CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
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CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Local Development build (v2.0.0-cibuild) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: NHSNIndividualMeasureReport - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

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.cdc.gov/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.cdc.gov/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.cdc.gov/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.cdc.gov/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.cdc.gov/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.cdc.gov/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()))