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: SubjectListMeasureReportProfile - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the subjectlist-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())))
subjectlist-measurereport-population-count-matches: SubjectList MeasureReport: group population count matches number of entries in Subject List entries (group.population.where( where(code.coding.where(code='initial-population').exists()).exists()).where(count = subjectResults.resolve().entry.count()).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.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 (NHSN-MS) Contained resources within the Subject List MeasureReport, containing the Individual MeasureReport ListContained, 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 10..*
Type Resource
Is Modifier false
Must Support true
Summary false
Alternate Names inline resources, anonymous resources, contained resources
Slicing This element introduces a set of slices on MeasureReport.contained. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • profile @ $this
  • 6. MeasureReport.contained:ip-measurereport-list
    Slice Name ip-measurereport-list
    Definition

    A list is a curated collection of resources.


    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 (NHSN-MS) The Individual MeasureReport List pointed to by MeasureReport.group.population.subjectResultsContained, 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 10..1*
    Type ListResource(NHSN Individual MeasureReport List)
    Is Modifier false
    Must Support true
    Summary false
    Alternate Names Collection, WorkingList, Organizer, inline resources, anonymous resources, contained resources
    8. 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())
    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: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())
    14. MeasureReport.extension:supplementalData
    Slice Name supplementalData
    Definition

    Optional Extension Element - found in all resources.

    Short Optional Extensions Element
    Control 0..*
    This element is affected by the following invariants: ele-1
    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())
    16. 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
    • 18. 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
      20. 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()))
      22. 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())
      24. 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())
      26. MeasureReport.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-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())
      28. 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())
      30. 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())
      32. 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())
      34. 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
      36. 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
      • 38. 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()))
        40. 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())
        42. 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 Messages encountered while creating the report
        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())
        44. 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())
        46. MeasureReport.status
        Definition

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

        Short (NHSN-MS) The status of the MeasureReport complete | pending | errorcomplete | 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)
        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()))
        48. 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) The type of MeasureReport is subject-list individual | subject-list | summary | data-collectionindividual | 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 subject-list quality meaure reporting, this report is constrained to reporting on a list of individuals, which also provides individual MeasureReports for the patients on the list.

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

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

        Short (NHSN-MS) What measure and version was calculatedWhat 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 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)
        52. MeasureReport.subject
        Definition

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

        Short What individual(s) the report is for
        Control 0..1
        Type Reference(Group, 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()))
        54. MeasureReport.date
        Definition

        The date this measure report was generated.

        Short (NHSN-MS) When the report was generated. Note: The language in R5 was changed to calculated. We are clarifying that intent.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()))
        56. MeasureReport.reporter
        Definition

        Organization that generated the MeasureReport.


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

        Short (NHSN-MS) The reporting entity that is reporting the dataWho 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()))
        58. 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())
        60. MeasureReport.period
        Definition

        The reporting period for which the report was calculated.

        Short (NHSN-MS) What period the report coversWhat 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)
        62. 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()))
        64. 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()))
        66. MeasureReport.improvementNotation
        Definition

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

        Short 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 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()))
        68. MeasureReport.group
        Definition

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

        Short (NHSN-MS) Initial population groupMeasure results for each group
        Control 10..1*
        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))
        70. 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
        72. MeasureReport.group.extension:scoring
        Slice Name scoring
        Definition

        Optional Extension Element - found in all resources.

        Short (NHSN-MS) The scoring extension to indicate the scoring type of the measure 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())
        74. 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())
        76. 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())
        78. 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())
        80. 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())
        82. MeasureReport.group.code
        Definition

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

        Short Meaning of the group
        Control 0..1
        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()))
        84. 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) Initial populationThe populations in the group
        Control 10..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-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())
        86. 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())
        88. 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())
        90. 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())
        92. MeasureReport.group.population.code
        Definition

        The type of the population.

        Short (NHSN-MS) The code identifying the population type is an initial population. Value is fixed to initial-populationinitial-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
        Pattern Value {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
            "code" : "initial-population",
            "display" : "Initial Population"
          }]
        }
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. MeasureReport.group.population.count
        Definition

        The number of members of the population.

        Short (NHSN-MS) The number of subjects in the initial populationSize of the population
        Control 10..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
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. MeasureReport.group.population.subjectResults
        Definition

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

        Short (NHSN-MS) List referencing all individual measure reports for this measureFor subject-list reports, the subject results in this population
        Control 10..1
        Type Reference(NHSN Individual MeasureReport List, List)
        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()))
        98. MeasureReport.group.population.subjectResults.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 (NHSN-MS) Reference to an Individual MeasureReport List resourceLiteral 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 10..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
        Must Support true
        Summary true
        Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        100. 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
        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()))
        102. 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())
        104. 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()))
        106. 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())
        108. 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())
        110. 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())
        112. 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()))
        114. 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()))
        116. 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())
        118. 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
        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.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())
        122. 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
        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())
        124. 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())
        126. 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()))
        128. 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()))
        130. 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 10..1
        Type Reference(DEQM Individual MeasureReport List, List)
        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.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()))
        134. 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())
        136. 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()))
        138. MeasureReport.evaluatedResource
        Definition

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

        Short What data was used to calculate the measure score
        Control 0..0*
        Type Reference(Resource, Resource)
        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()))

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

        0. MeasureReport
        Invariants subjectlist-measurereport-population-count-matches: SubjectList MeasureReport: group population count matches number of entries in Subject List entries (group.population.where( where(code.coding.where(code='initial-population').exists()).exists()).where(count = subjectResults.resolve().entry.count()).exists())
        2. MeasureReport.meta
        4. MeasureReport.meta.extension:link-received-date-extension
        Slice Name link-received-date-extension
        Control 0..1
        Type Extension(Received Date) (Extension Type: dateTime)
        6. MeasureReport.contained
        Short (NHSN-MS) Contained resources within the Subject List MeasureReport, containing the Individual MeasureReport List
        Control 1..?
        Must Support true
        Slicing This element introduces a set of slices on MeasureReport.contained. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • profile @ $this
        • 8. MeasureReport.contained:ip-measurereport-list
          Slice Name ip-measurereport-list
          Short (NHSN-MS) The Individual MeasureReport List pointed to by MeasureReport.group.population.subjectResults
          Control 1..1
          Type List(NHSN Individual MeasureReport List)
          Must Support true
          10. MeasureReport.status
          Short (NHSN-MS) The status of the MeasureReport complete | pending | error
          12. MeasureReport.type
          Short (NHSN-MS) The type of MeasureReport is subject-list individual | subject-list | summary | data-collection
          14. MeasureReport.measure
          Short (NHSN-MS) What measure and version was calculated
          16. MeasureReport.date
          Short (NHSN-MS) When the report was generated. Note: The language in R5 was changed to calculated. We are clarifying that intent.
          18. MeasureReport.reporter
          Short (NHSN-MS) The reporting entity that is reporting the data
          20. MeasureReport.period
          Short (NHSN-MS) What period the report covers
          22. MeasureReport.period.start
          Short (NHSN-MS) Starting time with inclusive boundary
          24. MeasureReport.period.end
          Short (NHSN-MS) End time with inclusive boundary, if not ongoing
          26. MeasureReport.group
          Short (NHSN-MS) Initial population group
          Control 0..1
          28. MeasureReport.group.extension:scoring
          Slice Name scoring
          Short (NHSN-MS) The scoring extension to indicate the scoring type of the measure proportion | ratio | continuous-variable | cohort | composite | attestation
          30. MeasureReport.group.population
          Short (NHSN-MS) Initial population
          Control 1..1
          32. MeasureReport.group.population.code
          Short (NHSN-MS) The code identifying the population type is an initial population. Value is fixed to initial-population
          Pattern Value {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
              "code" : "initial-population",
              "display" : "Initial Population"
            }]
          }
          34. MeasureReport.group.population.count
          Short (NHSN-MS) The number of subjects in the initial population
          Control 1..?
          36. MeasureReport.group.population.subjectResults
          Short (NHSN-MS) List referencing all individual measure reports for this measure
          Type Reference(NHSN Individual MeasureReport List)
          38. MeasureReport.group.population.subjectResults.reference
          Short (NHSN-MS) Reference to an Individual MeasureReport List resource
          Control 1..?
          Must Support true

          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())))
          subjectlist-measurereport-population-count-matches: SubjectList MeasureReport: group population count matches number of entries in Subject List entries (group.population.where( where(code.coding.where(code='initial-population').exists()).exists()).where(count = subjectResults.resolve().entry.count()).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.meta.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
          8. MeasureReport.meta.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.meta.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 10. MeasureReport.meta.extension:link-received-date-extension
            Slice Name link-received-date-extension
            Definition

            This extension stores the date and time a Resource was received by the processing system (e.g. NHSNLink).

            Short Received Date
            Control 0..1
            Type Extension(Received Date) (Extension Type: dateTime)
            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())
            12. MeasureReport.meta.versionId
            Definition

            The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

            Short Version specific identifier
            Comments

            The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

            Control 0..1
            Type id
            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()))
            14. MeasureReport.meta.lastUpdated
            Definition

            When the resource last changed - e.g. when the version changed.

            Short When the resource version last changed
            Comments

            This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

            Control 0..1
            Type instant
            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()))
            16. MeasureReport.meta.source
            Definition

            A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

            Short Identifies where the resource comes from
            Comments

            In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

            This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

            Control 0..1
            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()))
            18. MeasureReport.meta.profile
            Definition

            A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

            Short Profiles this resource claims to conform to
            Comments

            It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

            Control 0..*
            Type canonical(StructureDefinition)
            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()))
            20. MeasureReport.meta.security
            Definition

            Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

            Short Security Labels applied to this resource
            Comments

            The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

            Control 0..*
            Binding Unless not suitable, these codes SHALL be taken from All Security Labels
            (extensible to http://hl7.org/fhir/ValueSet/security-labels|4.0.1)

            Security Labels from the Healthcare Privacy and Security Classification System.

            Type Coding
            Is Modifier false
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. MeasureReport.meta.tag
            Definition

            Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

            Short Tags applied to this resource
            Comments

            The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

            Control 0..*
            Binding For example codes, see CommonTags
            (example to http://hl7.org/fhir/ValueSet/common-tags|4.0.1)

            Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

            Type Coding
            Is Modifier false
            Summary true
            Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. 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()))
            26. 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()))
            28. 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()))
            30. 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 (NHSN-MS) Contained resources within the Subject List MeasureReport, containing the Individual MeasureReport List
            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 1..*
            Type Resource
            Is Modifier false
            Must Support true
            Summary false
            Alternate Names inline resources, anonymous resources, contained resources
            Slicing This element introduces a set of slices on MeasureReport.contained. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • profile @ $this
            • 32. MeasureReport.contained:ip-measurereport-list
              Slice Name ip-measurereport-list
              Definition

              A list is a curated collection of resources.

              Short (NHSN-MS) The Individual MeasureReport List pointed to by MeasureReport.group.population.subjectResults
              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 1..1
              Type List(NHSN Individual MeasureReport List)
              Is Modifier false
              Must Support true
              Summary false
              Alternate Names Collection, WorkingList, Organizer
              34. MeasureReport.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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 36. 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())
                38. 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())
                40. 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())
                42. MeasureReport.extension:supplementalData
                Slice Name supplementalData
                Definition

                Optional Extension Element - found in all resources.

                Short Optional Extensions Element
                Control 0..*
                This element is affected by the following invariants: ele-1
                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())
                44. 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
                46. 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
                • 48. 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
                  50. 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()))
                  52. 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
                  54. 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
                  • 56. 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())
                    58. 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())
                    60. 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()))
                    62. 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()))
                    64. 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()))
                    66. 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()))
                    68. MeasureReport.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-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())
                    70. 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())
                    72. 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())
                    74. 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())
                    76. 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
                    78. 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
                    • 80. 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
                      82. 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
                      • 84. 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()))
                        86. 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())
                        88. 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 Messages encountered while creating the report
                        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())
                        90. 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())
                        92. 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()))
                        94. MeasureReport.status
                        Definition

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

                        Short (NHSN-MS) The status of the MeasureReport 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)
                        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()))
                        96. 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) The type of MeasureReport is subject-list individual | 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 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 subject-list quality meaure reporting, this report is constrained to reporting on a list of individuals, which also provides individual MeasureReports for the patients on the list.

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

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

                        Short (NHSN-MS) What measure and version 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 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)
                        100. MeasureReport.subject
                        Definition

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

                        Short What individual(s) the report is for
                        Control 0..1
                        Type Reference(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()))
                        102. MeasureReport.date
                        Definition

                        The date this measure report was generated.

                        Short (NHSN-MS) When the report was generated. Note: The language in R5 was changed to calculated. We are clarifying that intent.
                        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()))
                        104. MeasureReport.reporter
                        Definition

                        Organization that generated the MeasureReport.

                        Short (NHSN-MS) The reporting entity that is reporting the data
                        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()))
                        106. 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
                        108. 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
                        • 110. 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())
                          112. 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()))
                          114. 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()))
                          116. 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()))
                          118. 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()))
                          120. MeasureReport.period
                          Definition

                          The reporting period for which the report was calculated.

                          Short (NHSN-MS) 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)
                          122. 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
                          124. 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
                          • 126. 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()))
                            128. 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()))
                            130. MeasureReport.improvementNotation
                            Definition

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

                            Short 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()))
                            132. MeasureReport.group
                            Definition

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

                            Short (NHSN-MS) Initial population group
                            Control 1..1
                            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))
                            134. 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
                            136. 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
                            • 138. MeasureReport.group.extension:scoring
                              Slice Name scoring
                              Definition

                              Optional Extension Element - found in all resources.

                              Short (NHSN-MS) The scoring extension to indicate the scoring type of the measure 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())
                              140. 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())
                              142. 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())
                              144. 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())
                              146. 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())
                              148. MeasureReport.group.code
                              Definition

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

                              Short Meaning of the group
                              Control 0..1
                              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()))
                              150. 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) Initial population
                              Control 1..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-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())
                              152. 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
                              154. 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
                              • 156. 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())
                                158. 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())
                                160. 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())
                                162. MeasureReport.group.population.code
                                Definition

                                The type of the population.

                                Short (NHSN-MS) The code identifying the population type is an initial population. Value is fixed to initial-population
                                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
                                Pattern Value {
                                  "coding" : [{
                                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                                    "code" : "initial-population",
                                    "display" : "Initial Population"
                                  }]
                                }
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                164. MeasureReport.group.population.count
                                Definition

                                The number of members of the population.

                                Short (NHSN-MS) The number of subjects in the initial population
                                Control 1..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
                                Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                166. MeasureReport.group.population.subjectResults
                                Definition

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

                                Short (NHSN-MS) List referencing all individual measure reports for this measure
                                Control 1..1
                                Type Reference(NHSN Individual MeasureReport List)
                                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()))
                                168. MeasureReport.group.population.subjectResults.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
                                170. MeasureReport.group.population.subjectResults.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.population.subjectResults.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • value @ url
                                • 172. MeasureReport.group.population.subjectResults.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 (NHSN-MS) Reference to an Individual MeasureReport List resource
                                  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 1..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
                                  Must Support true
                                  Summary true
                                  Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  174. MeasureReport.group.population.subjectResults.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|4.0.1)

                                  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()))
                                  176. MeasureReport.group.population.subjectResults.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()))
                                  178. MeasureReport.group.population.subjectResults.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()))
                                  180. 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
                                  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()))
                                  182. 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
                                  184. 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
                                  • 186. 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())
                                    188. 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()))
                                    190. 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()))
                                    192. 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()))
                                    194. 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()))
                                    196. 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()))
                                    198. 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())
                                    200. 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
                                    202. 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
                                    • 204. 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())
                                      206. 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())
                                      208. 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()))
                                      210. 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()))
                                      212. 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
                                      214. 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())
                                      216. 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())
                                      218. 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
                                      Must Support true
                                      Summary false
                                      Invariants ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      220. 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()))
                                      222. 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
                                      224. 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())
                                      226. 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())
                                      228. 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()))
                                      230. 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()))
                                      232. 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())
                                      234. 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
                                      236. 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
                                      • 238. 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
                                        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())
                                        240. 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())
                                        242. 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()))
                                        244. 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()))
                                        246. 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 1..1
                                        Type Reference(DEQM Individual MeasureReport List)
                                        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()))
                                        248. 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()))
                                        250. 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
                                        252. 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
                                        • 254. 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())
                                          256. 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()))
                                          258. 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()))
                                          260. 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()))
                                          262. 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()))
                                          264. 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()))
                                          266. MeasureReport.evaluatedResource
                                          Definition

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

                                          Short What data was used to calculate the measure score
                                          Control 0..0
                                          Type Reference(Resource)
                                          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()))