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        CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
        2.0.0 - Release 2 US

        This page is part of the NHSN Digital Quality Measures (dQM) Content Package Implementation Guide (v2.0.0: Release) based on FHIR (HL7? FHIR? Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

        Resource Profile: NHSNIndividualMeasureReport - Detailed Descriptions

        Page standards status: Trial-use Maturity Level: 2

        Definitions for the nhsn-individual-measurereport resource profile.

        Guidance on how to interpret the contents of this table can be foundhere

        0. MeasureReport
        Definition

        The MeasureReport resource contains the results of the calculation of a measure; and optionally a reference to the resources involved in that calculation.

        Short Results of a measure evaluation
        Control 0..*
        Is Modifier false
        Must Support false
        Summary false
        Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
        dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
        mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
        deqm-2: If the measure scoring is specified at the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists())
        deqm-3: Measure scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').empty()) xor (extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').empty() and group.all(extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists())))
        deqm-5: If the scoring, at either the root level or the group level, is other than composite then the group.population cardinality is >=1 ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains ('composite')).not() or (group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains ('composite')).not() implies group.population.count()>=1)
        ach-monthly-measure-resource-requirements: MeasureReport: ACH Monthly MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
        ach-daily-measure-resource-requirements: MeasureReport: ACH Daily MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalDailyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
        mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
        mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
        2. MeasureReport.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        Short A set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control 0..1
        Type uri
        Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive Value This primitive element may be present, or absent, or replaced by an extension
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        4. MeasureReport.extension
        Definition

        An Extension


        May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        Short ExtensionAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control 10..*
        Type Extension
        Is Modifier false
        Summary false
        Alternate Names extensions, user content
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        Slicing This element introduces a set of slices on MeasureReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 6. MeasureReport.extension:careGapRemark
          Slice Name careGapRemark
          Definition

          Remark about a Condition Category.

          Short Condition Category remark
          Control 0..*
          This element is affected by the following invariants: ele-1, cgr-1
          Type Extension(DEQM Care Gap Remark Extension) (Complex Extension)
          Is Modifier false
          Must Support true
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          cgr-1: A remark shall include an author, an authorOrganization, or an authorSoftware (extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists())
          8. MeasureReport.extension:message
          Slice Name message
          Definition

          An OperationOutcome resource with information, warning, or error messages that were generated as part of processing an operation.

          Short Evaluation messages
          Control 0..1
          Type Extension(Messages) (Extension Type: Reference(OperationOutcome))
          Is Modifier false
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          10. MeasureReport.extension:category
          Slice Name category
          Definition

          Specifies the category of a measure report.

          Short What category is this measure report
          Control 0..1
          Type Extension(Measure Report Category) (Extension Type: CodeableConcept)
          Is Modifier false
          Must Support true
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          12. MeasureReport.extension:reportingProgram
          Slice Name reportingProgram
          Definition

          Reference the reporting program by referencing their unique id specified in a Library resource that conforms to the Quality Program profile.

          Short Reporting program
          Control 0..1
          This element is affected by the following invariants: ele-1
          Type Extension(DEQM Reporting Program Extension) (Extension Type: Choice of: Identifier, canonical(CRMI Manifest Library))
          Is Modifier false
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          14. MeasureReport.extension:inputParameters
          Slice Name inputParameters
          Definition

          Specifies the input parameters to the operation (such as a test case description or a data requirements or evaluate operation). This extension can be used as part of the result of an operation to indicate what the parameters were, but it can also be used as part of the definition of a test case to specify what the input parameters are expected to be for the test case.

          Short What parameters
          Control 0..1
          Type Extension(Input parameters) (Extension Type: Reference(Parameters))
          Is Modifier false
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          16. MeasureReport.extension:supplementalData
          Slice Name supplementalData
          Definition

          An Extension

          Short (NHSN-MS) Supplemental Data Element
          Control 1..*
          This element is affected by the following invariants: ele-1, ach-monthly-measure-resource-requirements
          Type Extension(Extension Definition for MeasureReport.supplementalData for Version 5.0) (Extension Type: Reference(Resource))
          Is Modifier false
          Must Support true
          Summary false
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          18. MeasureReport.extension:supplementalData.extension
          Definition

          An Extension


          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          Short ExtensionAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control 0..0*
          Type Extension
          Is Modifier false
          Summary false
          Alternate Names extensions, user content
          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          Slicing This element introduces a set of slices on MeasureReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 20. MeasureReport.extension:supplementalData.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Short identifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control 1..1
            Type uri
            Is Modifier false
            XML Format In the XML format, this property is represented as an attribute.
            Summary false
            Fixed Value http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData
            22. MeasureReport.extension:supplementalData.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            Short Value of extension
            Control 10..1
            Type Reference(Resource), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
            Is Modifier false
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. MeasureReport.extension:supplementalData.value[x].extension:criteriaReference
            Slice Name criteriaReference
            Definition

            Reference a criteria by specifying that criteria's unique id

            Short Criteria reference
            Comments

            When used in a MeasureReport, this is a reference to the id of a criteria within the Measure referenced by the MeasureReport.

            Control 0..1
            Type Extension(Criteria Reference Extension) (Extension Type: string)
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            26. MeasureReport.extension:supplementalData.value[x].extension:description
            Slice Name description
            Definition

            A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

            Short Description of the supplemental data
            Control 0..1
            Type Extension(Measure Report Population Description) (Extension Type: markdown)
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            28. MeasureReport.extension:scoring
            Slice Name scoring
            Definition

            Optional Extension Element - found in all resources.

            Short (NHSN-MS) cohort
            Control 0..1
            This element is affected by the following invariants: ele-1, deqm-2, deqm-3, deqm-6
            Type Extension(DEQM Measure Scoring Extension) (Extension Type: CodeableConcept)
            Is Modifier false
            Must Support true
            Summary false
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            30. MeasureReport.extension:scoring.extension
            Definition

            An Extension


            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            Short ExtensionAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control 0..0*
            Type Extension
            Is Modifier false
            Summary false
            Alternate Names extensions, user content
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            Slicing This element introduces a set of slices on MeasureReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 32. MeasureReport.extension:scoring.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Short identifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control 1..1
              Type uri
              Is Modifier false
              XML Format In the XML format, this property is represented as an attribute.
              Summary false
              Fixed Value http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring
              34. MeasureReport.extension:scoring.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              Short Value of extension
              Control 10..1
              Type CodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
              Is Modifier false
              Summary false
              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              Slicing This element introduces a set of slices on MeasureReport.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
              • type @ $this
              • 36. MeasureReport.extension:scoring.value[x]:valueCodeableConcept
                Slice Name valueCodeableConcept
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                Short Value of extension
                Control 10..1
                Binding Unless not suitable, these codes SHALL be taken from For codes, see MeasureScoring (2.0.0)
                (extensible to http://terminology.hl7.org/ValueSet/measure-scoring|2.0.0)
                Type CodeableConcept, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                Is Modifier false
                Summary false
                Pattern Value {
                ??"coding"?:?[{
                ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-scoring",
                ????"code"?:?"cohort"
                ??}]
                }
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                38. MeasureReport.extension:vendor
                Slice Name vendor
                Definition

                A reference to the vendor who queried the data, calculated results and/or generated the report.

                Short Vendor information
                Control 0..1
                This element is affected by the following invariants: ele-1
                Type Extension(DEQM Reporting Vendor Extension) (Extension Type: Reference(QICore Organization))
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                40. MeasureReport.extension:cehrt
                Slice Name cehrt
                Definition

                An identifier that represents the EHR certication number (CERHT). See Certified EHR Technology For more information.

                Short CMS EHR Certification ID
                Control 0..1
                This element is affected by the following invariants: ele-1
                Type Extension(DEQM Certification Identifier Extension) (Extension Type: Identifier)
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                42. MeasureReport.extension:cehrt.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Short identifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control 1..1
                Type uri
                Is Modifier false
                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                XML Format In the XML format, this property is represented as an attribute.
                Summary false
                Fixed Value http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier
                44. MeasureReport.extension:cehrt.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                Short Value of extension
                Control 10..1
                Type Identifier, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                Is Modifier false
                Summary false
                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                Slicing This element introduces a set of slices on MeasureReport.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 46. MeasureReport.extension:cehrt.value[x]:valueIdentifier
                  Slice Name valueIdentifier
                  Definition

                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  Short Value of extension
                  Control 10..1
                  Type Identifier, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifier false
                  Summary false
                  Pattern Value {
                  ??"system"?:?"urn:oid:2.16.840.1.113883.3.2074.1"
                  }
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  48. MeasureReport.extension:software
                  Slice Name software
                  Definition

                  Specifies the software systems used in the packaging and testing of knowledge artifacts. Specifically to support explicitly stating which versions of the various software components were used in the authoring, packaging, and testing.

                  Short Extension
                  Control 0..*
                  This element is affected by the following invariants: ele-1
                  Type Extension(CRMI Software System) (Extension Type: Reference(CRMI Software System Device))
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  50. MeasureReport.extension:location
                  Slice Name location
                  Definition

                  Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.

                  Short Location(s) from which reported data was gathered
                  Control 0..*
                  This element is affected by the following invariants: ele-1
                  Type Extension(DEQM Data Location Extension) (Extension Type: Reference(QICore Location))
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  52. MeasureReport.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  Summary false
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  54. MeasureReport.status
                  Definition

                  The MeasureReport status. No data will be available until the MeasureReport status is complete.

                  Short complete | pending | error
                  Comments

                  This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                  Control 1..1
                  Binding The codes SHALL be taken from MeasureReportStatushttp://hl7.org/fhir/ValueSet/measure-report-status|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1)

                  The status of the measure report.

                  Type code
                  Is Modifier true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  56. MeasureReport.type
                  Definition

                  The type of measure report. This may be an individual report, which provides the score for the measure for an individual member of the population; a subject-listing, which returns the list of members that meet the various criteria in the measure; a summary report, which returns a population count for each of the criteria in the measure; or a data-collection, which enables the MeasureReport to be used to exchange the data-of-interest for a quality measure.

                  Short (NHSN-MS) individualindividual | subject-list | summary | data-collection
                  Comments

                  Data-collection reports are used only to communicate data-of-interest for a measure. They do not necessarily include all the data for a particular subject or population, but they may.

                  Control 1..1
                  This element is affected by the following invariants: mrp-1
                  Binding The codes SHALL be taken from MeasureReportTypehttp://hl7.org/fhir/ValueSet/measure-report-type|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1)

                  The type of the measure report.

                  Type code
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Requirements

                  For individual quality meaure reporting, this report is constrained to reporting on an individual.

                  Fixed Value individual
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  58. MeasureReport.measure
                  Definition

                  A reference to the Measure that was calculated to produce this report.

                  Short What measure was calculated
                  Control 1..1
                  This element is affected by the following invariants: deqm-0
                  Type canonical(CRMI Shareable Measure, Measure)
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Requirements

                  This will indicate the measure and version being reported on. For example, the cannonical uri location for the MRP measure.

                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-0: Canonical URL SHALL contain a version. (%resource.measure.toString().contains('|') and %resource.measure.substring(%resource.measure.toString().indexOf('|') + 1).length() > 0)
                  60. MeasureReport.subject
                  Definition

                  Optional subject identifying the individual or individuals the report is for.

                  Short (NHSN-MS) What individual the report is forWhat individual(s) the report is for
                  Control 10..1
                  Type Reference(Cross-Measure Patient Profile, Patient, Practitioner, PractitionerRole, Location, Device, RelatedPerson, Group)
                  Is Modifier false
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. MeasureReport.date
                  Definition

                  The date this measure report was generated.

                  Short (NHSN-MS) When the report was calculated.When the report was generated
                  Control 10..1
                  Type dateTime
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  64. MeasureReport.reporter
                  Definition

                  Organization that generated the MeasureReport


                  The individual, location, or organization that is reporting the data.

                  Short (NHSN-MS) The reporting organization that is responsible for the reportWho is reporting the data
                  Control 10..1
                  Type Reference(QICore Organization, Practitioner, PractitionerRole, Location, Organization)
                  Is Modifier false
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  66. MeasureReport.reporter.extension:group
                  Slice Name group
                  Definition

                  Group of practitioners responsible for a report. This extension is used to provide the capability to allow the participating practitioners to be documented.

                  Short Group of practitioners responsible for a report
                  Control 0..1
                  Type Extension(DEQM Reporter Group Extension) (Extension Type: Reference(Group))
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  68. MeasureReport.period
                  Definition

                  The reporting period for which the report was calculated.

                  Short (NHSN-MS) The period for which the report was calculated. For the gaps in care use case, this is referred to as the gaps through period.What period the report covers
                  Control 1..1
                  This element is affected by the following invariants: deqm-1
                  Type Period
                  Is Modifier false
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) (start.toString().length()>9 and end.toString().length()>9)
                  70. MeasureReport.period.start
                  Definition

                  The start of the period. The boundary is inclusive.

                  Short (NHSN-MS) Starting time with inclusive boundaryStarting time with inclusive boundary
                  Comments

                  If the low element is missing, the meaning is that the low boundary is not known.

                  Control 10..1
                  This element is affected by the following invariants: per-1
                  Type dateTime
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  72. MeasureReport.period.end
                  Definition

                  The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                  Short (NHSN-MS) End time with inclusive boundary, if not ongoingEnd time with inclusive boundary, if not ongoing
                  Comments

                  The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                  Control 10..1
                  This element is affected by the following invariants: per-1
                  Type dateTime
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary true
                  Meaning if Missing If the end of the period is missing, it means that the period is ongoing
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  74. MeasureReport.improvementNotation
                  Definition

                  Whether improvement in the measure is noted by an increase or decrease in the measure score.

                  Short (NHSN-MS) increase | decreaseincrease | decrease
                  Comments

                  This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score.

                  Control 0..1
                  This element is affected by the following invariants: deqm-2
                  Binding The codes SHALL be taken from MeasureImprovementNotationhttp://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1)

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

                  Type CodeableConcept
                  Is Modifier true because Improvement notation determines how to interpret the measure score (i.e. whether an increase is an improvement)
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  76. MeasureReport.group
                  Definition

                  The results of the calculation, one for each population group in the measure.

                  Short (NHSN-MS) Measure results for each group.Measure results for each group
                  Control 0..*
                  This element is affected by the following invariants: mrp-1
                  Type BackboneElement
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-4: If the measure scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the groupImprovementNotation element is required. ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-groupImprovementNotation').exists())
                  deqm-6: If the measure scoring type is 'proportion' then the measureScore SHALL be a numerical value between 0 and 1 ((%resource.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains 'proportion' or extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains 'proportion') implies (measureScore.value >= 0.0 and measureScore.value <= 1.0))
                  78. MeasureReport.group.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  Short Unique id for inter-element referencing
                  Control 0..1
                  Type string
                  Is Modifier false
                  Must Support true
                  XML Format In the XML format, this property is represented as an attribute.
                  Summary false
                  80. MeasureReport.group.extension:scoring
                  Slice Name scoring
                  Definition

                  Optional Extension Element - found in all resources.

                  Short proportion | ratio | continuous-variable | cohort | composite | attestation
                  Control 0..1
                  This element is affected by the following invariants: ele-1, deqm-3
                  Type Extension(DEQM Measure Scoring Extension) (Extension Type: CodeableConcept)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  82. MeasureReport.group.extension:calculatedDate
                  Slice Name calculatedDate
                  Definition

                  This applies to the date this metric was actually calculated. If your measure calculation draws on stored calculations and there are multiple calculation dates, this extension would not apply, as in the example of a composite measure where the individual measures were calculated on different dates. This would only cover the case where there is only one calculation date.

                  Short The date the score was calculated
                  Control 0..1
                  This element is affected by the following invariants: ele-1
                  Type Extension(DEQM Calculated Date Extension) (Extension Type: dateTime)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  84. MeasureReport.group.extension:improvementNotation
                  Slice Name improvementNotation
                  Definition

                  Optional Extension Element - found in all resources.

                  Short increase | decrease
                  Control 0..1
                  This element is affected by the following invariants: ele-1, deqm-4
                  Type Extension(DEQM Group Improvement Notation Extension) (Extension Type: CodeableConcept)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  86. MeasureReport.group.extension:description
                  Slice Name description
                  Definition

                  A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                  Short Description of the group
                  Control 0..1
                  Type Extension(Measure Report Population Description) (Extension Type: markdown)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  88. MeasureReport.group.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content, modifiers
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  90. MeasureReport.group.code
                  Definition

                  The meaning of the population group as defined in the measure definition.

                  Short (NHSN-MS) Meaning of the groupMeaning of the group
                  Control 0..1
                  Type CodeableConcept
                  Is Modifier false
                  Must Support true
                  Summary true
                  Pattern Value {
                  ??"coding"?:?[{
                  ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-population",
                  ????"code"?:?"initial-population"
                  ??}]
                  }
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. MeasureReport.group.population
                  Definition

                  The populations that make up the population group, one for each type of population appropriate for the measure.

                  Short (NHSN-MS) The populations in the groupThe populations in the group
                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-8: The population must either have a count (integer) or a countQuantity (quantity), but not both. (extension('http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity').exists() xor count.exists())
                  94. MeasureReport.group.population.extension:countQuantity
                  Slice Name countQuantity
                  Definition

                  The count of the population represented as a Quantity. This is used in cases where the count may be a decimal value such as in a ratio measure.

                  Short Count as a Quantity
                  Control 0..1
                  This element is affected by the following invariants: deqm-8
                  Type Extension(Count Quantity) (Extension Type: Quantity)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  96. MeasureReport.group.population.extension:description
                  Slice Name description
                  Definition

                  A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                  Short Description of the population
                  Control 0..1
                  Type Extension(Measure Report Population Description) (Extension Type: markdown)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  98. MeasureReport.group.population.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content, modifiers
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  100. MeasureReport.group.population.code
                  Definition

                  The type of the population.

                  Short initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                  Control 10..1
                  Binding Unless not suitable, these codes SHALL be taken from MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population|4.0.1
                  (extensible to http://hl7.org/fhir/ValueSet/measure-population)

                  The type of population (e.g. initial, numerator, denominator, etc.).

                  Type CodeableConcept
                  Is Modifier false
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  102. MeasureReport.group.population.count
                  Definition

                  The number of members of the population.

                  Short (NHSN-MS) Size of the population. Always '1' for individual MeasureReport.Size of the population
                  Control 0..1
                  This element is affected by the following invariants: deqm-8
                  Type integer
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary false
                  Pattern Value 1
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  104. MeasureReport.group.population.subjectResults
                  Definition

                  This element refers to a List of subject level MeasureReport resources, one for each subject in this population.

                  Short For subject-list reports, the subject results in this population
                  Control 0..01
                  Type Reference(List, List)
                  Is Modifier false
                  Must Support false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  106. MeasureReport.group.measureScore
                  Definition

                  The measure score for this population group, calculated as appropriate for the measure type and scoring method, and based on the contents of the populations defined in the group.

                  Short What score this group achieved
                  Comments

                  For individual reporting, the measure score is calculated for the individual. For a proportion measure, it would be 0.0 or 1.0 (indicating 0% or 100%).

                  Control 0..1
                  This element is affected by the following invariants: deqm-6
                  Type Quantity
                  Is Modifier false
                  Must Support true
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  108. MeasureReport.group.measureScore.extension:alternateScoreType
                  Slice Name alternateScoreType
                  Definition

                  Possible value types for the measureScore elements in addition to the standard Quantity type. The alternate type is determined by the Quality Measure Aggregate Method extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation.

                  Short Possible additional measureScore value types
                  Comments

                  This extension corresponds to the additional MeasureScore type added to the R5 version of MeasureReport.

                  Control 0..1
                  Type Extension(DEQM Alternate Score Type Extension) (Extension Type: Choice of: dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  110. MeasureReport.group.measureScore.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short < | <= | >= | > - how to understand the value
                  Control 0..1
                  Binding The codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Type code
                  Is Modifier true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary true
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if Missing If there is no comparator, then there is no modification of the value
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  112. MeasureReport.group.stratifier
                  Definition

                  When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.

                  Short Stratification results
                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-7: If group.stratifier exists, then either group.stratifier.code or the group.stratifier.stratum.component.code is present, but not both (code.exists() xor stratum.component.exists())
                  114. MeasureReport.group.stratifier.extension:description
                  Slice Name description
                  Definition

                  A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                  Short Description of the stratifier
                  Control 0..1
                  Type Extension(Measure Report Population Description) (Extension Type: markdown)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  116. MeasureReport.group.stratifier.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content, modifiers
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  118. MeasureReport.group.stratifier.code
                  Definition

                  The meaning of this stratifier, as defined in the measure definition.

                  Short What stratifier of the group
                  Control 0..1*
                  Type CodeableConcept
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  120. MeasureReport.group.stratifier.stratum
                  Definition

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

                  Short Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  122. MeasureReport.group.stratifier.stratum.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content, modifiers
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  124. MeasureReport.group.stratifier.stratum.population
                  Definition

                  The populations that make up the stratum, one for each type of population appropriate to the measure.

                  Short Population results in this stratum
                  Control 0..*
                  Type BackboneElement
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  deqm-9: The stratum population must either have a count (integer) or a countQuantity (quantity), but not both. (extension('http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity').exists() xor count.exists())
                  126. MeasureReport.group.stratifier.stratum.population.extension:countQuantity
                  Slice Name countQuantity
                  Definition

                  A Quantity representing the size of the population. This is important to support the case when a population value may result in a decimal when reporting composite measures.

                  Short Size of the population as a quantity.
                  Control 0..1
                  This element is affected by the following invariants: deqm-9
                  Type Extension(Count Quantity) (Extension Type: Quantity)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  128. MeasureReport.group.stratifier.stratum.population.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  Short Extensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control 0..*
                  Type Extension
                  Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summary true
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Names extensions, user content, modifiers
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  130. MeasureReport.group.stratifier.stratum.population.code
                  Definition

                  The type of the population.

                  Short initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                  Control 10..1
                  Binding Unless not suitable, these codes SHALL be taken from MeasurePopulationTypehttp://hl7.org/fhir/ValueSet/measure-population|4.0.1
                  (extensible to http://hl7.org/fhir/ValueSet/measure-population)

                  The type of population (e.g. initial, numerator, denominator, etc.).

                  Type CodeableConcept
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  132. MeasureReport.group.stratifier.stratum.population.count
                  Definition

                  The number of members of the population in this stratum.

                  Short Size of the population
                  Control 10..1
                  This element is affected by the following invariants: deqm-9
                  Type integer
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  134. MeasureReport.group.stratifier.stratum.measureScore
                  Definition

                  The measure score for this stratum, calculated as appropriate for the measure type and scoring method, and based on only the members of this stratum.

                  Short What score this stratum achieved
                  Control 0..1
                  Type Quantity
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  136. MeasureReport.group.stratifier.stratum.measureScore.extension:alternateScoreType
                  Slice Name alternateScoreType
                  Definition

                  Possible value types for the measureScore elements in addition to the standard Quantity type. The alternate type is determined by the Quality Measure Aggregate Method extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation.

                  Short Possible additional measureScore value types
                  Comments

                  This extension corresponds to the additional MeasureScore type added to the R5 version of MeasureReport.

                  Control 0..1
                  Type Extension(DEQM Alternate Score Type Extension) (Extension Type: Choice of: dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  138. MeasureReport.group.stratifier.stratum.measureScore.comparator
                  Definition

                  How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                  Short < | <= | >= | > - how to understand the value
                  Control 0..1
                  Binding The codes SHALL be taken from QuantityComparatorhttp://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1
                  (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                  How the Quantity should be understood and represented.

                  Type code
                  Is Modifier true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary true
                  Requirements

                  Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                  Meaning if Missing If there is no comparator, then there is no modification of the value
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  140. MeasureReport.evaluatedResource
                  Definition

                  A reference to a Bundle containing the Resources that were used in the calculation of this measure.

                  Short (NHSN-MS) What data was used to calculate the measure scoreWhat data was used to calculate the measure score
                  Control 0..*
                  Type Reference(Resource, Resource)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Requirements

                  To support the reporting of supplemental data elements.

                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  142. MeasureReport.evaluatedResource.extension:criteriaReference
                  Slice Name criteriaReference
                  Definition

                  Reference a criteria by specifying that criteria's unique id

                  Short Criteria reference
                  Comments

                  When used in a MeasureReport, this is a reference to the id of a criteria within the Measure referenced by the MeasureReport.

                  Control 0..*
                  Type Extension(Criteria Reference Extension) (Extension Type: string)
                  Is Modifier false
                  Must Support true
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())

                  Guidance on how to interpret the contents of this table can be foundhere

                  0. MeasureReport
                  Invariants ach-monthly-measure-resource-requirements: MeasureReport: ACH Monthly MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
                  ach-daily-measure-resource-requirements: MeasureReport: ACH Daily MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalDailyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
                  2. MeasureReport.extension
                  Control 1..?
                  4. MeasureReport.extension:supplementalData
                  Slice Name supplementalData
                  Short (NHSN-MS) Supplemental Data Element
                  Control 1..?
                  This element is affected by the following invariants: ach-monthly-measure-resource-requirements
                  6. MeasureReport.extension:scoring
                  Slice Name scoring
                  Short (NHSN-MS) cohort
                  8. MeasureReport.extension:scoring.value[x]:valueCodeableConcept
                  Slice Name valueCodeableConcept
                  Type CodeableConcept
                  [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                  Pattern Value {
                  ??"coding"?:?[{
                  ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-scoring",
                  ????"code"?:?"cohort"
                  ??}]
                  }
                  10. MeasureReport.type
                  Short (NHSN-MS) individual
                  12. MeasureReport.subject
                  Short (NHSN-MS) What individual the report is for
                  Type Reference(Cross-Measure Patient Profile)
                  14. MeasureReport.date
                  Short (NHSN-MS) When the report was calculated.
                  16. MeasureReport.reporter
                  Short (NHSN-MS) The reporting organization that is responsible for the report
                  18. MeasureReport.period
                  Short (NHSN-MS) The period for which the report was calculated. For the gaps in care use case, this is referred to as the gaps through period.
                  20. MeasureReport.period.start
                  Short (NHSN-MS) Starting time with inclusive boundary
                  22. MeasureReport.period.end
                  Short (NHSN-MS) End time with inclusive boundary, if not ongoing
                  24. MeasureReport.improvementNotation
                  Short (NHSN-MS) increase | decrease
                  26. MeasureReport.group
                  Short (NHSN-MS) Measure results for each group.
                  28. MeasureReport.group.code
                  Short (NHSN-MS) Meaning of the group
                  Pattern Value {
                  ??"coding"?:?[{
                  ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-population",
                  ????"code"?:?"initial-population"
                  ??}]
                  }
                  30. MeasureReport.group.population
                  Short (NHSN-MS) The populations in the group
                  32. MeasureReport.group.population.count
                  Short (NHSN-MS) Size of the population. Always '1' for individual MeasureReport.
                  Pattern Value 1
                  34. MeasureReport.evaluatedResource
                  Short (NHSN-MS) What data was used to calculate the measure score

                  Guidance on how to interpret the contents of this table can be foundhere

                  0. MeasureReport
                  Definition

                  The MeasureReport resource contains the results of the calculation of a measure; and optionally a reference to the resources involved in that calculation.

                  Short Results of a measure evaluation
                  Control 0..*
                  Is Modifier false
                  Must Support false
                  Summary false
                  Invariants dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                  dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
                  dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
                  dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                  dom-6: A resource should have narrative for robust management (text.`div`.exists())
                  mrp-1: Measure Reports used for data collection SHALL NOT communicate group and score information ((type != 'data-collection') or group.exists().not())
                  mrp-2: Stratifiers SHALL be either a single criteria or a set of criteria components (group.stratifier.stratum.all(value.exists() xor component.exists()))
                  deqm-2: If the measure scoring is specified at the root and the scoring type is 'proportion','ratio', or 'continuous-variable' then the improvementNotation element is required ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies improvementNotation.exists())
                  deqm-3: Measure scoring is required. It must be specified on the root only, or on every group, and it cannot be on both. ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').empty()) xor (extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').empty() and group.all(extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists())))
                  deqm-5: If the scoring, at either the root level or the group level, is other than composite then the group.population cardinality is >=1 ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains ('composite')).not() or (group.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains ('composite')).not() implies group.population.count()>=1)
                  ach-monthly-measure-resource-requirements: MeasureReport: ACH Monthly MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalMonthlyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
                  ach-daily-measure-resource-requirements: MeasureReport: ACH Daily MeasureReport must have a single supplemental data reference to Patient and at least one supplemental data reference to each of Encounter and Location. (measure.startsWith('http://www.cy118119.com/nhsn/fhirportal/dqm/ig/Measure/NHSNAcuteCareHospitalDailyInitialPopulation') implies extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Patient).count() = 1 and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Encounter).exists() and extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData').value.resolve().ofType(Location).exists())
                  2. MeasureReport.id
                  Definition

                  The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                  Short Logical id of this artifact
                  Comments

                  The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                  Control 0..1
                  Type id
                  Is Modifier false
                  Summary true
                  4. MeasureReport.meta
                  Definition

                  The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                  Short Metadata about the resource
                  Control 0..1
                  Type Meta
                  Is Modifier false
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  6. MeasureReport.implicitRules
                  Definition

                  A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                  Short A set of rules under which this content was created
                  Comments

                  Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                  Control 0..1
                  Type uri
                  Is Modifier true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary true
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  8. MeasureReport.language
                  Definition

                  The base language in which the resource is written.

                  Short Language of the resource content
                  Comments

                  Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                  Control 0..1
                  Binding The codes SHOULD be taken from CommonLanguages
                  (preferred to http://hl7.org/fhir/ValueSet/languages)

                  A human language.

                  Additional Bindings Purpose
                  AllLanguages Max Binding
                  Type code
                  Is Modifier false
                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  10. MeasureReport.text
                  Definition

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

                  Short Text summary of the resource, for human interpretation
                  Comments

                  Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                  Control 0..1
                  Type Narrative
                  Is Modifier false
                  Summary false
                  Alternate Names narrative, html, xhtml, display
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  12. MeasureReport.contained
                  Definition

                  These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                  Short Contained, inline Resources
                  Comments

                  This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                  Control 0..*
                  Type Resource
                  Is Modifier false
                  Summary false
                  Alternate Names inline resources, anonymous resources, contained resources
                  14. MeasureReport.extension
                  Definition

                  An Extension

                  Short Extension
                  Control 1..*
                  Type Extension
                  Is Modifier false
                  Summary false
                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  Slicing This element introduces a set of slices on MeasureReport.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 16. MeasureReport.extension:careGapRemark
                    Slice Name careGapRemark
                    Definition

                    Remark about a Condition Category.

                    Short Condition Category remark
                    Control 0..*
                    This element is affected by the following invariants: ele-1, cgr-1
                    Type Extension(DEQM Care Gap Remark Extension) (Complex Extension)
                    Is Modifier false
                    Must Support true
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    cgr-1: A remark shall include an author, an authorOrganization, or an authorSoftware (extension.where(url = 'author').exists() or extension.where(url = 'authorOrganization').exists() or extension.where(url = 'authorSoftware').exists())
                    18. MeasureReport.extension:message
                    Slice Name message
                    Definition

                    An OperationOutcome resource with information, warning, or error messages that were generated as part of processing an operation.

                    Short Evaluation messages
                    Control 0..1
                    Type Extension(Messages) (Extension Type: Reference(OperationOutcome))
                    Is Modifier false
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    20. MeasureReport.extension:category
                    Slice Name category
                    Definition

                    Specifies the category of a measure report.

                    Short What category is this measure report
                    Control 0..1
                    Type Extension(Measure Report Category) (Extension Type: CodeableConcept)
                    Is Modifier false
                    Must Support true
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    22. MeasureReport.extension:reportingProgram
                    Slice Name reportingProgram
                    Definition

                    Reference the reporting program by referencing their unique id specified in a Library resource that conforms to the Quality Program profile.

                    Short Reporting program
                    Control 0..1
                    This element is affected by the following invariants: ele-1
                    Type Extension(DEQM Reporting Program Extension) (Extension Type: Choice of: Identifier, canonical(CRMI Manifest Library))
                    Is Modifier false
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    24. MeasureReport.extension:inputParameters
                    Slice Name inputParameters
                    Definition

                    Specifies the input parameters to the operation (such as a test case description or a data requirements or evaluate operation). This extension can be used as part of the result of an operation to indicate what the parameters were, but it can also be used as part of the definition of a test case to specify what the input parameters are expected to be for the test case.

                    Short What parameters
                    Control 0..1
                    Type Extension(Input parameters) (Extension Type: Reference(Parameters))
                    Is Modifier false
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    26. MeasureReport.extension:supplementalData
                    Slice Name supplementalData
                    Definition

                    An Extension

                    Short (NHSN-MS) Supplemental Data Element
                    Control 1..*
                    This element is affected by the following invariants: ele-1, ach-monthly-measure-resource-requirements
                    Type Extension(Extension Definition for MeasureReport.supplementalData for Version 5.0) (Extension Type: Reference(Resource))
                    Is Modifier false
                    Must Support true
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    28. MeasureReport.extension:supplementalData.id
                    Definition

                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                    Short Unique id for inter-element referencing
                    Control 0..1
                    Type string
                    Is Modifier false
                    XML Format In the XML format, this property is represented as an attribute.
                    Summary false
                    30. MeasureReport.extension:supplementalData.extension
                    Definition

                    An Extension

                    Short Extension
                    Control 0..0
                    Type Extension
                    Is Modifier false
                    Summary false
                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    Slicing This element introduces a set of slices on MeasureReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 32. MeasureReport.extension:supplementalData.url
                      Definition

                      Source of the definition for the extension code - a logical name or a URL.

                      Short identifies the meaning of the extension
                      Comments

                      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                      Control 1..1
                      Type uri
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      Fixed Value http://hl7.org/fhir/5.0/StructureDefinition/extension-MeasureReport.supplementalData
                      34. MeasureReport.extension:supplementalData.value[x]
                      Definition

                      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                      Short Value of extension
                      Control 1..1
                      Type Reference(Resource)
                      [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifier false
                      Summary false
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      36. MeasureReport.extension:supplementalData.value[x].id
                      Definition

                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                      Short Unique id for inter-element referencing
                      Control 0..1
                      Type string
                      Is Modifier false
                      XML Format In the XML format, this property is represented as an attribute.
                      Summary false
                      38. MeasureReport.extension:supplementalData.value[x].extension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                      Short Additional content defined by implementations
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control 0..*
                      Type Extension
                      Is Modifier false
                      Summary false
                      Alternate Names extensions, user content
                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      Slicing This element introduces a set of slices on MeasureReport.extension.value[x].extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 40. MeasureReport.extension:supplementalData.value[x].extension:criteriaReference
                        Slice Name criteriaReference
                        Definition

                        Reference a criteria by specifying that criteria's unique id

                        Short Criteria reference
                        Comments

                        When used in a MeasureReport, this is a reference to the id of a criteria within the Measure referenced by the MeasureReport.

                        Control 0..1
                        Type Extension(Criteria Reference Extension) (Extension Type: string)
                        Is Modifier false
                        Must Support true
                        Summary false
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        42. MeasureReport.extension:supplementalData.value[x].extension:description
                        Slice Name description
                        Definition

                        A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                        Short Description of the supplemental data
                        Control 0..1
                        Type Extension(Measure Report Population Description) (Extension Type: markdown)
                        Is Modifier false
                        Must Support true
                        Summary false
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        44. MeasureReport.extension:supplementalData.value[x].reference
                        Definition

                        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                        Short Literal reference, Relative, internal or absolute URL
                        Comments

                        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                        Control 0..1
                        This element is affected by the following invariants: ref-1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        46. MeasureReport.extension:supplementalData.value[x].type
                        Definition

                        The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                        The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                        Short Type the reference refers to (e.g. "Patient")
                        Comments

                        This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                        Control 0..1
                        Binding Unless not suitable, these codes SHALL be taken from ResourceType
                        (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                        Aa resource (or, for logical models, the URI of the logical model).

                        Type uri
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        48. MeasureReport.extension:supplementalData.value[x].identifier
                        Definition

                        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                        Short Logical reference, when literal reference is not known
                        Comments

                        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                        Note This is a business identifier, not a resource identifier (see discussion)
                        Control 0..1
                        Type Identifier
                        Is Modifier false
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        50. MeasureReport.extension:supplementalData.value[x].display
                        Definition

                        Plain text narrative that identifies the resource in addition to the resource reference.

                        Short Text alternative for the resource
                        Comments

                        This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                        Control 0..1
                        Type string
                        Is Modifier false
                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                        Summary true
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        52. MeasureReport.extension:scoring
                        Slice Name scoring
                        Definition

                        Optional Extension Element - found in all resources.

                        Short (NHSN-MS) cohort
                        Control 0..1
                        This element is affected by the following invariants: ele-1, deqm-2, deqm-3, deqm-6
                        Type Extension(DEQM Measure Scoring Extension) (Extension Type: CodeableConcept)
                        Is Modifier false
                        Must Support true
                        Summary false
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        54. MeasureReport.extension:scoring.id
                        Definition

                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                        Short Unique id for inter-element referencing
                        Control 0..1
                        Type string
                        Is Modifier false
                        XML Format In the XML format, this property is represented as an attribute.
                        Summary false
                        56. MeasureReport.extension:scoring.extension
                        Definition

                        An Extension

                        Short Extension
                        Control 0..0
                        Type Extension
                        Is Modifier false
                        Summary false
                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        Slicing This element introduces a set of slices on MeasureReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 58. MeasureReport.extension:scoring.url
                          Definition

                          Source of the definition for the extension code - a logical name or a URL.

                          Short identifies the meaning of the extension
                          Comments

                          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                          Control 1..1
                          Type uri
                          Is Modifier false
                          XML Format In the XML format, this property is represented as an attribute.
                          Summary false
                          Fixed Value http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring
                          60. MeasureReport.extension:scoring.value[x]
                          Definition

                          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                          Short Value of extension
                          Control 1..1
                          Type CodeableConcept
                          [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifier false
                          Summary false
                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          Slicing This element introduces a set of slices on MeasureReport.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 62. MeasureReport.extension:scoring.value[x]:valueCodeableConcept
                            Slice Name valueCodeableConcept
                            Definition

                            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                            Short Value of extension
                            Control 1..1
                            Binding Unless not suitable, these codes SHALL be taken from MeasureScoring (2.0.0)
                            (extensible to http://terminology.hl7.org/ValueSet/measure-scoring|2.0.0)
                            Type CodeableConcept
                            [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                            Is Modifier false
                            Summary false
                            Pattern Value {
                            ??"coding"?:?[{
                            ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-scoring",
                            ????"code"?:?"cohort"
                            ??}]
                            }
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            64. MeasureReport.extension:vendor
                            Slice Name vendor
                            Definition

                            A reference to the vendor who queried the data, calculated results and/or generated the report.

                            Short Vendor information
                            Control 0..1
                            This element is affected by the following invariants: ele-1
                            Type Extension(DEQM Reporting Vendor Extension) (Extension Type: Reference(QICore Organization))
                            Is Modifier false
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            66. MeasureReport.extension:cehrt
                            Slice Name cehrt
                            Definition

                            An identifier that represents the EHR certication number (CERHT). See Certified EHR Technology For more information.

                            Short CMS EHR Certification ID
                            Control 0..1
                            This element is affected by the following invariants: ele-1
                            Type Extension(DEQM Certification Identifier Extension) (Extension Type: Identifier)
                            Is Modifier false
                            Summary false
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            68. MeasureReport.extension:cehrt.id
                            Definition

                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                            Short Unique id for inter-element referencing
                            Control 0..1
                            Type string
                            Is Modifier false
                            XML Format In the XML format, this property is represented as an attribute.
                            Summary false
                            70. MeasureReport.extension:cehrt.extension
                            Definition

                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                            Short Additional content defined by implementations
                            Comments

                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                            Control 0..*
                            Type Extension
                            Is Modifier false
                            Summary false
                            Alternate Names extensions, user content
                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            Slicing This element introduces a set of slices on MeasureReport.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 72. MeasureReport.extension:cehrt.url
                              Definition

                              Source of the definition for the extension code - a logical name or a URL.

                              Short identifies the meaning of the extension
                              Comments

                              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                              Control 1..1
                              Type uri
                              Is Modifier false
                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                              XML Format In the XML format, this property is represented as an attribute.
                              Summary false
                              Fixed Value http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier
                              74. MeasureReport.extension:cehrt.value[x]
                              Definition

                              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                              Short Value of extension
                              Control 1..1
                              Type Identifier
                              [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                              Is Modifier false
                              Summary false
                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              Slicing This element introduces a set of slices on MeasureReport.extension.value[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                              • type @ $this
                              • 76. MeasureReport.extension:cehrt.value[x]:valueIdentifier
                                Slice Name valueIdentifier
                                Definition

                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                Short Value of extension
                                Control 1..1
                                Type Identifier
                                [x] Note SeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifier false
                                Summary false
                                Pattern Value {
                                ??"system"?:?"urn:oid:2.16.840.1.113883.3.2074.1"
                                }
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                78. MeasureReport.extension:software
                                Slice Name software
                                Definition

                                Specifies the software systems used in the packaging and testing of knowledge artifacts. Specifically to support explicitly stating which versions of the various software components were used in the authoring, packaging, and testing.

                                Short Extension
                                Control 0..*
                                This element is affected by the following invariants: ele-1
                                Type Extension(CRMI Software System) (Extension Type: Reference(CRMI Software System Device))
                                Is Modifier false
                                Summary false
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                80. MeasureReport.extension:location
                                Slice Name location
                                Definition

                                Location from which reported data was gathered. This extension is used to provide the location(s) from which reported data was gathered in a MeasureReport, such as individual, summary and data exchange measure report.

                                Short Location(s) from which reported data was gathered
                                Control 0..*
                                This element is affected by the following invariants: ele-1
                                Type Extension(DEQM Data Location Extension) (Extension Type: Reference(QICore Location))
                                Is Modifier false
                                Summary false
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                82. MeasureReport.modifierExtension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                Short Extensions that cannot be ignored
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control 0..*
                                Type Extension
                                Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                Summary false
                                Requirements

                                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                Alternate Names extensions, user content
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                84. MeasureReport.identifier
                                Definition

                                A formal identifier that is used to identify this MeasureReport when it is represented in other formats or referenced in a specification, model, design or an instance.

                                Short Additional identifier for the MeasureReport
                                Comments

                                Typically, this is used for identifiers that can go in an HL7 V3 II data type - e.g. to identify this {{title}} outside of FHIR, where the logical URL is not possible to use.

                                Note This is a business identifier, not a resource identifier (see discussion)
                                Control 0..*
                                Type Identifier
                                Is Modifier false
                                Summary true
                                Requirements

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

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                86. MeasureReport.status
                                Definition

                                The MeasureReport status. No data will be available until the MeasureReport status is complete.

                                Short complete | pending | error
                                Comments

                                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                                Control 1..1
                                Binding The codes SHALL be taken from MeasureReportStatus
                                (required to http://hl7.org/fhir/ValueSet/measure-report-status|4.0.1)

                                The status of the measure report.

                                Type code
                                Is Modifier true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                Must Support true
                                Summary true
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                88. MeasureReport.type
                                Definition

                                The type of measure report. This may be an individual report, which provides the score for the measure for an individual member of the population; a subject-listing, which returns the list of members that meet the various criteria in the measure; a summary report, which returns a population count for each of the criteria in the measure; or a data-collection, which enables the MeasureReport to be used to exchange the data-of-interest for a quality measure.

                                Short (NHSN-MS) individual
                                Comments

                                Data-collection reports are used only to communicate data-of-interest for a measure. They do not necessarily include all the data for a particular subject or population, but they may.

                                Control 1..1
                                This element is affected by the following invariants: mrp-1
                                Binding The codes SHALL be taken from MeasureReportType
                                (required to http://hl7.org/fhir/ValueSet/measure-report-type|4.0.1)

                                The type of the measure report.

                                Type code
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                Must Support true
                                Summary true
                                Requirements

                                For individual quality meaure reporting, this report is constrained to reporting on an individual.

                                Fixed Value individual
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                90. MeasureReport.measure
                                Definition

                                A reference to the Measure that was calculated to produce this report.

                                Short What measure was calculated
                                Control 1..1
                                This element is affected by the following invariants: deqm-0
                                Type canonical(CRMI Shareable Measure)
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                Must Support true
                                Summary true
                                Requirements

                                This will indicate the measure and version being reported on. For example, the cannonical uri location for the MRP measure.

                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                deqm-0: Canonical URL SHALL contain a version. (%resource.measure.toString().contains('|') and %resource.measure.substring(%resource.measure.toString().indexOf('|') + 1).length() > 0)
                                92. MeasureReport.subject
                                Definition

                                Optional subject identifying the individual or individuals the report is for.

                                Short (NHSN-MS) What individual the report is for
                                Control 1..1
                                Type Reference(Cross-Measure Patient Profile)
                                Is Modifier false
                                Must Support true
                                Summary true
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                94. MeasureReport.date
                                Definition

                                The date this measure report was generated.

                                Short (NHSN-MS) When the report was calculated.
                                Control 1..1
                                Type dateTime
                                Is Modifier false
                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                Must Support true
                                Summary true
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                96. MeasureReport.reporter
                                Definition

                                Organization that generated the MeasureReport

                                Short (NHSN-MS) The reporting organization that is responsible for the report
                                Control 1..1
                                Type Reference(QICore Organization)
                                Is Modifier false
                                Must Support true
                                Summary true
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                98. MeasureReport.reporter.id
                                Definition

                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                Short Unique id for inter-element referencing
                                Control 0..1
                                Type string
                                Is Modifier false
                                XML Format In the XML format, this property is represented as an attribute.
                                Summary false
                                100. MeasureReport.reporter.extension
                                Definition

                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                Short Additional content defined by implementations
                                Comments

                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                Control 0..*
                                Type Extension
                                Is Modifier false
                                Summary false
                                Alternate Names extensions, user content
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                Slicing This element introduces a set of slices on MeasureReport.reporter.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 102. MeasureReport.reporter.extension:group
                                  Slice Name group
                                  Definition

                                  Group of practitioners responsible for a report. This extension is used to provide the capability to allow the participating practitioners to be documented.

                                  Short Group of practitioners responsible for a report
                                  Control 0..1
                                  Type Extension(DEQM Reporter Group Extension) (Extension Type: Reference(Group))
                                  Is Modifier false
                                  Summary false
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  104. MeasureReport.reporter.reference
                                  Definition

                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                  Short Literal reference, Relative, internal or absolute URL
                                  Comments

                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                  Control 0..1
                                  This element is affected by the following invariants: ref-1
                                  Type string
                                  Is Modifier false
                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  106. MeasureReport.reporter.type
                                  Definition

                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                  Short Type the reference refers to (e.g. "Patient")
                                  Comments

                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                  Control 0..1
                                  Binding Unless not suitable, these codes SHALL be taken from ResourceType
                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                  Aa resource (or, for logical models, the URI of the logical model).

                                  Type uri
                                  Is Modifier false
                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  108. MeasureReport.reporter.identifier
                                  Definition

                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                  Short Logical reference, when literal reference is not known
                                  Comments

                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                  Note This is a business identifier, not a resource identifier (see discussion)
                                  Control 0..1
                                  Type Identifier
                                  Is Modifier false
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  110. MeasureReport.reporter.display
                                  Definition

                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                  Short Text alternative for the resource
                                  Comments

                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                  Control 0..1
                                  Type string
                                  Is Modifier false
                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  112. MeasureReport.period
                                  Definition

                                  The reporting period for which the report was calculated.

                                  Short (NHSN-MS) The period for which the report was calculated. For the gaps in care use case, this is referred to as the gaps through period.
                                  Control 1..1
                                  This element is affected by the following invariants: deqm-1
                                  Type Period
                                  Is Modifier false
                                  Must Support true
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  deqm-1: Date precision SHALL be at least to day ( YYYY-MM-DD ) (start.toString().length()>9 and end.toString().length()>9)
                                  114. MeasureReport.period.id
                                  Definition

                                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                  Short Unique id for inter-element referencing
                                  Control 0..1
                                  Type string
                                  Is Modifier false
                                  XML Format In the XML format, this property is represented as an attribute.
                                  Summary false
                                  116. MeasureReport.period.extension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                  Short Additional content defined by implementations
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control 0..*
                                  Type Extension
                                  Is Modifier false
                                  Summary false
                                  Alternate Names extensions, user content
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  Slicing This element introduces a set of slices on MeasureReport.period.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                  • value @ url
                                  • 118. MeasureReport.period.start
                                    Definition

                                    The start of the period. The boundary is inclusive.

                                    Short (NHSN-MS) Starting time with inclusive boundary
                                    Comments

                                    If the low element is missing, the meaning is that the low boundary is not known.

                                    Control 1..1
                                    This element is affected by the following invariants: per-1
                                    Type dateTime
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    120. MeasureReport.period.end
                                    Definition

                                    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

                                    Short (NHSN-MS) End time with inclusive boundary, if not ongoing
                                    Comments

                                    The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

                                    Control 1..1
                                    This element is affected by the following invariants: per-1
                                    Type dateTime
                                    Is Modifier false
                                    Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                    Must Support true
                                    Summary true
                                    Meaning if Missing If the end of the period is missing, it means that the period is ongoing
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    122. MeasureReport.improvementNotation
                                    Definition

                                    Whether improvement in the measure is noted by an increase or decrease in the measure score.

                                    Short (NHSN-MS) increase | decrease
                                    Comments

                                    This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score.

                                    Control 0..1
                                    This element is affected by the following invariants: deqm-2
                                    Binding The codes SHALL be taken from MeasureImprovementNotation
                                    (required to http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1)

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

                                    Type CodeableConcept
                                    Is Modifier true because Improvement notation determines how to interpret the measure score (i.e. whether an increase is an improvement)
                                    Must Support true
                                    Summary true
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    124. MeasureReport.group
                                    Definition

                                    The results of the calculation, one for each population group in the measure.

                                    Short (NHSN-MS) Measure results for each group.
                                    Control 0..*
                                    This element is affected by the following invariants: mrp-1
                                    Type BackboneElement
                                    Is Modifier false
                                    Must Support true
                                    Summary false
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    deqm-4: If the measure scoring is specified on the group and the scoring type is 'proportion', 'ratio', or 'continuous-variable' then the groupImprovementNotation element is required. ((extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').exists() and extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code in ('proportion' | 'ratio' | 'continuous-variable')) implies extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-groupImprovementNotation').exists())
                                    deqm-6: If the measure scoring type is 'proportion' then the measureScore SHALL be a numerical value between 0 and 1 ((%resource.extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains 'proportion' or extension('http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring').value.coding.code contains 'proportion') implies (measureScore.value >= 0.0 and measureScore.value <= 1.0))
                                    126. MeasureReport.group.id
                                    Definition

                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                    Short Unique id for inter-element referencing
                                    Control 0..1
                                    Type string
                                    Is Modifier false
                                    Must Support true
                                    XML Format In the XML format, this property is represented as an attribute.
                                    Summary false
                                    128. MeasureReport.group.extension
                                    Definition

                                    An Extension

                                    Short Extension
                                    Control 0..*
                                    Type Extension
                                    Is Modifier false
                                    Summary false
                                    Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                    Slicing This element introduces a set of slices on MeasureReport.group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                    • value @ url
                                    • 130. MeasureReport.group.extension:scoring
                                      Slice Name scoring
                                      Definition

                                      Optional Extension Element - found in all resources.

                                      Short proportion | ratio | continuous-variable | cohort | composite | attestation
                                      Control 0..1
                                      This element is affected by the following invariants: ele-1, deqm-3
                                      Type Extension(DEQM Measure Scoring Extension) (Extension Type: CodeableConcept)
                                      Is Modifier false
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      132. MeasureReport.group.extension:calculatedDate
                                      Slice Name calculatedDate
                                      Definition

                                      This applies to the date this metric was actually calculated. If your measure calculation draws on stored calculations and there are multiple calculation dates, this extension would not apply, as in the example of a composite measure where the individual measures were calculated on different dates. This would only cover the case where there is only one calculation date.

                                      Short The date the score was calculated
                                      Control 0..1
                                      This element is affected by the following invariants: ele-1
                                      Type Extension(DEQM Calculated Date Extension) (Extension Type: dateTime)
                                      Is Modifier false
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      134. MeasureReport.group.extension:improvementNotation
                                      Slice Name improvementNotation
                                      Definition

                                      Optional Extension Element - found in all resources.

                                      Short increase | decrease
                                      Control 0..1
                                      This element is affected by the following invariants: ele-1, deqm-4
                                      Type Extension(DEQM Group Improvement Notation Extension) (Extension Type: CodeableConcept)
                                      Is Modifier false
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      136. MeasureReport.group.extension:description
                                      Slice Name description
                                      Definition

                                      A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                                      Short Description of the group
                                      Control 0..1
                                      Type Extension(Measure Report Population Description) (Extension Type: markdown)
                                      Is Modifier false
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      138. MeasureReport.group.modifierExtension
                                      Definition

                                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                      Short Extensions that cannot be ignored even if unrecognized
                                      Comments

                                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                      Control 0..*
                                      Type Extension
                                      Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                      Summary true
                                      Requirements

                                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                      Alternate Names extensions, user content, modifiers
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      140. MeasureReport.group.code
                                      Definition

                                      The meaning of the population group as defined in the measure definition.

                                      Short (NHSN-MS) Meaning of the group
                                      Control 0..1
                                      Type CodeableConcept
                                      Is Modifier false
                                      Must Support true
                                      Summary true
                                      Pattern Value {
                                      ??"coding"?:?[{
                                      ????"system"?:?"http://terminology.hl7.org/CodeSystem/measure-population",
                                      ????"code"?:?"initial-population"
                                      ??}]
                                      }
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      142. MeasureReport.group.population
                                      Definition

                                      The populations that make up the population group, one for each type of population appropriate for the measure.

                                      Short (NHSN-MS) The populations in the group
                                      Control 0..*
                                      Type BackboneElement
                                      Is Modifier false
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      deqm-8: The population must either have a count (integer) or a countQuantity (quantity), but not both. (extension('http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity').exists() xor count.exists())
                                      144. MeasureReport.group.population.id
                                      Definition

                                      Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                      Short Unique id for inter-element referencing
                                      Control 0..1
                                      Type string
                                      Is Modifier false
                                      XML Format In the XML format, this property is represented as an attribute.
                                      Summary false
                                      146. MeasureReport.group.population.extension
                                      Definition

                                      An Extension

                                      Short Extension
                                      Control 0..*
                                      Type Extension
                                      Is Modifier false
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                      Slicing This element introduces a set of slices on MeasureReport.group.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                      • value @ url
                                      • 148. MeasureReport.group.population.extension:countQuantity
                                        Slice Name countQuantity
                                        Definition

                                        The count of the population represented as a Quantity. This is used in cases where the count may be a decimal value such as in a ratio measure.

                                        Short Count as a Quantity
                                        Control 0..1
                                        This element is affected by the following invariants: deqm-8
                                        Type Extension(Count Quantity) (Extension Type: Quantity)
                                        Is Modifier false
                                        Must Support true
                                        Summary false
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        150. MeasureReport.group.population.extension:description
                                        Slice Name description
                                        Definition

                                        A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                                        Short Description of the population
                                        Control 0..1
                                        Type Extension(Measure Report Population Description) (Extension Type: markdown)
                                        Is Modifier false
                                        Must Support true
                                        Summary false
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        152. MeasureReport.group.population.modifierExtension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                        Short Extensions that cannot be ignored even if unrecognized
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control 0..*
                                        Type Extension
                                        Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                        Summary true
                                        Requirements

                                        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                        Alternate Names extensions, user content, modifiers
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        154. MeasureReport.group.population.code
                                        Definition

                                        The type of the population.

                                        Short initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                        Control 1..1
                                        Binding Unless not suitable, these codes SHALL be taken from MeasurePopulationType
                                        (extensible to http://hl7.org/fhir/ValueSet/measure-population)

                                        The type of population (e.g. initial, numerator, denominator, etc.).

                                        Type CodeableConcept
                                        Is Modifier false
                                        Must Support true
                                        Summary true
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        156. MeasureReport.group.population.count
                                        Definition

                                        The number of members of the population.

                                        Short (NHSN-MS) Size of the population. Always '1' for individual MeasureReport.
                                        Control 0..1
                                        This element is affected by the following invariants: deqm-8
                                        Type integer
                                        Is Modifier false
                                        Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                        Must Support true
                                        Summary false
                                        Pattern Value 1
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        158. MeasureReport.group.population.subjectResults
                                        Definition

                                        This element refers to a List of subject level MeasureReport resources, one for each subject in this population.

                                        Short For subject-list reports, the subject results in this population
                                        Control 0..0
                                        Type Reference(List)
                                        Is Modifier false
                                        Must Support false
                                        Summary false
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        160. MeasureReport.group.measureScore
                                        Definition

                                        The measure score for this population group, calculated as appropriate for the measure type and scoring method, and based on the contents of the populations defined in the group.

                                        Short What score this group achieved
                                        Comments

                                        For individual reporting, the measure score is calculated for the individual. For a proportion measure, it would be 0.0 or 1.0 (indicating 0% or 100%).

                                        Control 0..1
                                        This element is affected by the following invariants: deqm-6
                                        Type Quantity
                                        Is Modifier false
                                        Must Support true
                                        Summary true
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        162. MeasureReport.group.measureScore.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        Short Unique id for inter-element referencing
                                        Control 0..1
                                        Type string
                                        Is Modifier false
                                        XML Format In the XML format, this property is represented as an attribute.
                                        Summary false
                                        164. MeasureReport.group.measureScore.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        Short Additional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control 0..*
                                        Type Extension
                                        Is Modifier false
                                        Summary false
                                        Alternate Names extensions, user content
                                        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        Slicing This element introduces a set of slices on MeasureReport.group.measureScore.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 166. MeasureReport.group.measureScore.extension:alternateScoreType
                                          Slice Name alternateScoreType
                                          Definition

                                          Possible value types for the measureScore elements in addition to the standard Quantity type. The alternate type is determined by the Quality Measure Aggregate Method extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation.

                                          Short Possible additional measureScore value types
                                          Comments

                                          This extension corresponds to the additional MeasureScore type added to the R5 version of MeasureReport.

                                          Control 0..1
                                          Type Extension(DEQM Alternate Score Type Extension) (Extension Type: Choice of: dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio)
                                          Is Modifier false
                                          Must Support true
                                          Summary false
                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          168. MeasureReport.group.measureScore.value
                                          Definition

                                          The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                          Short Numerical value (with implicit precision)
                                          Comments

                                          The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                          Control 0..1
                                          Type decimal
                                          Is Modifier false
                                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                          Summary true
                                          Requirements

                                          Precision is handled implicitly in almost all cases of measurement.

                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          170. MeasureReport.group.measureScore.comparator
                                          Definition

                                          How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                          Short < | <= | >= | > - how to understand the value
                                          Control 0..1
                                          Binding The codes SHALL be taken from QuantityComparator
                                          (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                          How the Quantity should be understood and represented.

                                          Type code
                                          Is Modifier true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                          Summary true
                                          Requirements

                                          Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                          Meaning if Missing If there is no comparator, then there is no modification of the value
                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          172. MeasureReport.group.measureScore.unit
                                          Definition

                                          A human-readable form of the unit.

                                          Short Unit representation
                                          Control 0..1
                                          Type string
                                          Is Modifier false
                                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                          Summary true
                                          Requirements

                                          There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          174. MeasureReport.group.measureScore.system
                                          Definition

                                          The identification of the system that provides the coded form of the unit.

                                          Short System that defines coded unit form
                                          Control 0..1
                                          This element is affected by the following invariants: qty-3
                                          Type uri
                                          Is Modifier false
                                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                          Summary true
                                          Requirements

                                          Need to know the system that defines the coded form of the unit.

                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          176. MeasureReport.group.measureScore.code
                                          Definition

                                          A computer processable form of the unit in some unit representation system.

                                          Short Coded form of the unit
                                          Comments

                                          The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                          Control 0..1
                                          Type code
                                          Is Modifier false
                                          Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                          Summary true
                                          Requirements

                                          Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          178. MeasureReport.group.stratifier
                                          Definition

                                          When a measure includes multiple stratifiers, there will be a stratifier group for each stratifier defined by the measure.

                                          Short Stratification results
                                          Control 0..*
                                          Type BackboneElement
                                          Is Modifier false
                                          Must Support true
                                          Summary false
                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          deqm-7: If group.stratifier exists, then either group.stratifier.code or the group.stratifier.stratum.component.code is present, but not both (code.exists() xor stratum.component.exists())
                                          180. MeasureReport.group.stratifier.id
                                          Definition

                                          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                          Short Unique id for inter-element referencing
                                          Control 0..1
                                          Type string
                                          Is Modifier false
                                          XML Format In the XML format, this property is represented as an attribute.
                                          Summary false
                                          182. MeasureReport.group.stratifier.extension
                                          Definition

                                          An Extension

                                          Short Extension
                                          Control 0..*
                                          Type Extension
                                          Is Modifier false
                                          Summary false
                                          Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                          Slicing This element introduces a set of slices on MeasureReport.group.stratifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                          • value @ url
                                          • 184. MeasureReport.group.stratifier.extension:description
                                            Slice Name description
                                            Definition

                                            A description of the group, population, stratifier, or supplemental data definition on which it appears. This is typically a restatement of the description of the corresponding element in the Measure being reported, but may also include additional information gathered by the reporting process.

                                            Short Description of the stratifier
                                            Control 0..1
                                            Type Extension(Measure Report Population Description) (Extension Type: markdown)
                                            Is Modifier false
                                            Must Support true
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            186. MeasureReport.group.stratifier.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            Short Extensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control 0..*
                                            Type Extension
                                            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summary true
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Names extensions, user content, modifiers
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            188. MeasureReport.group.stratifier.code
                                            Definition

                                            The meaning of this stratifier, as defined in the measure definition.

                                            Short What stratifier of the group
                                            Control 0..1
                                            Type CodeableConcept
                                            Is Modifier false
                                            Must Support true
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            190. MeasureReport.group.stratifier.stratum
                                            Definition

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

                                            Short Stratum results, one for each unique value, or set of values, in the stratifier, or stratifier components
                                            Control 0..*
                                            Type BackboneElement
                                            Is Modifier false
                                            Must Support true
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            192. MeasureReport.group.stratifier.stratum.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Short Unique id for inter-element referencing
                                            Control 0..1
                                            Type string
                                            Is Modifier false
                                            XML Format In the XML format, this property is represented as an attribute.
                                            Summary false
                                            194. MeasureReport.group.stratifier.stratum.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            Short Additional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control 0..*
                                            Type Extension
                                            Is Modifier false
                                            Summary false
                                            Alternate Names extensions, user content
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            196. MeasureReport.group.stratifier.stratum.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            Short Extensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control 0..*
                                            Type Extension
                                            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summary true
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Names extensions, user content, modifiers
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            198. MeasureReport.group.stratifier.stratum.value
                                            Definition

                                            The value for this stratum, expressed as a CodeableConcept. When defining stratifiers on complex values, the value must be rendered such that the value for each stratum within the stratifier is unique.

                                            Short The stratum value, e.g. male
                                            Control 0..1
                                            Type CodeableConcept
                                            Is Modifier false
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            200. MeasureReport.group.stratifier.stratum.component
                                            Definition

                                            A stratifier component value.

                                            Short Stratifier component values
                                            Control 0..*
                                            Type BackboneElement
                                            Is Modifier false
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            202. MeasureReport.group.stratifier.stratum.component.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Short Unique id for inter-element referencing
                                            Control 0..1
                                            Type string
                                            Is Modifier false
                                            XML Format In the XML format, this property is represented as an attribute.
                                            Summary false
                                            204. MeasureReport.group.stratifier.stratum.component.extension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                            Short Additional content defined by implementations
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control 0..*
                                            Type Extension
                                            Is Modifier false
                                            Summary false
                                            Alternate Names extensions, user content
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            206. MeasureReport.group.stratifier.stratum.component.modifierExtension
                                            Definition

                                            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                            Short Extensions that cannot be ignored even if unrecognized
                                            Comments

                                            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                            Control 0..*
                                            Type Extension
                                            Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                            Summary true
                                            Requirements

                                            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                            Alternate Names extensions, user content, modifiers
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            208. MeasureReport.group.stratifier.stratum.component.code
                                            Definition

                                            The code for the stratum component value.

                                            Short What stratifier component of the group
                                            Control 1..1
                                            Type CodeableConcept
                                            Is Modifier false
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            210. MeasureReport.group.stratifier.stratum.component.value
                                            Definition

                                            The stratum component value.

                                            Short The stratum component value, e.g. male
                                            Control 1..1
                                            Type CodeableConcept
                                            Is Modifier false
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            212. MeasureReport.group.stratifier.stratum.population
                                            Definition

                                            The populations that make up the stratum, one for each type of population appropriate to the measure.

                                            Short Population results in this stratum
                                            Control 0..*
                                            Type BackboneElement
                                            Is Modifier false
                                            Must Support true
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            deqm-9: The stratum population must either have a count (integer) or a countQuantity (quantity), but not both. (extension('http://hl7.org/fhir/StructureDefinition/measurereport-countQuantity').exists() xor count.exists())
                                            214. MeasureReport.group.stratifier.stratum.population.id
                                            Definition

                                            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                            Short Unique id for inter-element referencing
                                            Control 0..1
                                            Type string
                                            Is Modifier false
                                            XML Format In the XML format, this property is represented as an attribute.
                                            Summary false
                                            216. MeasureReport.group.stratifier.stratum.population.extension
                                            Definition

                                            An Extension

                                            Short Extension
                                            Control 0..*
                                            Type Extension
                                            Is Modifier false
                                            Summary false
                                            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                            Slicing This element introduces a set of slices on MeasureReport.group.stratifier.stratum.population.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                            • value @ url
                                            • 218. MeasureReport.group.stratifier.stratum.population.extension:countQuantity
                                              Slice Name countQuantity
                                              Definition

                                              A Quantity representing the size of the population. This is important to support the case when a population value may result in a decimal when reporting composite measures.

                                              Short Size of the population as a quantity.
                                              Control 0..1
                                              This element is affected by the following invariants: deqm-9
                                              Type Extension(Count Quantity) (Extension Type: Quantity)
                                              Is Modifier false
                                              Must Support true
                                              Summary false
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              220. MeasureReport.group.stratifier.stratum.population.modifierExtension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                              Short Extensions that cannot be ignored even if unrecognized
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control 0..*
                                              Type Extension
                                              Is Modifier true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                              Summary true
                                              Requirements

                                              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                              Alternate Names extensions, user content, modifiers
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              222. MeasureReport.group.stratifier.stratum.population.code
                                              Definition

                                              The type of the population.

                                              Short initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation
                                              Control 1..1
                                              Binding Unless not suitable, these codes SHALL be taken from MeasurePopulationType
                                              (extensible to http://hl7.org/fhir/ValueSet/measure-population)

                                              The type of population (e.g. initial, numerator, denominator, etc.).

                                              Type CodeableConcept
                                              Is Modifier false
                                              Must Support true
                                              Summary false
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              224. MeasureReport.group.stratifier.stratum.population.count
                                              Definition

                                              The number of members of the population in this stratum.

                                              Short Size of the population
                                              Control 1..1
                                              This element is affected by the following invariants: deqm-9
                                              Type integer
                                              Is Modifier false
                                              Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                              Must Support true
                                              Summary false
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              226. MeasureReport.group.stratifier.stratum.population.subjectResults
                                              Definition

                                              This element refers to a List of subject level MeasureReport resources, one for each subject in this population in this stratum.

                                              Short For subject-list reports, the subject results in this population
                                              Control 0..1
                                              Type Reference(List)
                                              Is Modifier false
                                              Summary false
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              228. MeasureReport.group.stratifier.stratum.measureScore
                                              Definition

                                              The measure score for this stratum, calculated as appropriate for the measure type and scoring method, and based on only the members of this stratum.

                                              Short What score this stratum achieved
                                              Control 0..1
                                              Type Quantity
                                              Is Modifier false
                                              Must Support true
                                              Summary false
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              230. MeasureReport.group.stratifier.stratum.measureScore.id
                                              Definition

                                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                              Short Unique id for inter-element referencing
                                              Control 0..1
                                              Type string
                                              Is Modifier false
                                              XML Format In the XML format, this property is represented as an attribute.
                                              Summary false
                                              232. MeasureReport.group.stratifier.stratum.measureScore.extension
                                              Definition

                                              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                              Short Additional content defined by implementations
                                              Comments

                                              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                              Control 0..*
                                              Type Extension
                                              Is Modifier false
                                              Summary false
                                              Alternate Names extensions, user content
                                              Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                              Slicing This element introduces a set of slices on MeasureReport.group.stratifier.stratum.measureScore.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                              • value @ url
                                              • 234. MeasureReport.group.stratifier.stratum.measureScore.extension:alternateScoreType
                                                Slice Name alternateScoreType
                                                Definition

                                                Possible value types for the measureScore elements in addition to the standard Quantity type. The alternate type is determined by the Quality Measure Aggregate Method extension used on the Measure. The reported type of the measureScore for continuous variable measures is determined by the result type of the aggregate method operation.

                                                Short Possible additional measureScore value types
                                                Comments

                                                This extension corresponds to the additional MeasureScore type added to the R5 version of MeasureReport.

                                                Control 0..1
                                                Type Extension(DEQM Alternate Score Type Extension) (Extension Type: Choice of: dateTime, CodeableConcept, Period, Range, Duration, boolean, Ratio)
                                                Is Modifier false
                                                Must Support true
                                                Summary false
                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                236. MeasureReport.group.stratifier.stratum.measureScore.value
                                                Definition

                                                The value of the measured amount. The value includes an implicit precision in the presentation of the value.

                                                Short Numerical value (with implicit precision)
                                                Comments

                                                The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books).

                                                Control 0..1
                                                Type decimal
                                                Is Modifier false
                                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                Summary true
                                                Requirements

                                                Precision is handled implicitly in almost all cases of measurement.

                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                238. MeasureReport.group.stratifier.stratum.measureScore.comparator
                                                Definition

                                                How the value should be understood and represented - whether the actual value is greater or less than the stated value due to measurement issues; e.g. if the comparator is "<" , then the real value is < stated value.

                                                Short < | <= | >= | > - how to understand the value
                                                Control 0..1
                                                Binding The codes SHALL be taken from QuantityComparator
                                                (required to http://hl7.org/fhir/ValueSet/quantity-comparator|4.0.1)

                                                How the Quantity should be understood and represented.

                                                Type code
                                                Is Modifier true because This is labeled as "Is Modifier" because the comparator modifies the interpretation of the value significantly. If there is no comparator, then there is no modification of the value
                                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                Summary true
                                                Requirements

                                                Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology.

                                                Meaning if Missing If there is no comparator, then there is no modification of the value
                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                240. MeasureReport.group.stratifier.stratum.measureScore.unit
                                                Definition

                                                A human-readable form of the unit.

                                                Short Unit representation
                                                Control 0..1
                                                Type string
                                                Is Modifier false
                                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                Summary true
                                                Requirements

                                                There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms.

                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                242. MeasureReport.group.stratifier.stratum.measureScore.system
                                                Definition

                                                The identification of the system that provides the coded form of the unit.

                                                Short System that defines coded unit form
                                                Control 0..1
                                                This element is affected by the following invariants: qty-3
                                                Type uri
                                                Is Modifier false
                                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                Summary true
                                                Requirements

                                                Need to know the system that defines the coded form of the unit.

                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                244. MeasureReport.group.stratifier.stratum.measureScore.code
                                                Definition

                                                A computer processable form of the unit in some unit representation system.

                                                Short Coded form of the unit
                                                Comments

                                                The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system.

                                                Control 0..1
                                                Type code
                                                Is Modifier false
                                                Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                Summary true
                                                Requirements

                                                Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest.

                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                246. MeasureReport.evaluatedResource
                                                Definition

                                                A reference to a Bundle containing the Resources that were used in the calculation of this measure.

                                                Short (NHSN-MS) What data was used to calculate the measure score
                                                Control 0..*
                                                Type Reference(Resource)
                                                Is Modifier false
                                                Must Support true
                                                Summary false
                                                Requirements

                                                To support the reporting of supplemental data elements.

                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                248. MeasureReport.evaluatedResource.id
                                                Definition

                                                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                Short Unique id for inter-element referencing
                                                Control 0..1
                                                Type string
                                                Is Modifier false
                                                XML Format In the XML format, this property is represented as an attribute.
                                                Summary false
                                                250. MeasureReport.evaluatedResource.extension
                                                Definition

                                                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                Short Additional content defined by implementations
                                                Comments

                                                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                Control 0..*
                                                Type Extension
                                                Is Modifier false
                                                Summary false
                                                Alternate Names extensions, user content
                                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                Slicing This element introduces a set of slices on MeasureReport.evaluatedResource.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                                • value @ url
                                                • 252. MeasureReport.evaluatedResource.extension:criteriaReference
                                                  Slice Name criteriaReference
                                                  Definition

                                                  Reference a criteria by specifying that criteria's unique id

                                                  Short Criteria reference
                                                  Comments

                                                  When used in a MeasureReport, this is a reference to the id of a criteria within the Measure referenced by the MeasureReport.

                                                  Control 0..*
                                                  Type Extension(Criteria Reference Extension) (Extension Type: string)
                                                  Is Modifier false
                                                  Must Support true
                                                  Summary false
                                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                  254. MeasureReport.evaluatedResource.reference
                                                  Definition

                                                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                                  Short Literal reference, Relative, internal or absolute URL
                                                  Comments

                                                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                                  Control 0..1
                                                  This element is affected by the following invariants: ref-1
                                                  Type string
                                                  Is Modifier false
                                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                  Summary true
                                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  256. MeasureReport.evaluatedResource.type
                                                  Definition

                                                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                                  Short Type the reference refers to (e.g. "Patient")
                                                  Comments

                                                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                                  Control 0..1
                                                  Binding Unless not suitable, these codes SHALL be taken from ResourceType
                                                  (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                                  Aa resource (or, for logical models, the URI of the logical model).

                                                  Type uri
                                                  Is Modifier false
                                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                  Summary true
                                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  258. MeasureReport.evaluatedResource.identifier
                                                  Definition

                                                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                                  Short Logical reference, when literal reference is not known
                                                  Comments

                                                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                                  Note This is a business identifier, not a resource identifier (see discussion)
                                                  Control 0..1
                                                  Type Identifier
                                                  Is Modifier false
                                                  Summary true
                                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  260. MeasureReport.evaluatedResource.display
                                                  Definition

                                                  Plain text narrative that identifies the resource in addition to the resource reference.

                                                  Short Text alternative for the resource
                                                  Comments

                                                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                                  Control 0..1
                                                  Type string
                                                  Is Modifier false
                                                  Primitive Value This primitive element may be present, or absent, or replaced by an extension
                                                  Summary true
                                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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