMeasureScoring
. . . . code 0..1 CodeableConcept Meaning of the group
Binding: Measure Group Example ( Extensible Example )
. . . . description 0..1 markdown Summary description
.. . . type Σ 0..* CodeableConcept process | outcome | structure | patient-reported-outcome | composite
Binding: MeasureType icon ( Extensible )

. . riskAdjustment . . subject[x] 0..1 Σ E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device
Binding: Participant Resource Types ( Extensible )
. . . . . subjectCodeableConcept string CodeableConcept How risk adjustment is applied for this measure
. . . . . subjectReference Reference ( Group )
. . . . rateAggregation basis Σ 0..1 string code Population basis
Binding: All FHIR Types ( Required )
How is rate aggregation performed for this measure
. . . rationale . basisRequirement C Σ 0..* DataRequirement Population basis requirements
+ Rule: Basis requirements SHALL have a type, MAY have profile and codeFilter elements, and SHALL NOT specify dateFilter, valueFilter, limit, or sort

0..1
. . . . scoring Σ 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite
Binding: Measure Scoring icon ( Extensible )
Detailed description of why the measure exists
. . . clinicalRecommendationStatement . scoringUnit Σ 0..1 CodeableConcept markdown What units?
Binding: Measure Scoring Unit ( Example )
. . . . scoringPrecision Σ 0..1 positiveInt How many decimals (The number of clinical guidelines decimal places to include in the score when the score is a decimal-valued result)
. . . . improvementNotation compositeScoring Σ 0..1 CodeableConcept opportunity | decrease all-or-nothing | linear | weighted
Binding: CompositeMeasureScoring icon MeasureImprovementNotation ( Required Extensible )
. . definition . . component 0..* Σ BackboneElement A component of a composite measure

0..*
. . . . . measure Defined terms used in the measure documentation 0..1 canonical () What measure?
. . . . guidance . groupId 0..1 Σ string What group?
0..1
. . . . . weight 0..1 decimal What weight?
Additional guidance for implementers
. . . group . rateAggregation Σ 0..1 BackboneElement markdown How is rate aggregation performed for this measure
. . . . code improvementNotation Σ 0..1 CodeableConcept increase | decrease
Binding: MeasureImprovementNotation icon ( Extensible )
Meaning of the group
. . . . description improvementNotationGuidance Σ 0..1 string markdown Explanation of improvement notation
Summary description
. . . population . library 0..* canonical ( Library ) Logic used by the measure group

0..*
. . . . population 0..* BackboneElement Population criteria

. . . . code . linkId C 0..1 string Unique id for population in measure
+ Warning: Link ids should be 255 characters or less
..... title 0..1 string Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
..... code 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
Binding: MeasurePopulationType icon ( Extensible )
. . . . . description 0..1 string markdown The human readable description of this population criteria
. . . . . criteria 0..1 Expression The criteria that defines this population
. . . . . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
. . . . . inputPopulationId 0..1 string Which population
... . . aggregateMethod 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
Binding: Measure Aggregate Method icon ( Extensible )
... . stratifier C 0..* BackboneElement Stratifier criteria for the measure

. . . . code . linkId C 0..1 string Unique id for stratifier in measure
+ Warning: Link ids should be 255 characters or less
..... title 0..1 string Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
..... code C 0..1 CodeableConcept Meaning of the stratifier
Binding: Measure Stratifier Example ( Example )
. . . . . description C 0..1 string markdown The human readable description of this stratifier
. . . . . criteria C 0..1 Expression How the measure should be stratified
. . . . component . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
0..*
. . . . . component C 0..* BackboneElement Stratifier criteria component for the measure

. . . . . code . linkId C 0..1 string Unique id for stratifier component in measure
+ Warning: Link ids should be 255 characters or less
...... code 0..1 CodeableConcept Meaning of the stratifier component
Binding: Measure Stratifier Example ( Example )
. . . . . . description 0..1 string markdown The human readable description of this stratifier component
. . . . . . criteria 0..1 Expression Component of how the measure should be stratified
. . . . . . groupDefinition 0..1 Reference ( Group ) A group resource that defines this population
...... valueSet 0..1 canonical ( ValueSet ) What stratum values?
. . . . . supplementalData . unit 0..1 string What units?
0..*
. . . supplementalData 0..* BackboneElement What other data should be reported with the measure

. . . code . linkId C 0..1 string Unique id for supplementalData in measure
+ Warning: Link ids should be 255 characters or less
.... code 0..1 CodeableConcept Meaning of the supplemental data
Binding: Measure Supplemental Data Example ( Example )
. . . . usage 0..* CodeableConcept supplemental-data | risk-adjustment-factor
Binding: MeasureDataUsage icon ( Extensible )

. . . . description 0..1 string markdown The human readable description of this supplemental data
. . . . criteria 1..1 Expression Expression describing additional data to be reported
. . . . valueSet 0..1 canonical ( ValueSet ) What supplemental data values?
.... unit 0..1 string What units?

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

Measure ( DomainResource ) + MetadataResource An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers 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] Indicates the mechanism used to compare versions to determine which is more current versionAlgorithm[x] : DataType [0..1] « string | Coding ; null (Strength=Extensible) VersionAlgorithm + » 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] « This element has or is affected by some invariants C » 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. null (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 no version of this resource will ever be used intended for genuine usage 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 DataType [0..1] « CodeableConcept | Reference ( Group ); The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.). null (Strength=Extensible) SubjectType ParticipantResourceTypes + » The date (and optionally time) when the measure was published. last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes date : dateTime [0..1] The name of the organization or individual that published responsible for the release and ongoing maintenance of 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 contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances useContext : UsageContext [0..*] A legal or geographic region in which the measure authority that maintains the resource is intended to be used operating. In general, the jurisdiction is also found in the useContext. The useContext may reference additional jurisdictions because the defining jurisdiction does not necessarily limit the jurisdictions of use jurisdiction : CodeableConcept [0..*] « Countries and regions within which this artifact is targeted for use. null (Strength=Extensible) Jurisdiction ValueSet JurisdictionValueSet + » 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 markdown [0..1] A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal notices of intellectual property ownership and can include restrictions on the use and publishing of the measure copyright : markdown [0..1] A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are restricted. (e.g. 'All rights reserved', 'Some rights reserved') copyrightLabel : string [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] The frequency that this measure should be reported, usually specified by the program it is being submitted to reportingFrequency : Quantity [0..1] « null (Strength=Extensible) FrequencyUnit + » 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. null (Strength=Example) DefinitionTopic ?? » 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 asserted by the publisher to be primarily responsible for review of some aspect of the content reviewer : ContactDetail [0..*] An individual or organization asserted by the publisher to be 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 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 : markdown [0..1] Describes how to combine the calculation is performed information calculated, based on logic in each of several populations, into one summarized result rateAggregation : markdown [0..1] Provides a detailed justification of the need for the measure, measure including proportion, ratio, continuous-variable, statements pertaining to importance criterion: impact, gap in care, and cohort. The value set is extensible, allowing additional evidence rationale : markdown [0..1] Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure scoring types to clinicalRecommendationStatement : markdown [0..1] Additional guidance for the measure including how it can be represented used in a clinical context, and the intent of the measure scoring guidance : CodeableConcept markdown [0..1] « The scoring type Term A codeable representation of the measure. (Strength=Extensible) defined term MeasureScoring code + : CodeableConcept [0..1] « null (Strength=Example) MeasureDefinitionExample ?? » If this is Provides a composite measure, definition for the scoring method term as used to combine within the component measures measure definition : markdown [0..1] Group An identifier that is unique within the Measure allowing linkage to determine the composite score equivalent item in a MeasureReport resource compositeScoring linkId : string [0..1] Indicates the title for the group title : string [0..1] 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] « null (Strength=Example) MeasureGroupExample ?? » The composite scoring method human readable description of the measure. (Strength=Extensible) this population group CompositeMeasureScoring description + » : markdown [0..1] 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..*] « null (Strength=Extensible) MeasureType + » The type intended subjects for the measure. If this element is not provided, there is no subject context (i.e. population criteria are evaluated from the perspective of measure (includes codes the entire system, rather than from 2.16.840.1.113883.1.11.20368). the perspective of a particular subject) subject[x] : DataType [0..1] « CodeableConcept | Reference ( Group ); null (Strength=Extensible) MeasureType ParticipantResourceTypes + » A description The population basis specifies the type of elements in the risk adjustment factors that may impact population. For a subject-based measure, this is boolean (because the resulting score subject and the population basis are the same, and the population criteria define yes/no values for each individual in the population). For measures that have a population basis that is different than the subject, this element specifies the type of the population basis. For example, an encounter-based measure has a subject of Patient and how they a population basis of Encounter, and the population criteria all return lists of Encounters basis : code [0..1] « null (Strength=Required) FHIRTypes ! » Specifies population basis requirements (i.e. what constitutes a case, or what is being counted) as a DataRequirement. If multiple basisRequirements are specified, criteria expressions may return data that satisfies ANY basisRequirement. A data element satisfies a basisRequirement if the instance `is` of the type, conforms to ALL the specified profiles, and matches ALL the codeFilters. basisRequirements SHALL specify type, MAY specify profile and codeFilter, and SHALL NOT specify dateFilter, valueFilter, limit, or sort. If basis is specified, any basisRequirement SHALL be accounted consistent with the specified basis (i.e. the type of each basisRequirement SHALL be the same type as, or a subtype of the basis type) basisRequirement : DataRequirement [0..*] Indicates how the calculation is performed for when computing the measure, including proportion, ratio, continuous-variable, and reporting cohort. The value set is extensible, allowing additional measure results scoring types to be represented riskAdjustment scoring : string CodeableConcept [0..1] « null (Strength=Extensible) MeasureScoring + » Describes how to combine Defines the information calculated, based on logic in each expected units of several populations, into one summarized result measure for the measure score. This element SHOULD be specified as a UCUM unit rateAggregation scoringUnit : string CodeableConcept [0..1] « null (Strength=Example) MeasureScoringUnit ?? » Provides When the score is a succinct statement decimal value this should be used to specify the expected minimum number of digits after the need decimal point to use for the measure. Usually includes statements pertaining to importance criterion: impact, gap precision of the value. When a scoringUnit is also specified, this value is the expected minimum number of digits after the decimal point when the score is expressed in care, and evidence the units specified rationale scoringPrecision : markdown positiveInt [0..1] Provides If this is a summary of relevant clinical guidelines or other clinical recommendations supporting composite measure, the measure scoring method used to combine the component measures to determine the composite score clinicalRecommendationStatement compositeScoring : CodeableConcept [0..1] « null (Strength=Extensible) CompositeMeasureScoring + » Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result rateAggregation : 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) range). Exercise caution when using any values besides increase or decrease for improvementNotation improvementNotation : CodeableConcept [0..1] « Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue. (Strength=Required) null (Strength=Extensible) MeasureImprovementNotation ! + » Provides a description of an individual term used within Narrative text to explain the measure improvement notation and how to interpret it definition improvementNotationGuidance : markdown [0..*] [0..1] Additional guidance for the measure including how it can be used in A reference to a clinical context, and Library resource containing the intent of formal logic used by the measure group guidance library : markdown canonical [0..1] [0..*] « Library » Group Component Indicates a meaning for The measure that contains the group. This can be as simple as a unique identifier, or it can establish meaning in definition of the component calculation measure : canonical [0..1] « » Specifies the id of a broader context particular group within the measure referenced by drawing from a terminology, allowing groups to be correlated across measures the related artifact resource code groupId : CodeableConcept string [0..1] The human readable description What is the weight of the contribution of this population group measure to the overall score description weight : string decimal [0..1] Population An identifier that is unique within the Measure allowing linkage to the equivalent population in a MeasureReport resource linkId : string [0..1] Indicates the title for the group's population title : string [0..1] The type of population criteria code : CodeableConcept [0..1] « The type of population. null (Strength=Extensible) MeasurePopulationType + » The human readable description of this population criteria description : string markdown [0..1] An expression that specifies the criteria for the population, typically the name of an expression in a library criteria : Expression [1..1] [0..1] A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » The id of a population element in this measure that provides the input for this population criteria. In most cases, the scoring structure of the measure implies specific relationships (e.g. the Numerator uses the Denominator as the source in a proportion scoring). In some cases, however, multiple possible choices exist and must be resolved explicitly. For example in a ratio measure with multiple initial populations, the denominator must specify which population should be used as the starting point inputPopulationId : string [0..1] Specifies which method should be used to aggregate measure observation values. For most scoring types, this is implied by scoring (e.g. a proportion measure counts members of the populations). For continuous variables, however, this information must be specified to ensure correct calculation aggregateMethod : CodeableConcept [0..1] « null (Strength=Extensible) MeasureAggregateMethod + » Stratifier An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] Indicates the title for the stratifier of the group title : string [0..1] 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] « null (Strength=Example) MeasureStratifierExample ?? » « This element has or is affected by some invariants C » The human readable description of this stratifier criteria description : string markdown [0..1] « This element has or is affected by some invariants C » An expression that specifies the criteria a criteria-based stratifier for the stratifier. measure. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element and SHALL use the same basis as other population criteria for the population group criteria : Expression [0..1] « This element has or is affected by some invariants C » A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » Component An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures code : CodeableConcept [0..1] « null (Strength=Example) MeasureStratifierExample ?? » The human readable description of this stratifier criteria component description : string markdown [0..1] An expression that specifies returns the criteria for value of this component of the stratifier. stratifier for a member of the population. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element element, evaluated from the perspective of the measure subject. If this is a non-subject-based measure, the expression may be a reference to a function that takes an argument of the type of the measure basis, allowing the stratifier value to be determined for each member of the population criteria : Expression [1..1] [0..1] A Group resource that defines this population as a set of characteristics groupDefinition : Reference [0..1] « Group » A value set defining the set of possible values for stratum in this stratifier. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce stratum values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value `01Y--05Y` with the system ignored) valueSet : canonical [0..1] « ValueSet » Indicates what units, if any, stratifier values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units unit : string [0..1] SupplementalData An identifier that is unique within the Measure allowing linkage to the equivalent item in a MeasureReport resource linkId : string [0..1] 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] « null (Strength=Example) MeasureSupplementalDataExample ?? » 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. null (Strength=Extensible) MeasureDataUsage + » The human readable description of this supplemental data description : string markdown [0..1] The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element criteria : Expression [1..1] A value set defining the set of possible values for supplemental data in this element. If criteria and valueSet are both present, they SHALL be consistent (i.e. criteria expressions SHALL produce supplemental data values that are codes in the value set referenced by this element). Note that this MAY be strictly at the code level (e.g. an Age Range code that is just the string value `01Y--05Y` with the system ignored) valueSet : canonical [0..1] « ValueSet » Indicates what units, if any, supplemental data values are expected to be expressed in. This element SHOULD be specified in UCUM units or calendar units unit : string [0..1] Provides a description of an individual term used within the measure term [0..*] If this is a composite measure, a component of the composite component [0..*] A population criteria for the measure population [0..*] The A component of a value-based stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path component [0..*] A stratifier for the measure, specified as either a criteria expression, or a set of components that define value-based stratifier expressions 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 -->
 <

 <versionAlgorithm[x]><!-- 0..1 string|Coding How to compare versions --></versionAlgorithm[x]>
 <name value="[string]"/><!-- I 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 -->
 <
 <</subject[x]>
 <
 <

 <experimental value="[boolean]"/><!-- 0..1 For testing only - never for 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/steward (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>

 <jurisdiction><!-- 0..* CodeableConcept Jurisdiction of the authority that maintains the measure (if applicable) icon --></jurisdiction>

 <purpose value="[markdown]"/><!-- 0..1 Why this measure is defined -->
 <
 <

 <usage value="[markdown]"/><!-- 0..1 Describes the clinical usage of the measure -->
 <copyright value="[markdown]"/><!-- 0..1 Notice about intellectual property ownership, can include restrictions on use -->
 <copyrightLabel value="[string]"/><!-- 0..1 Copyright holder and year(s) -->

 <approvalDate value="[date]"/><!-- 0..1 When the measure was approved by publisher -->
 <

 <lastReviewDate value="[date]"/><!-- 0..1 When the measure was last reviewed by the publisher -->

 <effectivePeriod><!-- 0..1 Period When the measure is expected to be used --></effectivePeriod>
 <</topic>

 <reportingFrequency><!-- 0..1 Quantity The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly) --></reportingFrequency>
 <topic><!-- 0..* CodeableConcept The category of the measure, such as Education, Treatment, Assessment, etc --></topic>

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

 <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>
 <</compositeScoring>
 <</type>
 <
 <
 <

 <riskAdjustment value="[markdown]"/><!-- 0..1 How risk adjustment is applied for this measure -->
 <rateAggregation value="[markdown]"/><!-- 0..1 How is rate aggregation performed for this measure -->
 <rationale value="[markdown]"/><!-- 0..1 Justification for the measure in terms of impact, gap in care, and evidence -->

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

 <term>  <!-- 0..* Defined terms used in the measure documentation -->
  <code><!-- 0..1 CodeableConcept What term? --></code>
  <definition value="[markdown]"/><!-- 0..1 Meaning of the term -->
 </term>
 <guidance value="[markdown]"/><!-- 0..1 Additional guidance for implementers (deprecated) -->
 <group>  <!-- I 0..* Population criteria group -->
  <linkId value="[string]"/><!-- 0..1 Unique id for group in measure -->
  <title value="[string]"/><!-- 0..1 Title of the group. This title is expected in the corresponding MeasureReport.group.title -->
  <code><!-- 0..1 CodeableConcept Meaning of the group --></code>
  <description value="[markdown]"/><!-- 0..1 Summary description -->
  <type><!-- 0..* CodeableConcept process | outcome | structure | patient-reported-outcome icon --></type>
  <subject[x]><!-- 0..1 CodeableConcept|Reference(Group) E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device --></subject[x]>
  <basis value="[code]"/><!-- 0..1 Population basis -->
  <basisRequirement><!-- 0..* DataRequirement Population basis requirements --></basisRequirement>
  <scoring><!-- 0..1 CodeableConcept proportion | ratio | continuous-variable | cohort | composite icon --></scoring>
  <scoringUnit><!-- 0..1 CodeableConcept What units? --></scoringUnit>
  <scoringPrecision value="[positiveInt]"/><!-- 0..1 How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result) -->
  <compositeScoring><!-- 0..1 CodeableConcept opportunity | all-or-nothing | linear | weighted icon --></compositeScoring>
  <component>  <!-- 0..* A component of a composite measure -->
   <measure value="[canonical]"/><!-- 0..1 What measure? -->
   <groupId value="[string]"/><!-- 0..1 What group? -->
   <weight value="[decimal]"/><!-- 0..1 What weight? -->
  </component>
  <rateAggregation value="[markdown]"/><!-- 0..1 How is rate aggregation performed for this measure -->
  <improvementNotation><!-- 0..1 CodeableConcept increase | decrease icon --></improvementNotation>
  <improvementNotationGuidance value="[markdown]"/><!-- 0..1 Explanation of improvement notation -->
  <library><!-- 0..* canonical(Library) Logic used by the measure group --></library>

  <population>  <!-- 0..* Population criteria -->
   <</code>
   <
   <</criteria>

   <linkId value="[string]"/><!-- 0..1 Unique id for population in measure -->
   <title value="[string]"/><!-- 0..1 Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title -->
   <code><!-- 0..1 CodeableConcept initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation icon --></code>
   <description value="[markdown]"/><!-- 0..1 The human readable description of this population criteria -->
   <criteria><!-- 0..1 Expression The criteria that defines this population --></criteria>
   <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
   <inputPopulationId value="[string]"/><!-- 0..1 Which population -->
   <aggregateMethod><!-- 0..1 CodeableConcept Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) icon --></aggregateMethod>

  </population>
  <
   <</code>
   <
   <</criteria>
   <
    <</code>
    <
    <</criteria>

  <stratifier>  <!-- I 0..* Stratifier criteria for the measure -->
   <linkId value="[string]"/><!-- 0..1 Unique id for stratifier in measure -->
   <title value="[string]"/><!-- 0..1 Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title -->
   <code><!-- I 0..1 CodeableConcept Meaning of the stratifier --></code>
   <description value="[markdown]"/><!-- I 0..1 The human readable description of this stratifier -->
   <criteria><!-- I 0..1 Expression How the measure should be stratified --></criteria>
   <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
   <component>  <!-- I 0..* Stratifier criteria component for the measure -->
    <linkId value="[string]"/><!-- 0..1 Unique id for stratifier component in measure -->
    <code><!-- 0..1 CodeableConcept Meaning of the stratifier component --></code>
    <description value="[markdown]"/><!-- 0..1 The human readable description of this stratifier component -->
    <criteria><!-- 0..1 Expression Component of how the measure should be stratified --></criteria>
    <groupDefinition><!-- 0..1 Reference(Group) A group resource that defines this population --></groupDefinition>
    <valueSet><!-- 0..1 canonical(ValueSet) What stratum values? --></valueSet>
    <unit value="[string]"/><!-- 0..1 What units? -->

   </component>
  </stratifier>
 </group>
 <supplementalData>  <!-- 0..* What other data should be reported with the measure -->
  <</code>
  <</usage>
  <

  <linkId value="[string]"/><!-- 0..1 Unique id for supplementalData in measure -->
  <code><!-- 0..1 CodeableConcept Meaning of the supplemental data --></code>
  <usage><!-- 0..* CodeableConcept supplemental-data | risk-adjustment-factor icon --></usage>
  <description value="[markdown]"/><!-- 0..1 The human readable description of this supplemental data -->

  <criteria><!-- 1..1 Expression Expression describing additional data to be reported --></criteria>
  <valueSet><!-- 0..1 canonical(ValueSet) What supplemental data values? --></valueSet>
  <unit value="[string]"/><!-- 0..1 What units? -->

 </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
  "

  // versionAlgorithm[x]: How to compare versions. One of these 2:
  "versionAlgorithmString" : "<string>",
  "versionAlgorithmCoding" : { Coding },
  "name" : "<string>", // I 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 only - never for 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/steward (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 }], // Jurisdiction of the authority that maintains the measure (if applicable) icon

  "purpose" : "<markdown>", // Why this measure is defined
  "
  "

  "usage" : "<markdown>", // Describes the clinical usage of the measure
  "copyright" : "<markdown>", // Notice about intellectual property ownership, can include restrictions on use
  "copyrightLabel" : "<string>", // Copyright holder and year(s)

  "approvalDate" : "<date>", // When the measure was approved by publisher
  "

  "lastReviewDate" : "<date>", // When the measure was last reviewed by the publisher

  "effectivePeriod" : { Period }, // When the measure is expected to be used
  "

  "reportingFrequency" : { Quantity }, // The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
  "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
  "
  "
  "
  "
  "
  "

  "riskAdjustment" : "<markdown>", // How risk adjustment is applied for this measure
  "rateAggregation" : "<markdown>", // How is rate aggregation performed for this measure
  "rationale" : "<markdown>", // Justification for the measure in terms of impact, gap in care, and evidence

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

  "term" : [{ // Defined terms used in the measure documentation
    "code" : { CodeableConcept }, // What term?
    "definition" : "<markdown>" // Meaning of the term
  }],
  "guidance" : "<markdown>", // Additional guidance for implementers (deprecated)
  "group" : [{ // I Population criteria group
    "linkId" : "<string>", // Unique id for group in measure
    "title" : "<string>", // Title of the group. This title is expected in the corresponding MeasureReport.group.title
    "code" : { CodeableConcept }, // Meaning of the group
    "description" : "<markdown>", // Summary description
    "type" : [{ CodeableConcept }], // process | outcome | structure | patient-reported-outcome icon
    // subject[x]: E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2:

    "subjectCodeableConcept" : { CodeableConcept },
    "subjectReference" : { Reference(Group) },
    "basis" : "<code>", // Population basis
    "basisRequirement" : [{ DataRequirement }], // Population basis requirements
    "scoring" : { CodeableConcept }, // proportion | ratio | continuous-variable | cohort | composite icon
    "scoringUnit" : { CodeableConcept }, // What units?
    "scoringPrecision" : "<positiveInt>", // How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result)
    "compositeScoring" : { CodeableConcept }, // opportunity | all-or-nothing | linear | weighted icon
    "component" : [{ // A component of a composite measure
      "measure" : "<canonical>", // What measure?
      "groupId" : "<string>", // What group?
      "weight" : <decimal> // What weight?
    }],
    "rateAggregation" : "<markdown>", // How is rate aggregation performed for this measure
    "improvementNotation" : { CodeableConcept }, // increase | decrease icon
    "improvementNotationGuidance" : "<markdown>", // Explanation of improvement notation
    "library" : ["<canonical(Library)>"], // Logic used by the measure group

    "population" : [{ // Population criteria
      "
      "
      "

      "linkId" : "<string>", // Unique id for population in measure
      "title" : "<string>", // Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
      "code" : { CodeableConcept }, // initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation icon
      "description" : "<markdown>", // The human readable description of this population criteria
      "criteria" : { Expression }, // The criteria that defines this population
      "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
      "inputPopulationId" : "<string>", // Which population
      "aggregateMethod" : { CodeableConcept } // Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count) icon

    }],
    "
      "
      "
      "
      "
        "
        "
        "

    "stratifier" : [{ // I Stratifier criteria for the measure
      "linkId" : "<string>", // Unique id for stratifier in measure
      "title" : "<string>", // Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
      "code" : { CodeableConcept }, // I Meaning of the stratifier
      "description" : "<markdown>", // I The human readable description of this stratifier
      "criteria" : { Expression }, // I How the measure should be stratified
      "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
      "component" : [{ // I Stratifier criteria component for the measure
        "linkId" : "<string>", // Unique id for stratifier component in measure
        "code" : { CodeableConcept }, // Meaning of the stratifier component
        "description" : "<markdown>", // The human readable description of this stratifier component
        "criteria" : { Expression }, // Component of how the measure should be stratified
        "groupDefinition" : { Reference(Group) }, // A group resource that defines this population
        "valueSet" : "<canonical(ValueSet)>", // What stratum values?
        "unit" : "<string>" // What units?

      }]
    }]
  }],
  "supplementalData" : [{ // What other data should be reported with the measure
    "
    "
    "
    "

    "linkId" : "<string>", // Unique id for supplementalData in measure
    "code" : { CodeableConcept }, // Meaning of the supplemental data
    "usage" : [{ CodeableConcept }], // supplemental-data | risk-adjustment-factor icon
    "description" : "<markdown>", // The human readable description of this supplemental data
    "criteria" : { Expression }, // R!  Expression describing additional data to be reported
    "valueSet" : "<canonical(ValueSet)>", // What supplemental data values?
    "unit" : "<string>" // What units?

  }]
}

Turtle Template 

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


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

  # from 
  # from 
  fhir:
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  # . One of these 2
    fhir: ]
    fhir:) ]
  fhir:
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    fhir:
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      fhir:
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    ], ...;
    fhir:
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      ], ...;
    ], ...;
  ], ...;
  fhir:
    fhir:
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  ], ...;

  # from Resource: fhir:id, fhir:meta, fhir:implicitRules, and fhir:language
  # from DomainResource: fhir:text, fhir:contained, fhir:extension, and fhir:modifierExtension
  fhir:url [ uri ] ; # 0..1 Canonical identifier for this measure, represented as a URI (globally unique)
  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Additional identifier for the measure
  fhir:version [ string ] ; # 0..1 Business version of the measure
  # versionAlgorithm[x] : 0..1 How to compare versions. One of these 2
    fhir:versionAlgorithm [  a fhir:String ; string ]
    fhir:versionAlgorithm [  a fhir:Coding ; Coding ]
  fhir:name [ string ] ; # 0..1 I Name for this measure (computer friendly)
  fhir:title [ string ] ; # 0..1 Name for this measure (human friendly)
  fhir:subtitle [ string ] ; # 0..1 Subordinate title of the measure
  fhir:status [ code ] ; # 1..1 draft | active | retired | unknown
  fhir:experimental [ boolean ] ; # 0..1 For testing only - never for real usage
  # subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
    fhir:subject [  a fhir:CodeableConcept ; CodeableConcept ]
    fhir:subject [  a fhir:Reference ; Reference(Group) ]
  fhir:date [ dateTime ] ; # 0..1 Date last changed
  fhir:publisher [ string ] ; # 0..1 Name of the publisher/steward (organization or individual)
  fhir:contact  ( [ ContactDetail ] ... ) ; # 0..* Contact details for the publisher
  fhir:description [ markdown ] ; # 0..1 Natural language description of the measure
  fhir:useContext  ( [ UsageContext ] ... ) ; # 0..* The context that the content is intended to support
  fhir:jurisdiction  ( [ CodeableConcept ] ... ) ; # 0..* Jurisdiction of the authority that maintains the measure (if applicable)
  fhir:purpose [ markdown ] ; # 0..1 Why this measure is defined
  fhir:usage [ markdown ] ; # 0..1 Describes the clinical usage of the measure
  fhir:copyright [ markdown ] ; # 0..1 Notice about intellectual property ownership, can include restrictions on use
  fhir:copyrightLabel [ string ] ; # 0..1 Copyright holder and year(s)
  fhir:approvalDate [ date ] ; # 0..1 When the measure was approved by publisher
  fhir:lastReviewDate [ date ] ; # 0..1 When the measure was last reviewed by the publisher
  fhir:effectivePeriod [ Period ] ; # 0..1 When the measure is expected to be used
  fhir:reportingFrequency [ Quantity ] ; # 0..1 The frequency in which this measure should be reported (e.g. 1 '/a' - yearly, 4 '/a' - quarterly)
  fhir:topic  ( [ CodeableConcept ] ... ) ; # 0..* The category of the measure, such as Education, Treatment, Assessment, etc
  fhir:author  ( [ ContactDetail ] ... ) ; # 0..* Who authored the content
  fhir:editor  ( [ ContactDetail ] ... ) ; # 0..* Who edited the content
  fhir:reviewer  ( [ ContactDetail ] ... ) ; # 0..* Who reviewed the content
  fhir:endorser  ( [ ContactDetail ] ... ) ; # 0..* Who endorsed the content
  fhir:relatedArtifact  ( [ RelatedArtifact ] ... ) ; # 0..* Additional documentation, citations, etc
  fhir:library  ( [ canonical(Library) ] ... ) ; # 0..* Logic used by the measure
  fhir:disclaimer [ markdown ] ; # 0..1 Disclaimer for use of the measure or its referenced content
  fhir:riskAdjustment [ markdown ] ; # 0..1 How risk adjustment is applied for this measure
  fhir:rateAggregation [ markdown ] ; # 0..1 How is rate aggregation performed for this measure
  fhir:rationale [ markdown ] ; # 0..1 Justification for the measure in terms of impact, gap in care, and evidence
  fhir:clinicalRecommendationStatement [ markdown ] ; # 0..1 Summary of clinical guidelines
  fhir:term ( [ # 0..* Defined terms used in the measure documentation
    fhir:code [ CodeableConcept ] ; # 0..1 What term?
    fhir:definition [ markdown ] ; # 0..1 Meaning of the term
  ] ... ) ;
  fhir:guidance [ markdown ] ; # 0..1 Additional guidance for implementers (deprecated)
  fhir:group ( [ # 0..* I Population criteria group
    fhir:linkId [ string ] ; # 0..1 Unique id for group in measure
    fhir:title [ string ] ; # 0..1 Title of the group. This title is expected in the corresponding MeasureReport.group.title
    fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the group
    fhir:description [ markdown ] ; # 0..1 Summary description
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* process | outcome | structure | patient-reported-outcome
    # subject[x] : 0..1 E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device. One of these 2
      fhir:subject [  a fhir:CodeableConcept ; CodeableConcept ]
      fhir:subject [  a fhir:Reference ; Reference(Group) ]
    fhir:basis [ code ] ; # 0..1 Population basis
    fhir:basisRequirement  ( [ DataRequirement ] ... ) ; # 0..* Population basis requirements
    fhir:scoring [ CodeableConcept ] ; # 0..1 proportion | ratio | continuous-variable | cohort | composite
    fhir:scoringUnit [ CodeableConcept ] ; # 0..1 What units?
    fhir:scoringPrecision [ positiveInt ] ; # 0..1 How many decimals (The number of decimal places to include in the score when the score is a decimal-valued result)
    fhir:compositeScoring [ CodeableConcept ] ; # 0..1 opportunity | all-or-nothing | linear | weighted
    fhir:component ( [ # 0..* A component of a composite measure
      fhir:measure [ canonical ] ; # 0..1 What measure?
      fhir:groupId [ string ] ; # 0..1 What group?
      fhir:weight [ decimal ] ; # 0..1 What weight?
    ] ... ) ;
    fhir:rateAggregation [ markdown ] ; # 0..1 How is rate aggregation performed for this measure
    fhir:improvementNotation [ CodeableConcept ] ; # 0..1 increase | decrease
    fhir:improvementNotationGuidance [ markdown ] ; # 0..1 Explanation of improvement notation
    fhir:library  ( [ canonical(Library) ] ... ) ; # 0..* Logic used by the measure group
    fhir:population ( [ # 0..* Population criteria
      fhir:linkId [ string ] ; # 0..1 Unique id for population in measure
      fhir:title [ string ] ; # 0..1 Title of the group's population. This title is expected in the corresponding MeasureReport.group.population.title
      fhir:code [ CodeableConcept ] ; # 0..1 initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
      fhir:description [ markdown ] ; # 0..1 The human readable description of this population criteria
      fhir:criteria [ Expression ] ; # 0..1 The criteria that defines this population
      fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
      fhir:inputPopulationId [ string ] ; # 0..1 Which population
      fhir:aggregateMethod [ CodeableConcept ] ; # 0..1 Aggregation method for a measure score (e.g. sum, average, median, minimum, maximum, count)
    ] ... ) ;
    fhir:stratifier ( [ # 0..* I Stratifier criteria for the measure
      fhir:linkId [ string ] ; # 0..1 Unique id for stratifier in measure
      fhir:title [ string ] ; # 0..1 Title of a group's stratifier. This title is expected in the corresponding MeasureReport.group.title
      fhir:code [ CodeableConcept ] ; # 0..1 I Meaning of the stratifier
      fhir:description [ markdown ] ; # 0..1 I The human readable description of this stratifier
      fhir:criteria [ Expression ] ; # 0..1 I How the measure should be stratified
      fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
      fhir:component ( [ # 0..* I Stratifier criteria component for the measure
        fhir:linkId [ string ] ; # 0..1 Unique id for stratifier component in measure
        fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the stratifier component
        fhir:description [ markdown ] ; # 0..1 The human readable description of this stratifier component
        fhir:criteria [ Expression ] ; # 0..1 Component of how the measure should be stratified
        fhir:groupDefinition [ Reference(Group) ] ; # 0..1 A group resource that defines this population
        fhir:valueSet [ canonical(ValueSet) ] ; # 0..1 What stratum values?
        fhir:unit [ string ] ; # 0..1 What units?
      ] ... ) ;
    ] ... ) ;
  ] ... ) ;
  fhir:supplementalData ( [ # 0..* What other data should be reported with the measure
    fhir:linkId [ string ] ; # 0..1 Unique id for supplementalData in measure
    fhir:code [ CodeableConcept ] ; # 0..1 Meaning of the supplemental data
    fhir:usage  ( [ CodeableConcept ] ... ) ; # 0..* supplemental-data | risk-adjustment-factor
    fhir:description [ markdown ] ; # 0..1 The human readable description of this supplemental data
    fhir:criteria [ Expression ] ; # 1..1 Expression describing additional data to be reported
    fhir:valueSet [ canonical(ValueSet) ] ; # 0..1 What supplemental data values?
    fhir:unit [ string ] ; # 0..1 What units?
  ] ... ) ;

]

Changes since Release 3 from R5 to R6

Measure
Measure.jurisdiction
Measure.reportingFrequency
  • Added Element
Measure.subtitle Measure.group.title
  • Added Element
Measure.status Measure.group.type
  • Change value set from http://hl7.org/fhir/ValueSet/publication-status http://hl7.org/fhir/ValueSet/measure-type to http://hl7.org/fhir/ValueSet/publication-status|4.0.1 MeasureType icon
Measure.experimental Measure.group.basis
  • No longer marked as Modifier Remove codes Element , BackboneElement , DataType , Address , Annotation , Attachment , Availability , BackboneType , Dosage , ElementDefinition , MarketingStatus , ProductShelfLife , Timing , CodeableConcept , CodeableReference , Coding , ContactDetail , ContactPoint , Contributor , DataRequirement , Expression , ExtendedContactDetail , Extension , HumanName , Identifier , Meta , MonetaryComponent , Money , Narrative , ParameterDefinition , Period , PrimitiveType , base64Binary , boolean , date , dateTime , decimal , instant , integer , positiveInt , unsignedInt , integer64 , string , code , id , markdown , time , uri , canonical , oid , url , uuid , Quantity , Age , Count , Distance , Duration , Range , Ratio , RatioRange , Reference , RelatedArtifact , SampledData , Signature , TriggerDefinition , UsageContext , VirtualServiceDetail , xhtml , Resource , Binary , Bundle , DomainResource , Account , ActivityDefinition , ActorDefinition , AdministrableProductDefinition , AdverseEvent , AllergyIntolerance , Appointment , AppointmentResponse , ArtifactAssessment , AuditEvent , Basic , BiologicallyDerivedProduct , BiologicallyDerivedProductDispense , BodyStructure , CanonicalResource , CapabilityStatement , CarePlan , CareTeam , ChargeItem , ChargeItemDefinition , Citation , Claim , ClaimResponse , ClinicalImpression , ClinicalUseDefinition , CodeSystem , Communication , CommunicationRequest , CompartmentDefinition , Composition , ConceptMap , Condition , ConditionDefinition , Consent , Contract , Coverage , CoverageEligibilityRequest , CoverageEligibilityResponse , DetectedIssue , Device , DeviceAssociation , DeviceDefinition , DeviceDispense , DeviceMetric , DeviceRequest , DeviceUsage , DiagnosticReport , DocumentReference , Encounter , EncounterHistory , Endpoint , EnrollmentRequest , EnrollmentResponse , EpisodeOfCare , EventDefinition , Evidence , EvidenceReport , EvidenceVariable , ExampleScenario , ExplanationOfBenefit , FamilyMemberHistory , Flag , FormularyItem , GenomicStudy , Goal , GraphDefinition , Group , GuidanceResponse , HealthcareService , ImagingSelection , ImagingStudy , Immunization , ImmunizationEvaluation , ImmunizationRecommendation , ImplementationGuide , Ingredient , InsurancePlan , InventoryItem , InventoryReport , Invoice , Library , Linkage , List , Location , ManufacturedItemDefinition , Measure , MeasureReport , Medication , MedicationAdministration , MedicationDispense , MedicationKnowledge , MedicationRequest , MedicationStatement , MedicinalProductDefinition , MessageDefinition , MessageHeader , MetadataResource , MolecularSequence , NamingSystem , NutritionIntake , NutritionOrder , NutritionProduct , Observation , ObservationDefinition , OperationDefinition , OperationOutcome , Organization , OrganizationAffiliation , PackagedProductDefinition , Patient , PaymentNotice , PaymentReconciliation , Permission , Person , PlanDefinition , Practitioner , PractitionerRole , Procedure , Provenance , Questionnaire , QuestionnaireResponse , RegulatedAuthorization , RelatedPerson , RequestOrchestration , Requirements , ResearchStudy , ResearchSubject , RiskAssessment , Schedule , SearchParameter , ServiceRequest , Slot , Specimen , SpecimenDefinition , StructureDefinition , StructureMap , Subscription , SubscriptionStatus , SubscriptionTopic , Substance , SubstanceDefinition , SubstanceNucleicAcid , SubstancePolymer , SubstanceProtein , SubstanceReferenceInformation , SubstanceSourceMaterial , SupplyDelivery , SupplyRequest , Task , TerminologyCapabilities , TestPlan , TestReport , TestScript , Transport , ValueSet , VerificationResult , VisionPrescription , Parameters
Measure.subject[x] Measure.group.basisRequirement
  • Added Element
Measure.author Measure.group.scoringPrecision
  • Added Element
Measure.editor Measure.group.compositeScoring
  • Added Element
Measure.reviewer Measure.group.component
  • Added Element
Measure.endorser Measure.group.component.measure
  • Added Element
Measure.group.component.groupId
  • Added Element
Measure.group.component.weight
  • Added Element
Measure.library Measure.group.improvementNotation
  • Type changed Change binding strength from Reference(Library) required to canonical(Library) extensible
  • Change value set from http://hl7.org/fhir/ValueSet/measure-improvement-notation|5.0.0 to MeasureImprovementNotation icon
Measure.group.improvementNotationGuidance
  • Added Element
Measure.group.population.title
  • Added Element
Measure.scoring Measure.group.population.code
  • Change code system for extensibly bound codes value set from "http://hl7.org/fhir/measure-scoring" http://hl7.org/fhir/ValueSet/measure-population to "http://terminology.hl7.org/CodeSystem/measure-scoring" MeasurePopulationType icon
Measure.compositeScoring Measure.group.population.aggregateMethod
  • Change value set from http://hl7.org/fhir/ValueSet/measure-aggregate-method to Measure Aggregate Method icon
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/composite-measure-scoring" "http://hl7.org/fhir/CodeSystem/measure-aggregate-method" to "http://terminology.hl7.org/CodeSystem/composite-measure-scoring" "http://terminology.hl7.org/CodeSystem/measure-aggregate-method"
Measure.group.stratifier.title
  • Added Element
Measure.group.stratifier.component.valueSet
  • Added Element
Measure.group.stratifier.component.unit
  • Added Element
Measure.supplementalData.usage
  • Change value set from http://hl7.org/fhir/ValueSet/measure-data-usage to MeasureDataUsage icon
Measure.supplementalData.valueSet
  • Added Element
Measure.supplementalData.unit
  • Added Element
Measure.basis
  • Deleted
Measure.scoring
  • Deleted
Measure.scoringUnit
  • Deleted
Measure.compositeScoring
  • Deleted
Measure.type
  • Deleted
Measure.improvementNotation
  • Deleted

Changes from R4 and R4B to R6

Measure
Measure.versionAlgorithm[x]
  • Added Element
Measure.subject[x]
  • Change value set from http://hl7.org/fhir/ValueSet/subject-type to Participant Resource Types
  • Change code system for extensibly bound codes from "http://hl7.org/fhir/measure-type" "http://hl7.org/fhir/resource-types" to "http://terminology.hl7.org/CodeSystem/measure-type" "http://hl7.org/fhir/fhir-types"
Measure.improvementNotation Measure.jurisdiction
Measure.usage
  • Type changed from string to CodeableConcept markdown
Measure.copyrightLabel
  • Add Binding http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1 (required) Added Element
Measure.group.code Measure.reportingFrequency
  • Added Element
Measure.group.population.code Measure.riskAdjustment
  • Change code system for extensibly bound codes Type changed from "http://hl7.org/fhir/measure-population" string to "http://terminology.hl7.org/CodeSystem/measure-population" markdown
Measure.group.population.criteria Measure.rateAggregation
  • Type changed from string to Expression markdown
Measure.group.stratifier.code Measure.term
  • Added Element
Measure.group.stratifier.description Measure.term.code
  • Added Element
Measure.term.definition
  • Added Element
Measure.group.linkId
  • Added Element
Measure.group.title
  • Added Element
Measure.group.stratifier.criteria Measure.group.description
  • Type changed from string to Expression markdown
Measure.group.stratifier.component Measure.group.type
  • Added Element
Measure.group.stratifier.component.code Measure.group.subject[x]
  • Added Element
Measure.group.stratifier.component.description Measure.group.basis
  • Added Element
Measure.group.stratifier.component.criteria Measure.group.basisRequirement
  • Added Mandatory Element
Measure.supplementalData.code Measure.group.scoring
  • Added Element
Measure.group.scoringUnit
  • Added Element
Measure.group.scoringPrecision
  • Added Element
Measure.group.compositeScoring
  • Added Element
Measure.group.component
  • Added Element
Measure.group.component.measure
  • Added Element
Measure.group.component.groupId
  • Added Element
Measure.group.component.weight
  • Added Element
Measure.group.rateAggregation
  • Added Element
Measure.group.improvementNotation
  • Added Element
Measure.group.improvementNotationGuidance
  • Added Element
Measure.group.library
  • Added Element
Measure.group.population.linkId
  • Added Element
Measure.group.population.title
  • Added Element
Measure.supplementalData.usage Measure.group.population.code
  • Change code system for extensibly bound codes value set from "http://hl7.org/fhir/measure-data-usage" http://hl7.org/fhir/ValueSet/measure-population to "http://terminology.hl7.org/CodeSystem/measure-data-usage" MeasurePopulationType icon
Measure.supplementalData.description Measure.group.population.description
  • Added Element Type changed from string to markdown
Measure.supplementalData.criteria Measure.group.population.criteria
  • Min Cardinality changed from 1 to 0
Measure.group.population.groupDefinition
  • Added Element
Measure.group.population.inputPopulationId
  • Added Element
Measure.group.population.aggregateMethod
  • Added Element
Measure.group.stratifier.linkId
  • Added Element
Measure.group.stratifier.title
  • Added Element
Measure.group.stratifier.description
  • Type changed from string to 1 markdown
Measure.group.stratifier.groupDefinition
  • Added Element
Measure.group.stratifier.component.linkId
  • Added Element
Measure.group.stratifier.component.description
  • Type changed from string to Expression markdown
Measure.contributor Measure.group.stratifier.component.criteria
  • deleted Min Cardinality changed from 1 to 0
Measure.set Measure.group.stratifier.component.groupDefinition
  • deleted Added Element
Measure.group.stratifier.component.valueSet
  • Added Element
Measure.group.identifier Measure.group.stratifier.component.unit
  • deleted Added Element
Measure.group.name Measure.supplementalData.linkId
  • deleted Added Element
Measure.group.population.identifier Measure.supplementalData.usage
  • deleted Change value set from http://hl7.org/fhir/ValueSet/measure-data-usage to MeasureDataUsage icon
Measure.supplementalData.description
  • Type changed from string to markdown
Measure.supplementalData.valueSet
  • Added Element
Measure.supplementalData.unit
  • Added Element
Measure.group.population.name Measure.scoring
  • deleted Deleted
Measure.group.stratifier.identifier Measure.compositeScoring
  • deleted Deleted
Measure.group.stratifier.path Measure.type
  • deleted Deleted
Measure.supplementalData.identifier Measure.improvementNotation
  • deleted Deleted
Measure.supplementalData.path Measure.definition
  • deleted Deleted

See the Full Difference for further information

This analysis is available for R4 as XML or JSON . See R3 <--> R4 Conversion Maps (status = 6 tests that all execute ok. All tests pass round-trip testing and 6 r3 resources are invalid (0 errors). ) for R4B as XML or JSON .

 

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

14.14.3.1 17.15.4.1 Terminology Bindings

Measure.status Measure.scoring Measure.compositeScoring Measure.type Required Measure.supplementalData.usage
Path Definition ValueSet Type Reference Documentation
Measure.versionAlgorithm[x] The lifecycle status of an artifact. VersionAlgorithm Required Extensible

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

Measure.status PublicationStatus Measure.subject[x] Required

The possible types lifecycle status of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.). an artifact.

Measure.subject[x] ParticipantResourceTypes Extensible SubjectType

All Resource Types that represent participant resources

Measure.jurisdiction JurisdictionValueSet icon Extensible Countries

This value set defines a base set of codes for country, country subdivision and regions within which this artifact region for indicating where a resource is targeted intended to be used.

Note: The codes for use. countries and country subdivisions are taken from ISO 3166 icon while the codes for "supra-national" regions are from UN Standard country or area codes for statistical use (M49) icon.
Measure.reportingFrequency FrequencyUnit Extensible Jurisdiction ValueSet

Frequency units (i.e. per time-duration-unit).

Measure.topic DefinitionTopic Example

High-level categorization of the definition, used for searching, sorting, and filtering.

Measure.term.code MeasureDefinitionExample Example

Example Measure Definitions for the Measure Resource.

Measure.group.code DefinitionTopic MeasureGroupExample Example

Example Measure Groups for the Measure Resource.

Measure.group.type MeasureType icon Extensible

The scoring type of the measure. measure (includes codes from 2.16.840.1.113883.1.11.20368).

Measure.group.subject[x] ParticipantResourceTypes Extensible

All Resource Types that represent participant resources

Measure.group.basis MeasureScoring FHIRTypes (a valid code from All FHIR Types ) Required

All FHIR types

Measure.group.scoring MeasureScoring icon Extensible

The composite scoring method type of the measure.

Measure.group.scoringUnit MeasureScoringUnit Extensible Example CompositeMeasureScoring

This is an example value set illustrating some typical scoring units used in quality measure specifications.

Measure.group.compositeScoring The type of measure (includes codes from 2.16.840.1.113883.1.11.20368). CompositeMeasureScoring icon Extensible MeasureType

The composite scoring method of the measure.

Measure.improvementNotation Measure.group.improvementNotation MeasureImprovementNotation icon Extensible

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

Measure.group.population.code MeasureImprovementNotation MeasurePopulationType icon Measure.group.population.code Extensible

The type of population.

Measure.group.population.aggregateMethod MeasureAggregateMethod icon Extensible

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

Measure.group.stratifier.code MeasurePopulationType MeasureStratifierExample Example

Identifier subgroups in a population for measuring purposes.

Measure.group.stratifier.component.code MeasureStratifierExample Example The intended usage

Identifier subgroups in a population for supplemental measuring purposes.

Measure.supplementalData.code MeasureSupplementalDataExample Example

Supplemental data elements in the measure. a population for measuring purposes.

Measure.supplementalData.usage MeasureDataUsage icon Extensible MeasureDataUsage

The intended usage for supplemental data elements in the measure.

14.14.3.2 17.15.4.2 Constraints

id UniqueKey Level Location Description Expression
mea-0 img  cnl-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}') name.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$')
mea-1 img  mea-1 Rule (base) Stratifier SHALL be either a single criteria or a set of criteria components group.stratifier.all((code | description | criteria).exists() xor component.exists())
img  cnl-1 Warning Measure.url URL should not contain | or # - these characters make processing canonical references problematic exists() implies matches('^[^|# ]+$')
img  mea-2 Warning Measure.group.linkId Link ids should be 255 characters or less $this.length() <= 255
img  mea-3 Warning Measure.group.population.linkId Link ids should be 255 characters or less $this.length() <= 255
img  mea-4 Warning Measure.group.stratifier.linkId Link ids should be 255 characters or less $this.length() <= 255
img  mea-5 Warning Measure.group.stratifier.component.linkId Link ids should be 255 characters or less $this.length() <= 255
img  mea-6 Warning Measure.supplementalData.linkId Link ids should be 255 characters or less $this.length() <= 255
img  mea-7 Rule Measure.group.basisRequirement Basis requirements SHALL have a type, MAY have profile and codeFilter elements, and SHALL NOT specify dateFilter, valueFilter, limit, or sort dateFilter.exists().not() and valueFilter.exists().not() and limit.exists().not() and sort.exists().not()
img  mea-8 Warning Measure.relatedArtifact Dependencies and components of a Measure should reference a resource type in ('depends-on' | 'composed-of' | 'part-of') implies ((resource.exists() xor resourceReference.exists()) or (artifact is canonical xor artifact is Reference))

14.14.4 17.15.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource , and check the Extensions registry for search parameters on extensions related to 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) 		5 Resources
context token A use context assigned to the measure (Measure.useContext.value as CodeableConcept) (Measure.useContext.value.ofType(CodeableConcept)) 24 Resources
context-quantity quantity A quantity- or range-valued use context assigned to the measure (Measure.useContext.value as Quantity) (Measure.useContext.value.ofType(Quantity)) | (Measure.useContext.value as Range) (Measure.useContext.value.ofType(Range)) 24 Resources
context-type token A type of use context assigned to the measure Measure.useContext.code 24 Resources
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.ofType(Quantity) | value.as(Range) value.ofType(Range) 		24 Resources
context-type-value composite A use context type and value assigned to the measure On Measure.useContext:
  context-type: code
  context: value.as(CodeableConcept) value.ofType(CodeableConcept) 		24 Resources
date date The measure publication date Measure.date 25 Resources
depends-on reference What resource is being referenced Measure.relatedArtifact.where(type='depends-on').resource | Measure.library
( Library , Any) 		5 Resources
derived-from reference What resource is being referenced Measure.relatedArtifact.where(type='derived-from').resource
(Any) 		9 Resources
description string The description of the measure Measure.description 23 Resources
effective date The time during which the measure is intended to be in use Measure.effectivePeriod 10 Resources
experimental token Whether the Measure is experimental Measure.experimental
identifier token External identifier for the measure Measure.identifier 28 Resources
jurisdiction token Intended jurisdiction for Jurisdiction of the authority that maintains the the measure Measure.jurisdiction 21 Resources
name string Computationally friendly name of the measure Measure.name 23 Resources
predecessor reference What resource is being referenced Measure.relatedArtifact.where(type='predecessor').resource
(Any) 		9 Resources
publisher string Name of the publisher of the measure Measure.publisher 25 Resources
status token The current status of the measure Measure.status 28 Resources
subject-canonical reference The subject of the Measure when expressed as a canonical Measure.subject as canonical
( Group )
subject-code token successor The subject of the Measure when expressed as a code Measure.subject as CodeableConcept
subject-reference reference The subject of the Measure when expressed as a reference Measure.subject as Reference
( Group )
successor reference What resource is being referenced Measure.relatedArtifact.where(type='successor').resource
(Any) 		5 Resources
title string The human-friendly name of the measure Measure.title 23 Resources
topic token Topics associated with the measure Measure.topic 10 Resources
url uri The uri that identifies the measure Measure.url 29 Resources
version token The business version of the measure Measure.version 26 Resources