{
  "description": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).\\n\\n**Additional Guidance: improvementNotation**\\n\\n`Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.\\n\\nPlease provide comments on this additional code and if there are other codes needed in the improvement notation value set.\\n\\nIf an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use?  Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.",
  "_filename": "StructureDefinition-cqm-improvementNotation.json",
  "package_name": "hl7.fhir.uv.cqm",
  "date": "2024-12-16T21:50:47+00:00",
  "derivation": "constraint",
  "publisher": "HL7 International / Clinical Quality Information",
  "fhirVersion": "4.0.1",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm"
    } ]
  } ],
  "purpose": "**Purpose**\n\nMeasure consumers and implementers must be able to determine how to interpret a measure score.",
  "name": "CQMImprovementNotation",
  "mapping": [ {
    "uri": "http://hl7.org/v3",
    "name": "RIM Mapping",
    "identity": "rim"
  } ],
  "abstract": false,
  "type": "Extension",
  "experimental": "false",
  "resourceType": "StructureDefinition",
  "title": "CQM Improvement Notation",
  "package_version": "1.0.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "cqi"
  } ],
  "snapshot": {
    "element": [ {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "http://hl7.org/fhir/StructureDefinition/Element",
        "severity": "error",
        "expression": "hasValue() or (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "source": "http://hl7.org/fhir/StructureDefinition/Extension",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "Extension",
      "min": 0,
      "definition": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).",
      "isModifier": false,
      "short": "increase | decrease",
      "max": "1",
      "id": "Extension",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "Extension"
      }
    }, {
      "path": "Extension.id",
      "min": 0,
      "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "isModifier": false,
      "short": "Unique id for inter-element referencing",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "http://hl7.org/fhirpath/System.String",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
          "valueUrl": "string"
        } ]
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Extension.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      },
      "isSummary": false
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "http://hl7.org/fhir/StructureDefinition/Element",
        "severity": "error",
        "expression": "hasValue() or (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
        "source": "http://hl7.org/fhir/StructureDefinition/Extension",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "Extension.extension",
      "min": 0,
      "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.",
      "isModifier": false,
      "short": "Additional content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Extension.extension",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "isSummary": false
    }, {
      "path": "Extension.url",
      "min": 1,
      "definition": "Source of the definition for the extension code - a logical name or a URL.",
      "isModifier": false,
      "short": "identifies the meaning of the extension",
      "fixedUri": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Extension.url",
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Extension.url"
      },
      "isSummary": false
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "http://hl7.org/fhir/StructureDefinition/Element",
        "severity": "error",
        "expression": "hasValue() or (children().count() > id.count())"
      } ],
      "path": "Extension.value[x]",
      "min": 0,
      "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).",
      "isModifier": false,
      "short": "Value of extension",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "required",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-improvement-notation",
        "description": "Indicates how to interpret the calculated score of the measure"
      },
      "max": "1",
      "id": "Extension.value[x]",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Extension.value[x]"
      },
      "isSummary": false
    } ]
  },
  "status": "active",
  "id": "3100acde-31f5-445f-a91d-fb11bc12fa88",
  "kind": "complex-type",
  "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation",
  "context": [ {
    "type": "element",
    "expression": "Measure.group"
  } ],
  "version": "1.0.0",
  "differential": {
    "element": [ {
      "id": "Extension",
      "max": "1",
      "min": 0,
      "path": "Extension",
      "short": "increase | decrease",
      "definition": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range)."
    }, {
      "id": "Extension.url",
      "path": "Extension.url",
      "type": [ {
        "code": "uri"
      } ],
      "fixedUri": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
    }, {
      "id": "Extension.value[x]",
      "path": "Extension.value[x]",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "required",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-improvement-notation",
        "description": "Indicates how to interpret the calculated score of the measure"
      }
    } ]
  },
  "contact": [ {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cqi",
      "system": "url"
    } ]
  } ],
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension"
}