{
  "description": "The CQFM Publishable Measure profile defines the minimum expectations to enable appropriate content management, discovery, and utilization of published electronic Clinical Quality Measures (eCQMs)",
  "_filename": "StructureDefinition-publishable-measure-cqfm.json",
  "package_name": "hl7.fhir.us.cqfmeasures",
  "date": "2021-11-27T13:31:32-07:00",
  "derivation": "constraint",
  "publisher": "Clinical Quality Information WG",
  "fhirVersion": "4.0.1",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "CQFMPublishableMeasure",
  "mapping": [ {
    "uri": "http://hl7.org/v3",
    "name": "RIM Mapping",
    "identity": "rim"
  }, {
    "uri": "http://hl7.org/fhir/workflow",
    "name": "Workflow Pattern",
    "identity": "workflow"
  }, {
    "uri": "http://hl7.org/fhir/fivews",
    "name": "FiveWs Pattern Mapping",
    "identity": "w5"
  }, {
    "uri": "http://hl7.org/fhir/object-implementation",
    "name": "Object Implementation Information",
    "identity": "objimpl"
  } ],
  "abstract": false,
  "type": "Measure",
  "experimental": "false",
  "resourceType": "StructureDefinition",
  "title": "CQFM Publishable Measure",
  "package_version": "4.0.0",
  "snapshot": {
    "element": [ {
      "constraint": [ {
        "key": "dom-2",
        "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
        "xpath": "not(parent::f:contained and f:contained)",
        "source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
        "severity": "error",
        "expression": "contained.contained.empty()"
      }, {
        "key": "dom-3",
        "human": "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",
        "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
        "source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
        "severity": "error",
        "expression": "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()"
      }, {
        "key": "dom-4",
        "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
        "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
        "source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
        "severity": "error",
        "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
      }, {
        "key": "dom-5",
        "human": "If a resource is contained in another resource, it SHALL NOT have a security label",
        "xpath": "not(exists(f:contained/*/f:meta/f:security))",
        "source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
        "severity": "error",
        "expression": "contained.meta.security.empty()"
      }, {
        "key": "dom-6",
        "human": "A resource should have narrative for robust management",
        "xpath": "exists(f:text/h:div)",
        "source": "http://hl7.org/fhir/StructureDefinition/DomainResource",
        "severity": "warning",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
          "valueBoolean": true
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
          "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
        } ],
        "expression": "text.`div`.exists()"
      }, {
        "key": "mea-0",
        "human": "Name should be usable as an identifier for the module by machine processing applications such as code generation",
        "xpath": "not(exists(f:name/@value)) or matches(f:name/@value, '[A-Z]([A-Za-z0-9_]){0,254}')",
        "source": "http://hl7.org/fhir/StructureDefinition/Measure",
        "severity": "warning",
        "expression": "name.matches('[A-Z]([A-Za-z0-9_]){0,254}')"
      }, {
        "key": "mea-1",
        "human": "Stratifier SHALL be either a single criteria or a set of criteria components",
        "xpath": "exists(f:group/stratifier/code) or exists(f:group/stratifier/component)",
        "source": "http://hl7.org/fhir/StructureDefinition/Measure",
        "severity": "error",
        "expression": "group.stratifier.all((code | description | criteria).exists() xor component.exists())"
      } ],
      "path": "Measure",
      "min": 1,
      "definition": "The Measure resource provides the definition of a quality measure.",
      "isModifier": false,
      "short": "A quality measure definition",
      "mapping": [ {
        "map": "Entity. Role, or Act",
        "identity": "rim"
      }, {
        "map": "Definition",
        "identity": "workflow"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure"
      },
      "isSummary": false
    }, {
      "path": "Measure.id",
      "min": 0,
      "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
      "isModifier": false,
      "short": "Logical id of this artifact",
      "type": [ {
        "code": "http://hl7.org/fhirpath/System.String",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
          "valueUrl": "id"
        } ]
      } ],
      "max": "1",
      "id": "Measure.id",
      "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.id"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta",
      "min": 1,
      "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.",
      "isModifier": false,
      "short": "Metadata about the resource",
      "type": [ {
        "code": "Meta"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.meta",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.meta"
      },
      "isSummary": true
    }, {
      "path": "Measure.meta.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": "Measure.meta.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": "Measure.meta.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": "Measure.meta.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
    }, {
      "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": "Measure.meta.versionId",
      "min": 0,
      "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.",
      "isModifier": false,
      "short": "Version specific identifier",
      "type": [ {
        "code": "id"
      } ],
      "max": "1",
      "id": "Measure.meta.versionId",
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Meta.versionId"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta.lastUpdated",
      "min": 0,
      "definition": "When the resource last changed - e.g. when the version changed.",
      "isModifier": false,
      "short": "When the resource version last changed",
      "type": [ {
        "code": "instant"
      } ],
      "max": "1",
      "id": "Measure.meta.lastUpdated",
      "comment": "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](http://hl7.org/fhir/R4/http.html#read) interaction.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Meta.lastUpdated"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta.source",
      "min": 0,
      "definition": "A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) 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.",
      "isModifier": false,
      "short": "Identifies where the resource comes from",
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "Measure.meta.source",
      "comment": "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. \n\nThis 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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Meta.source"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta.profile",
      "requirements": "A measure must declare its profile.",
      "min": 1,
      "definition": "A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).",
      "isModifier": false,
      "short": "Profiles this resource claims to conform to",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/StructureDefinition" ]
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.meta.profile",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Meta.profile"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta.security",
      "min": 0,
      "definition": "Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.",
      "isModifier": false,
      "short": "Security Labels applied to this resource",
      "type": [ {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/security-labels",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "SecurityLabels"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "Security Labels from the Healthcare Privacy and Security Classification System."
      },
      "max": "*",
      "id": "Measure.meta.security",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Meta.security"
      },
      "isSummary": true
    }, {
      "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": "Measure.meta.tag",
      "min": 0,
      "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.",
      "isModifier": false,
      "short": "Tags applied to this resource",
      "type": [ {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "example",
        "valueSet": "http://hl7.org/fhir/ValueSet/common-tags",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "Tags"
        } ],
        "description": "Codes that represent various types of tags, commonly workflow-related; e.g. \"Needs review by Dr. Jones\"."
      },
      "max": "*",
      "id": "Measure.meta.tag",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Meta.tag"
      },
      "isSummary": true
    }, {
      "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": "Measure.implicitRules",
      "min": 0,
      "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.",
      "isModifier": true,
      "short": "A set of rules under which this content was created",
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "Measure.implicitRules",
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.implicitRules"
      },
      "isModifierReason": "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",
      "isSummary": true
    }, {
      "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": "Measure.language",
      "min": 0,
      "definition": "The base language in which the resource is written.",
      "isModifier": false,
      "short": "Language of the resource content",
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "preferred",
        "valueSet": "http://hl7.org/fhir/ValueSet/languages",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
          "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "Language"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A human language."
      },
      "max": "1",
      "id": "Measure.language",
      "comment": "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).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.language"
      },
      "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": "Measure.text",
      "requirements": "A published measure must provide human-readable narrative description of the measure contents.",
      "min": 1,
      "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.",
      "isModifier": false,
      "short": "Text summary of the resource, for human interpretation",
      "mapping": [ {
        "map": "Act.text?",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Narrative"
      } ],
      "mustSupport": true,
      "alias": [ "narrative", "html", "xhtml", "display" ],
      "max": "1",
      "id": "Measure.text",
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "DomainResource.text"
      },
      "isSummary": false
    }, {
      "path": "Measure.contained",
      "min": 0,
      "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.",
      "isModifier": false,
      "short": "Contained, inline Resources",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Resource"
      } ],
      "alias": [ "inline resources", "anonymous resources", "contained resources" ],
      "max": "*",
      "id": "Measure.contained",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.contained"
      },
      "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": "Measure.extension",
      "min": 0,
      "definition": "An Extension",
      "isModifier": false,
      "short": "Extension",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "max": "*",
      "id": "Measure.extension",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      },
      "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": "Measure.extension",
      "min": 0,
      "definition": "A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.",
      "isModifier": false,
      "short": "Additional documentation, review, or usage guidance",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-artifactComment" ]
      } ],
      "mustSupport": true,
      "sliceName": "comment",
      "max": "*",
      "id": "Measure.extension:comment",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      }
    }, {
      "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": "Measure.extension",
      "min": 0,
      "definition": "Specifies the software systems used in the packaging and testing of measure and library resources. Specifically to know which version of what software was used.",
      "isModifier": false,
      "short": "Extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem" ]
      } ],
      "mustSupport": true,
      "sliceName": "softwaresystem",
      "max": "*",
      "id": "Measure.extension:softwaresystem",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      }
    }, {
      "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": "Measure.extension",
      "min": 0,
      "definition": "Specifies additional guidance related to the collection and reporting of supplemental data elements defined in the measure.",
      "isModifier": false,
      "short": "Supplemental data guidance",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" ]
      } ],
      "mustSupport": true,
      "sliceName": "supplementalDataGuidance",
      "max": "*",
      "id": "Measure.extension:supplementalDataGuidance",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      },
      "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": "Measure.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.modifierExtension",
      "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": "DomainResource.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
      "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": "Measure.url",
      "requirements": "Allows the measure to be referenced by a single globally unique identifier.",
      "min": 1,
      "definition": "An absolute URI that is used to identify this measure when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this measure is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the measure is stored on different servers.",
      "isModifier": false,
      "short": "Canonical identifier for this measure, represented as a URI (globally unique)",
      "mapping": [ {
        "map": "Definition.url",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "Measure.url",
      "comment": "Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred.  Multiple instances may share the same URL if they have a distinct version.\n\nThe determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author.  Considerations for making this decision are found in [Technical and Business Versions](http://hl7.org/fhir/resource.html#versions). \n\nIn some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the [meta.source](http://hl7.org/fhir/resource.html#meta) element to indicate where the current master source of the resource can be found.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.url"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "A published measure must be able to specify additional identifiers such as endorser and publisher identifiers for the measure.",
      "min": 3,
      "definition": "A formal identifier that is used to identify this measure when it is represented in other formats, or referenced in a specification, model, design or an instance.",
      "isModifier": false,
      "short": "Additional identifier for the measure",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "type",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.identifier",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "Allows externally provided and/or usable business identifiers to be easily associated with the module.",
      "min": 1,
      "definition": "The version-independent globally unique identifier for the measure (GUID).",
      "isModifier": false,
      "short": "Measure guid",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "sliceName": "versionIndependentIdentifier",
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier.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": "Measure.identifier:versionIndependentIdentifier.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": "Measure.identifier.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": "Measure.identifier:versionIndependentIdentifier.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
    }, {
      "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": "Measure.identifier.use",
      "fixedCode": "official",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 1,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary | old (If known)",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known ."
      },
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.use",
      "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
      "isSummary": true
    }, {
      "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": "Measure.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 1,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "isModifier": false,
      "short": "Description of identifier",
      "mapping": [ {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."
      },
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.type",
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "patternCodeableConcept": {
        "coding": [ {
          "code": "version-independent",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      },
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 1,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "isModifier": false,
      "short": "The namespace for the identifier value",
      "fixedUri": "urn:ietf:rfc:3986",
      "mapping": [ {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.system",
      "comment": "Identifier.system is always case sensitive.",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "isModifier": false,
      "short": "The value that is unique",
      "mapping": [ {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.value",
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "isModifier": false,
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.period",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.assigner",
      "min": 0,
      "definition": "Organization that issued/manages the identifier.",
      "isModifier": false,
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
      } ],
      "max": "1",
      "id": "Measure.identifier:versionIndependentIdentifier.assigner",
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "Allows externally provided and/or usable business identifiers to be easily associated with the module.",
      "min": 1,
      "definition": "The version-specific globally unique identifier for the measure (GUID).",
      "isModifier": false,
      "short": "Measure version guid",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "sliceName": "versionSpecificIdentifier",
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier.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": "Measure.identifier:versionSpecificIdentifier.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": "Measure.identifier.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": "Measure.identifier:versionSpecificIdentifier.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
    }, {
      "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": "Measure.identifier.use",
      "fixedCode": "official",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 1,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary | old (If known)",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known ."
      },
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.use",
      "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
      "isSummary": true
    }, {
      "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": "Measure.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 1,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "isModifier": false,
      "short": "Description of identifier",
      "mapping": [ {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."
      },
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.type",
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "patternCodeableConcept": {
        "coding": [ {
          "code": "version-specific",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      },
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 1,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "isModifier": false,
      "short": "The namespace for the identifier value",
      "fixedUri": "urn:ietf:rfc:3986",
      "mapping": [ {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.system",
      "comment": "Identifier.system is always case sensitive.",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "isModifier": false,
      "short": "The value that is unique",
      "mapping": [ {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.value",
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "isModifier": false,
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.period",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.assigner",
      "min": 0,
      "definition": "Organization that issued/manages the identifier.",
      "isModifier": false,
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
      } ],
      "max": "1",
      "id": "Measure.identifier:versionSpecificIdentifier.assigner",
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "Allows externally provided and/or usable business identifiers to be easily associated with the module.",
      "min": 1,
      "definition": "The short name for the measure (e.g. CMS104v4).",
      "isModifier": false,
      "short": "Short name",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "sliceName": "shortName",
      "max": "1",
      "id": "Measure.identifier:shortName",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier.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": "Measure.identifier:shortName.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": "Measure.identifier.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": "Measure.identifier:shortName.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
    }, {
      "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": "Measure.identifier.use",
      "fixedCode": "usual",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 1,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary | old (If known)",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known ."
      },
      "max": "1",
      "id": "Measure.identifier:shortName.use",
      "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
      "isSummary": true
    }, {
      "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": "Measure.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 1,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "isModifier": false,
      "short": "Description of identifier",
      "mapping": [ {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."
      },
      "max": "1",
      "id": "Measure.identifier:shortName.type",
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "patternCodeableConcept": {
        "coding": [ {
          "code": "short-name",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      },
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 0,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "isModifier": false,
      "short": "The namespace for the identifier value",
      "mapping": [ {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "Measure.identifier:shortName.system",
      "comment": "Identifier.system is always case sensitive.",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "isModifier": false,
      "short": "The value that is unique",
      "mapping": [ {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:shortName.value",
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "isModifier": false,
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "1",
      "id": "Measure.identifier:shortName.period",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.assigner",
      "min": 0,
      "definition": "Organization that issued/manages the identifier.",
      "isModifier": false,
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
      } ],
      "max": "1",
      "id": "Measure.identifier:shortName.assigner",
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "Allows externally provided and/or usable business identifiers to be easily associated with the module.",
      "min": 0,
      "definition": "An identifier assigned by the measure endorser.",
      "isModifier": false,
      "short": "Endorser identifier",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "sliceName": "endorserIdentifier",
      "max": "*",
      "id": "Measure.identifier:endorserIdentifier",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier.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": "Measure.identifier:endorserIdentifier.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": "Measure.identifier.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": "Measure.identifier:endorserIdentifier.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
    }, {
      "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": "Measure.identifier.use",
      "fixedCode": "official",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 1,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary | old (If known)",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known ."
      },
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.use",
      "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
      "isSummary": true
    }, {
      "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": "Measure.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 1,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "isModifier": false,
      "short": "Description of identifier",
      "mapping": [ {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."
      },
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.type",
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "patternCodeableConcept": {
        "coding": [ {
          "code": "endorser",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      },
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 0,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "isModifier": false,
      "short": "The namespace for the identifier value",
      "mapping": [ {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.system",
      "comment": "Identifier.system is always case sensitive.",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "isModifier": false,
      "short": "The value that is unique",
      "mapping": [ {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.value",
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "isModifier": false,
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.period",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.assigner",
      "min": 1,
      "definition": "Organization that issued/manages the identifier.",
      "isModifier": false,
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:endorserIdentifier.assigner",
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier",
      "requirements": "Allows externally provided and/or usable business identifiers to be easily associated with the module.",
      "min": 0,
      "definition": "An identifier assigned by the measure publisher.",
      "isModifier": false,
      "short": "Publisher identifier",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "FiveWs.identifier",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "sliceName": "publisherIdentifier",
      "max": "*",
      "id": "Measure.identifier:publisherIdentifier",
      "comment": "Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this measure outside of FHIR, where it is not possible to use the logical URI.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.identifier"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier.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": "Measure.identifier:publisherIdentifier.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": "Measure.identifier.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": "Measure.identifier:publisherIdentifier.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
    }, {
      "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": "Measure.identifier.use",
      "fixedCode": "official",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 1,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary | old (If known)",
      "mapping": [ {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-use|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known ."
      },
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.use",
      "comment": "Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one.",
      "isSummary": true
    }, {
      "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": "Measure.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 1,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "isModifier": false,
      "short": "Description of identifier",
      "mapping": [ {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/identifier-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose."
      },
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.type",
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage.   Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "patternCodeableConcept": {
        "coding": [ {
          "code": "publisher",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      },
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 0,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "isModifier": false,
      "short": "The namespace for the identifier value",
      "mapping": [ {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.system",
      "comment": "Identifier.system is always case sensitive.",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "isModifier": false,
      "short": "The value that is unique",
      "mapping": [ {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.value",
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "isModifier": false,
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.period",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "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": "Measure.identifier.assigner",
      "min": 1,
      "definition": "Organization that issued/manages the identifier.",
      "isModifier": false,
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Organization" ]
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.identifier:publisherIdentifier.assigner",
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "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": "Measure.version",
      "min": 1,
      "definition": "The identifier that is used to identify this version of the measure when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the measure author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence. To provide a version consistent with the Decision Support Service specification, use the format Major.Minor.Revision (e.g. 1.0.0). For more information on versioning knowledge assets, refer to the Decision Support Service specification. Note that a version is required for non-experimental active artifacts.",
      "isModifier": false,
      "short": "Business version of the measure",
      "mapping": [ {
        "map": "Definition.version",
        "identity": "workflow"
      }, {
        "map": "FiveWs.version",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.version",
      "comment": "There may be different measure instances that have the same identifier but different versions.  The version can be appended to the url in a reference to allow a reference to a particular business version of the measure with the format [url]|[version].",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.version"
      },
      "isSummary": true
    }, {
      "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": "Measure.name",
      "requirements": "Support human navigation and code generation.",
      "min": 1,
      "definition": "A natural language name identifying the measure. This name should be usable as an identifier for the module by machine processing applications such as code generation.",
      "isModifier": false,
      "short": "Name for this measure (computer friendly)",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.name",
      "condition": [ "inv-0" ],
      "comment": "The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.name"
      },
      "isSummary": true
    }, {
      "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": "Measure.title",
      "requirements": "A published measure must specify a human-friendly title.",
      "min": 1,
      "definition": "A short, descriptive, user-friendly title for the measure.",
      "isModifier": false,
      "short": "Name for this measure (human friendly)",
      "mapping": [ {
        "map": "Definition.title",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.title",
      "comment": "This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.title"
      },
      "isSummary": true
    }, {
      "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": "Measure.subtitle",
      "min": 0,
      "definition": "An explanatory or alternate title for the measure giving additional information about its content.",
      "isModifier": false,
      "short": "Subordinate title of the measure",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.subtitle",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.subtitle"
      },
      "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": "Measure.status",
      "fixedCode": "active",
      "requirements": "A published measure must have a status of active.",
      "min": 1,
      "definition": "The status of this measure. Enables tracking the life-cycle of the content.",
      "isModifier": true,
      "short": "draft | active | retired | unknown",
      "mapping": [ {
        "map": "Definition.status",
        "identity": "workflow"
      }, {
        "map": "FiveWs.status",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": false,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/publication-status|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "PublicationStatus"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "The lifecycle status of an artifact."
      },
      "max": "1",
      "id": "Measure.status",
      "comment": "Allows filtering of measures that are appropriate for use versus not.",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.status"
      },
      "isModifierReason": "This is labeled as \"Is Modifier\" because applications should not use a retired {{title}} without due consideration",
      "isSummary": true
    }, {
      "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": "Measure.experimental",
      "requirements": "Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.",
      "min": 1,
      "definition": "A Boolean value to indicate that this measure is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.",
      "isModifier": false,
      "short": "For testing purposes, not real usage",
      "mapping": [ {
        "map": "Definition.experimental",
        "identity": "workflow"
      }, {
        "map": "FiveWs.class",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "boolean"
      } ],
      "max": "1",
      "id": "Measure.experimental",
      "comment": "Allows filtering of measures that are appropriate for use versus not.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.experimental"
      },
      "isSummary": true
    }, {
      "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": "Measure.subject[x]",
      "min": 0,
      "definition": "The intended subjects for the measure. If this element is not provided, a Patient subject is assumed, but the subject of the measure can be anything.",
      "isModifier": false,
      "short": "E.g. Patient, Practitioner, RelatedPerson, Organization, Location, Device",
      "type": [ {
        "code": "CodeableConcept"
      }, {
        "code": "Reference",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Group" ]
      } ],
      "meaningWhenMissing": "Patient",
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/subject-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "SubjectType"
        } ],
        "description": "The possible types of subjects for a measure (E.g. Patient, Practitioner, Organization, Location, etc.)."
      },
      "max": "1",
      "id": "Measure.subject[x]",
      "comment": "The subject of the measure is critical in interpreting the criteria definitions, as the logic in the measures is evaluated with respect to a particular subject. This corresponds roughly to the notion of a Compartment in that it limits what content is available based on its relationship to the subject. In CQL, this corresponds to the context declaration.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.subject[x]"
      },
      "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": "Measure.date",
      "requirements": "A published measure must specify the date the measure content was last changed.",
      "min": 1,
      "definition": "The date  (and optionally time) when the measure was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the measure changes.",
      "isModifier": false,
      "short": "Date last changed",
      "mapping": [ {
        "map": "Definition.date",
        "identity": "workflow"
      }, {
        "map": "FiveWs.recorded",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "mustSupport": true,
      "alias": [ "Revision Date" ],
      "max": "1",
      "id": "Measure.date",
      "comment": "Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the measure. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.date"
      },
      "isSummary": true
    }, {
      "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": "Measure.publisher",
      "requirements": "A published measure must provide publisher information.",
      "min": 1,
      "definition": "The name of the organization or individual that published the measure.",
      "isModifier": false,
      "short": "Name of the publisher (organization or individual)",
      "mapping": [ {
        "map": "Definition.publisher",
        "identity": "workflow"
      }, {
        "map": "FiveWs.witness",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false,
      "alias": [ "steward" ],
      "max": "1",
      "id": "Measure.publisher",
      "comment": "Usually an organization but may be an individual. The publisher (or steward) of the measure is the organization or individual primarily responsible for the maintenance and upkeep of the measure. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the measure. This item SHOULD be populated unless the information is available from context.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.publisher"
      },
      "isSummary": true
    }, {
      "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": "Measure.contact",
      "requirements": "A published measure must provide contact information for the publisher.",
      "min": 1,
      "definition": "Contact details to assist a user in finding and communicating with the publisher.",
      "isModifier": false,
      "short": "Contact details for the publisher",
      "mapping": [ {
        "map": "Definition.contact",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.contact",
      "comment": "May be a web site, an email address, a telephone number, etc.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.contact"
      },
      "isSummary": true
    }, {
      "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": "Measure.description",
      "min": 1,
      "definition": "A free text natural language description of the measure from a consumer's perspective.",
      "isModifier": false,
      "short": "Natural language description of the measure",
      "mapping": [ {
        "map": "Definition.description",
        "identity": "workflow"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "markdown"
      } ],
      "alias": [ "scope" ],
      "max": "1",
      "id": "Measure.description",
      "comment": "This description can be used to capture details such as why the measure was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the measure as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the measure is presumed to be the predominant language in the place the measure was created).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.description"
      },
      "isSummary": true
    }, {
      "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": "Measure.useContext",
      "requirements": "Assist in searching for appropriate content.",
      "min": 0,
      "definition": "The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.",
      "isModifier": false,
      "short": "The context that the content is intended to support",
      "mapping": [ {
        "map": "Definition.useContext",
        "identity": "workflow"
      } ],
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "code",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "UsageContext"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.useContext",
      "comment": "When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.useContext"
      },
      "isSummary": true
    }, {
      "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": "Measure.useContext",
      "requirements": "Assist in searching for appropriate content.",
      "min": 0,
      "definition": "The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate measure instances.",
      "isModifier": false,
      "short": "The context that the content is intended to support",
      "mapping": [ {
        "map": "Definition.useContext",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "UsageContext"
      } ],
      "mustSupport": true,
      "sliceName": "qualityProgram",
      "max": "1",
      "id": "Measure.useContext:qualityProgram",
      "comment": "When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.useContext"
      },
      "isSummary": true
    }, {
      "path": "Measure.useContext.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": "Measure.useContext:qualityProgram.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": "Measure.useContext.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": "Measure.useContext:qualityProgram.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
    }, {
      "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": "Measure.useContext.code",
      "min": 1,
      "definition": "A code that identifies the type of context being specified by this usage context.",
      "isModifier": false,
      "short": "Type of context being specified",
      "type": [ {
        "code": "Coding"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/usage-context-type",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "UsageContextType"
        } ],
        "description": "A code that specifies a type of context being specified by a usage context."
      },
      "max": "1",
      "id": "Measure.useContext:qualityProgram.code",
      "patternCoding": {
        "code": "program",
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type"
      },
      "base": {
        "max": "1",
        "min": 1,
        "path": "UsageContext.code"
      },
      "isSummary": true
    }, {
      "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": "Measure.useContext.value[x]",
      "min": 1,
      "definition": "A value that defines the context specified in this context of use. The interpretation of the value is defined by the code.",
      "isModifier": false,
      "short": "Value that defines the context",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/us/cqfmeasures/ValueSet/quality-programs",
        "description": "The quality programs"
      },
      "max": "1",
      "id": "Measure.useContext:qualityProgram.value[x]",
      "base": {
        "max": "1",
        "min": 1,
        "path": "UsageContext.value[x]"
      },
      "isSummary": true
    }, {
      "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": "Measure.jurisdiction",
      "min": 0,
      "definition": "A legal or geographic region in which the measure is intended to be used.",
      "isModifier": false,
      "short": "Intended jurisdiction for measure (if applicable)",
      "mapping": [ {
        "map": "Definition.jurisdiction",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/jurisdiction",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "Jurisdiction"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "Countries and regions within which this artifact is targeted for use."
      },
      "max": "*",
      "id": "Measure.jurisdiction",
      "comment": "It may be possible for the measure to be used in jurisdictions other than those for which it was originally designed or intended.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.jurisdiction"
      },
      "isSummary": true
    }, {
      "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": "Measure.purpose",
      "requirements": "A published measure should provide a clear description of the purpose of the measure.",
      "min": 0,
      "definition": "Explanation of why this measure is needed and why it has been designed as it has.",
      "isModifier": false,
      "short": "Why this measure is defined",
      "mapping": [ {
        "map": "Definition.purpose",
        "identity": "workflow"
      }, {
        "map": "FiveWs.why[x]",
        "identity": "w5"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.purpose",
      "comment": "This element does not describe the usage of the measure. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is.  This may be used to point to source materials or specifications that drove the structure of this measure.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.purpose"
      },
      "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": "Measure.usage",
      "requirements": "A published measure should provide clinical usage notes for the measure.",
      "min": 0,
      "definition": "A detailed description, from a clinical perspective, of how the measure is used.",
      "isModifier": false,
      "short": "Allows measure developers to provide additional guidance so that implementers can more easily interpret and implement components of the measure.",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.usage",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.usage"
      },
      "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": "Measure.copyright",
      "requirements": "A published measure should provide copyright information for the measure content.",
      "min": 0,
      "definition": "A copyright statement relating to the measure and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the measure.",
      "isModifier": false,
      "short": "Use and/or publishing restrictions",
      "mapping": [ {
        "map": "Definition.copyright",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": true,
      "alias": [ "License", "Restrictions" ],
      "max": "1",
      "id": "Measure.copyright",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.copyright"
      },
      "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": "Measure.approvalDate",
      "requirements": "A published measure must indicate the date the measure content was approved by the publisher.",
      "min": 0,
      "definition": "The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.",
      "isModifier": false,
      "short": "When the measure was approved by publisher",
      "mapping": [ {
        "map": "Definition.approvalDate",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "date"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.approvalDate",
      "comment": "The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.approvalDate"
      },
      "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": "Measure.lastReviewDate",
      "requirements": "A published measure must indicate when the measure content was last reviewed.",
      "min": 0,
      "definition": "The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.",
      "isModifier": false,
      "short": "When the measure was last reviewed",
      "mapping": [ {
        "map": "Definition.lastReviewDate",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "date"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.lastReviewDate",
      "comment": "If specified, this date follows the original approval date.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.lastReviewDate"
      },
      "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": "Measure.effectivePeriod",
      "requirements": "A published measure should provide an indication of the period during which the measure content can be effectively applied.",
      "min": 0,
      "definition": "The period during which the measure content was or is planned to be in active use.",
      "isModifier": false,
      "short": "When the measure is expected to be used",
      "mapping": [ {
        "map": "Definition.effectivePeriod",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.effectivePeriod",
      "comment": "The effective period for a measure  determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.effectivePeriod"
      },
      "isSummary": true
    }, {
      "path": "Measure.effectivePeriod.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": "Measure.effectivePeriod.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": "Measure.effectivePeriod.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": "Measure.effectivePeriod.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
    }, {
      "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": "Measure.effectivePeriod.extension",
      "min": 0,
      "definition": "Specifies the anchor date for the effective period as defined by a starting date and a range.",
      "isModifier": false,
      "short": "Date of first effective use",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodAnchor" ]
      } ],
      "mustSupport": true,
      "sliceName": "anchor",
      "max": "1",
      "id": "Measure.effectivePeriod.extension:anchor",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.effectivePeriod.extension",
      "min": 0,
      "definition": "Specifies the reporting period for the measure.",
      "isModifier": false,
      "short": "What reporting period is used",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodDuration" ]
      } ],
      "mustSupport": true,
      "sliceName": "duration",
      "max": "1",
      "id": "Measure.effectivePeriod.extension:duration",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.effectivePeriod.start",
      "min": 0,
      "definition": "The start of the period. The boundary is inclusive.",
      "isModifier": false,
      "short": "Starting time with inclusive boundary",
      "mapping": [ {
        "map": "DR.1",
        "identity": "v2"
      }, {
        "map": "./low",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "max": "1",
      "id": "Measure.effectivePeriod.start",
      "condition": [ "per-1" ],
      "comment": "If the low element is missing, the meaning is that the low boundary is not known.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Period.start"
      },
      "isSummary": true
    }, {
      "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": "Measure.effectivePeriod.end",
      "min": 0,
      "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.",
      "isModifier": false,
      "short": "End time with inclusive boundary, if not ongoing",
      "mapping": [ {
        "map": "DR.2",
        "identity": "v2"
      }, {
        "map": "./high",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing",
      "max": "1",
      "id": "Measure.effectivePeriod.end",
      "condition": [ "per-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Period.end"
      },
      "isSummary": true
    }, {
      "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": "Measure.topic",
      "requirements": "A published measure should provide relevant topics for the measure content.",
      "min": 0,
      "definition": "Descriptive topics related to the content of the measure. Topics provide a high-level categorization grouping types of measures that can be useful for filtering and searching.",
      "isModifier": false,
      "short": "The category of the measure, such as Education, Treatment, Assessment, etc.",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "example",
        "valueSet": "http://hl7.org/fhir/ValueSet/definition-topic",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "DefinitionTopic"
        } ],
        "description": "High-level categorization of the definition, used for searching, sorting, and filtering."
      },
      "max": "*",
      "id": "Measure.topic",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.topic"
      },
      "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": "Measure.author",
      "min": 0,
      "definition": "An individiual or organization primarily involved in the creation and maintenance of the content.",
      "isModifier": false,
      "short": "Who authored the content",
      "mapping": [ {
        "map": ".participation[typeCode=AUT]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.author",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.author"
      },
      "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": "Measure.editor",
      "min": 0,
      "definition": "An individual or organization primarily responsible for internal coherence of the content.",
      "isModifier": false,
      "short": "Who edited the content",
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.editor",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.editor"
      },
      "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": "Measure.reviewer",
      "min": 0,
      "definition": "An individual or organization primarily responsible for review of some aspect of the content.",
      "isModifier": false,
      "short": "Who reviewed the content",
      "mapping": [ {
        "map": ".participation[typeCode=VRF] {not clear whether VRF best corresponds to reviewer or endorser}",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.reviewer",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.reviewer"
      },
      "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": "Measure.endorser",
      "min": 0,
      "definition": "An individual or organization responsible for officially endorsing the content for use in some setting.",
      "isModifier": false,
      "short": "Who endorsed the content",
      "mapping": [ {
        "map": ".participation[typeCode=VRF] {not clear whether VRF best corresponds to reviewer or endorser}",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.endorser",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.endorser"
      },
      "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": "Measure.relatedArtifact",
      "requirements": "A published measure should provide related information such as supporting evidence, citations, and documentation.",
      "min": 0,
      "definition": "Related artifacts such as additional documentation, justification, or bibliographic references.",
      "isModifier": false,
      "short": "Additional documentation, citations, etc.",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "type",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "RelatedArtifact"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.relatedArtifact",
      "comment": "Each related artifact is either an attachment, or a reference to another resource, but not both.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.relatedArtifact"
      },
      "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": "Measure.relatedArtifact",
      "requirements": "A published measure should indicate which measure it is replacing, if any.",
      "min": 0,
      "definition": "Reference to a predecessor measure that this measure is replacing.",
      "isModifier": false,
      "short": "Previous measure?",
      "type": [ {
        "code": "RelatedArtifact"
      } ],
      "mustSupport": true,
      "sliceName": "predecessor",
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor",
      "comment": "Each related artifact is either an attachment, or a reference to another resource, but not both.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.relatedArtifact"
      },
      "isSummary": false
    }, {
      "path": "Measure.relatedArtifact.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": "Measure.relatedArtifact:predecessor.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": "Measure.relatedArtifact.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": "Measure.relatedArtifact:predecessor.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
    }, {
      "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": "Measure.relatedArtifact.type",
      "fixedCode": "predecessor",
      "min": 1,
      "definition": "The type of relationship to the related artifact.",
      "isModifier": false,
      "short": "documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of",
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "RelatedArtifactType"
        } ],
        "description": "The type of relationship to the related artifact."
      },
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.type",
      "base": {
        "max": "1",
        "min": 1,
        "path": "RelatedArtifact.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.label",
      "min": 0,
      "definition": "A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.",
      "isModifier": false,
      "short": "Short label",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.label",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.label"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.display",
      "min": 0,
      "definition": "A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.",
      "isModifier": false,
      "short": "Brief description of the related artifact",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.display",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.display"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.citation",
      "min": 0,
      "definition": "A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.",
      "isModifier": false,
      "short": "Bibliographic citation for the artifact",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.citation",
      "comment": "Additional structured information about citations should be captured as extensions.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.citation"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.url",
      "min": 0,
      "definition": "A url for the artifact that can be followed to access the actual content.",
      "isModifier": false,
      "short": "Where the artifact can be accessed",
      "type": [ {
        "code": "url"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.url",
      "comment": "If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.url"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.document",
      "min": 0,
      "definition": "The document being referenced, represented as an attachment. This is exclusive with the resource element.",
      "isModifier": false,
      "short": "What document is being referenced",
      "type": [ {
        "code": "Attachment"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.document",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.document"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.resource",
      "min": 1,
      "definition": "The related resource, such as a library, value set, profile, or other knowledge resource.",
      "isModifier": false,
      "short": "What resource is being referenced",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Measure" ]
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor.resource",
      "comment": "If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.resource"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact",
      "requirements": "Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.",
      "min": 0,
      "definition": "Related artifacts such as additional documentation, justification, or bibliographic references.",
      "isModifier": false,
      "short": "Reference/citation",
      "type": [ {
        "code": "RelatedArtifact"
      } ],
      "mustSupport": true,
      "sliceName": "citation",
      "max": "*",
      "id": "Measure.relatedArtifact:citation",
      "comment": "Each related artifact is either an attachment, or a reference to another resource, but not both.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.relatedArtifact"
      },
      "isSummary": false
    }, {
      "path": "Measure.relatedArtifact.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": "Measure.relatedArtifact:citation.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": "Measure.relatedArtifact.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": "Measure.relatedArtifact:citation.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
    }, {
      "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": "Measure.relatedArtifact.extension",
      "min": 0,
      "definition": "Specifies whether the related artifact is defining a primary citation for the measure (i.e. one that should appear in the narrative for the measure specification.",
      "isModifier": false,
      "short": "Primary reference",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation" ]
      } ],
      "mustSupport": false,
      "sliceName": "isPrimaryCitation",
      "max": "1",
      "id": "Measure.relatedArtifact:citation.extension:isPrimaryCitation",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.relatedArtifact.extension",
      "min": 0,
      "definition": "Specifies the publication status of the referenced artifacts.",
      "isModifier": false,
      "short": "Publication status of referenced artifact",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-publicationStatus" ]
      } ],
      "mustSupport": false,
      "sliceName": "publicationStatus",
      "max": "1",
      "id": "Measure.relatedArtifact:citation.extension:publicationStatus",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.relatedArtifact.extension",
      "min": 0,
      "definition": "Specifies the publication date of the referenced artifacts.",
      "isModifier": false,
      "short": "Publication date of referenced artifact",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-publicationDate" ]
      } ],
      "mustSupport": false,
      "sliceName": "publicationDate",
      "max": "1",
      "id": "Measure.relatedArtifact:citation.extension:publicationDate",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.relatedArtifact.type",
      "fixedCode": "citation",
      "min": 1,
      "definition": "The type of relationship to the related artifact.",
      "isModifier": false,
      "short": "documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of",
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "RelatedArtifactType"
        } ],
        "description": "The type of relationship to the related artifact."
      },
      "max": "1",
      "id": "Measure.relatedArtifact:citation.type",
      "base": {
        "max": "1",
        "min": 1,
        "path": "RelatedArtifact.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.label",
      "min": 0,
      "definition": "A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.",
      "isModifier": false,
      "short": "Short label",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.label",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.label"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.display",
      "min": 0,
      "definition": "A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.",
      "isModifier": false,
      "short": "Brief description of the related artifact",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.display",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.display"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.citation",
      "min": 0,
      "definition": "A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.",
      "isModifier": false,
      "short": "Bibliographic citation for the artifact",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.citation",
      "comment": "Additional structured information about citations should be captured as extensions.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.citation"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.url",
      "min": 0,
      "definition": "A url for the artifact that can be followed to access the actual content.",
      "isModifier": false,
      "short": "Where the artifact can be accessed",
      "type": [ {
        "code": "url"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.url",
      "comment": "If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.url"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.document",
      "min": 0,
      "definition": "The document being referenced, represented as an attachment. This is exclusive with the resource element.",
      "isModifier": false,
      "short": "What document is being referenced",
      "type": [ {
        "code": "Attachment"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.document",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.document"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.resource",
      "min": 0,
      "definition": "The related resource, such as a library, value set, profile, or other knowledge resource.",
      "isModifier": false,
      "short": "What resource is being referenced",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Resource" ]
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:citation.resource",
      "comment": "If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.resource"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact",
      "requirements": "Measures must be able to provide enough information for consumers of the content (and/or interventions or results produced by the content) to be able to determine and understand the justification for and evidence in support of the content.",
      "min": 0,
      "definition": "Related artifacts such as additional documentation, justification, or bibliographic references.",
      "isModifier": false,
      "short": "URL or canonical reference to other resources that a measure is derived from",
      "type": [ {
        "code": "RelatedArtifact"
      } ],
      "mustSupport": true,
      "sliceName": "derived-from",
      "max": "*",
      "id": "Measure.relatedArtifact:derived-from",
      "comment": "Each related artifact is either an attachment, or a reference to another resource, but not both.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.relatedArtifact"
      },
      "isSummary": false
    }, {
      "path": "Measure.relatedArtifact.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": "Measure.relatedArtifact:derived-from.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": "Measure.relatedArtifact.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": "Measure.relatedArtifact:derived-from.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
    }, {
      "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": "Measure.relatedArtifact.type",
      "fixedCode": "derived-from",
      "min": 1,
      "definition": "The type of relationship to the related artifact.",
      "isModifier": false,
      "short": "documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of",
      "type": [ {
        "code": "code"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/related-artifact-type|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "RelatedArtifactType"
        } ],
        "description": "The type of relationship to the related artifact."
      },
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.type",
      "base": {
        "max": "1",
        "min": 1,
        "path": "RelatedArtifact.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.label",
      "min": 0,
      "definition": "A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.",
      "isModifier": false,
      "short": "Short label",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.label",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.label"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.display",
      "min": 0,
      "definition": "A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.",
      "isModifier": false,
      "short": "Brief description of the related artifact",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.display",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.display"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.citation",
      "min": 0,
      "definition": "A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.",
      "isModifier": false,
      "short": "Bibliographic citation for the artifact",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.citation",
      "comment": "Additional structured information about citations should be captured as extensions.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.citation"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.url",
      "min": 0,
      "definition": "A url for the artifact that can be followed to access the actual content.",
      "isModifier": false,
      "short": "Should be permalink otherwise include an \"accessed date\"",
      "type": [ {
        "code": "url"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.url",
      "comment": "If a document or resource element is present, this element SHALL NOT be provided (use the url or reference in the Attachment or resource reference).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.url"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.document",
      "min": 0,
      "definition": "The document being referenced, represented as an attachment. This is exclusive with the resource element.",
      "isModifier": false,
      "short": "What document is being referenced",
      "type": [ {
        "code": "Attachment"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.document",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.document"
      },
      "isSummary": true
    }, {
      "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": "Measure.relatedArtifact.resource",
      "min": 0,
      "definition": "The related resource, such as a library, value set, profile, or other knowledge resource.",
      "isModifier": false,
      "short": "Should be permalink otherwise include an \"accessed date\"",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Measure" ]
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.relatedArtifact:derived-from.resource",
      "comment": "If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.resource"
      },
      "isSummary": true
    }, {
      "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": "cqm-2",
        "human": "Measures utilizing CQL SHALL reference one and only one CQL library (and that referenced library MUST be the primary library for the measure)",
        "xpath": "exists(f)",
        "source": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/measure-cqfm",
        "severity": "warning",
        "expression": "exists()"
      } ],
      "path": "Measure.library",
      "requirements": "A computable measure MUST provide one primary library reference containing population criteria definitions for the measure.",
      "min": 0,
      "definition": "A reference to a Library resource containing the formal logic used by the measure.",
      "isModifier": false,
      "short": "CQFMMeasures are not required to use a Library, but if they do, it SHALL be a CQFMLibrary.",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/library-cqfm" ]
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.library",
      "condition": [ "cqm-2" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.library"
      },
      "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": "Measure.disclaimer",
      "requirements": "A published measure should provide legal disclaimer relating to the use of the measure content.",
      "min": 0,
      "definition": "Notices and disclaimers regarding the use of the measure or related to intellectual property (such as code systems) referenced by the measure.",
      "isModifier": false,
      "short": "Disclaimer for use of the measure or its referenced content",
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.disclaimer",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.disclaimer"
      },
      "isSummary": true
    }, {
      "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": "Measure.scoring",
      "min": 0,
      "definition": "Indicates how the calculation is performed for the measure, including proportion, ratio, continuous-variable, and cohort. The value set is extensible, allowing additional measure scoring types to be represented.",
      "isModifier": false,
      "short": "proportion | ratio | continuous-variable | cohort",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/measure-scoring",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasureScoring"
        } ],
        "description": "The scoring type of the measure."
      },
      "max": "1",
      "id": "Measure.scoring",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.scoring"
      },
      "isSummary": true
    }, {
      "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": "Measure.compositeScoring",
      "min": 0,
      "definition": "If this is a composite measure, the scoring method used to combine the component measures to determine the composite score.",
      "isModifier": false,
      "short": "opportunity | all-or-nothing | linear | weighted",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/ValueSet/composite-measure-scoring",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "CompositeMeasureScoring"
        } ],
        "description": "The composite scoring method of the measure."
      },
      "max": "1",
      "id": "Measure.compositeScoring",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.compositeScoring"
      },
      "isSummary": true
    }, {
      "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": "Measure.type",
      "requirements": "A measure must indicate the type of the measure.",
      "min": 0,
      "definition": "Indicates whether the measure is used to examine a process, an outcome over time, a patient-reported outcome, or a structure measure such as utilization.",
      "isModifier": false,
      "short": "process | outcome | structure | patient-reported-outcome | composite",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-type"
      },
      "max": "*",
      "id": "Measure.type",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.type"
      },
      "isSummary": true
    }, {
      "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": "Measure.riskAdjustment",
      "min": 0,
      "definition": "A description of the risk adjustment factors that may impact the resulting score for the measure and how they may be accounted for when computing and reporting measure results.",
      "isModifier": false,
      "short": "How risk adjustment is applied for this measure",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.riskAdjustment",
      "comment": "Describes the method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow for more useful comparisons.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.riskAdjustment"
      },
      "isSummary": true
    }, {
      "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": "Measure.rateAggregation",
      "min": 0,
      "definition": "Describes how to combine the information calculated, based on logic in each of several populations, into one summarized result.",
      "isModifier": false,
      "short": "How is rate aggregation performed for this measure",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.rateAggregation",
      "comment": "The measure rate for an organization or clinician is based upon the entities’ aggregate data and summarizes the performance of the entity over a given time period (e.g., monthly, quarterly, yearly). The aggregated data are derived from the results of a specific measure algorithm and, if appropriate, the application of specific risk adjustment models.  Can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two). This could be applied to aggregated cohort measure definitions (e.g., CDC's aggregate reporting for TB at the state level).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.rateAggregation"
      },
      "isSummary": true
    }, {
      "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": "Measure.rationale",
      "requirements": "Measure developers need to be able to provide a detailed description of the purpose of the measure. This element provides detailed rationale, where the purpose element provides a summary of the rationale.",
      "min": 0,
      "definition": "Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.",
      "isModifier": false,
      "short": "Detailed description of why the measure exists",
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.rationale",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.rationale"
      },
      "isSummary": true
    }, {
      "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": "Measure.clinicalRecommendationStatement",
      "min": 0,
      "definition": "Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.",
      "isModifier": false,
      "short": "Summary of clinical guidelines",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.clinicalRecommendationStatement",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.clinicalRecommendationStatement"
      },
      "isSummary": true
    }, {
      "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": "Measure.improvementNotation",
      "requirements": "Measure consumers and implementers must be able to determine how to interpret a measure score.",
      "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",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "required",
        "valueSet": "http://hl7.org/fhir/ValueSet/measure-improvement-notation|4.0.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasureImprovementNotation"
        } ],
        "description": "Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue."
      },
      "max": "1",
      "id": "Measure.improvementNotation",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.improvementNotation"
      },
      "isSummary": true
    }, {
      "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": "Measure.definition",
      "requirements": "Measure developers must be able to provide precise definitions of terms used within measure descriptions and guidance to help communicate the intent of the measure.",
      "min": 0,
      "definition": "Provides a description of an individual term used within the measure.",
      "isModifier": false,
      "short": "Defined terms used in the measure documentation",
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": false,
      "max": "*",
      "id": "Measure.definition",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.definition"
      },
      "isSummary": true
    }, {
      "path": "Measure.definition.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references)",
      "isModifier": false,
      "short": "xml:id (or equivalent in JSON)",
      "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": "Measure.definition.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": "Measure.definition.extension",
      "min": 1,
      "definition": "An Extension",
      "isModifier": false,
      "short": "Extension",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "max": "*",
      "id": "Measure.definition.extension",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.definition.extension",
      "min": 1,
      "definition": "Specifies a term and its associated definition.",
      "isModifier": false,
      "short": "Defined term",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm" ]
      } ],
      "mustSupport": false,
      "sliceName": "definitionTerm",
      "max": "1",
      "id": "Measure.definition.extension:definitionTerm",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "path": "Measure.definition.value",
      "min": 0,
      "definition": "Primitive value for markdown",
      "isModifier": false,
      "short": "Primitive value for markdown",
      "type": [ {
        "code": "http://hl7.org/fhirpath/System.String",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
          "valueUrl": "string"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/regex",
          "valueString": "[ \\r\\n\\t\\S]+"
        } ]
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.definition.value",
      "base": {
        "max": "1",
        "min": 0,
        "path": "string.value"
      },
      "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": "Measure.guidance",
      "requirements": "Measure developers must be able to provide additional guidance for implementers to understand the intent with greater specificity than that provided in the population criteria of the measure. This element provides detailed guidance, where the usage element provides a summary of the guidance.",
      "min": 0,
      "definition": "Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.",
      "isModifier": false,
      "short": "Additional guidance for implementers",
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": false,
      "max": "0",
      "id": "Measure.guidance",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.guidance"
      },
      "isSummary": true
    }, {
      "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": "Measure.group",
      "min": 0,
      "definition": "A group of population criteria for the measure.",
      "isModifier": false,
      "short": "Population criteria group",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.group",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group"
      },
      "isSummary": false
    }, {
      "constraint": [ {
        "key": "cqm-3",
        "human": "Group identifiers SHOULD use the convention: \"group-[group number]\", where [group number] corresponds with the group naming convention for the criteria within the group",
        "xpath": "exists(f:value)",
        "source": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/measure-cqfm",
        "severity": "warning",
        "expression": "startsWith('group-')"
      } ],
      "path": "Measure.group.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"
        } ]
      } ],
      "mustSupport": true,
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.id",
      "condition": [ "cqm-3" ],
      "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": "Measure.group.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"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.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
    }, {
      "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": "Measure.group.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored even if unrecognized",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.modifierExtension",
      "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": "BackboneElement.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
      "isSummary": true
    }, {
      "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": "Measure.group.code",
      "min": 0,
      "definition": "Indicates a meaning for the group. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing groups to be correlated across measures.",
      "isModifier": false,
      "short": "Meaning of the group",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "max": "1",
      "id": "Measure.group.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.code"
      },
      "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": "Measure.group.description",
      "min": 0,
      "definition": "The human readable description of this population group.",
      "isModifier": false,
      "short": "Summary description",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.group.description",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.description"
      },
      "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": "Measure.group.population",
      "requirements": "A measure must specify at least one population or composite calculation for each population group.",
      "min": 0,
      "definition": "A population criteria for the measure.",
      "isModifier": false,
      "short": "Population criteria",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.group.population",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      },
      "isSummary": false
    }, {
      "path": "Measure.group.population.id",
      "requirements": "A measure must specify at least one population or composite calculation for each population group.",
      "min": 1,
      "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"
        } ]
      } ],
      "mustSupport": true,
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population.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": "Measure.group.population.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"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population.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
    }, {
      "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": "Measure.group.population.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored even if unrecognized",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population.modifierExtension",
      "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": "BackboneElement.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
      "isSummary": true
    }, {
      "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": "Measure.group.population.code",
      "requirements": "A measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "isModifier": false,
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-population"
      },
      "max": "1",
      "id": "Measure.group.population.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      },
      "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": "Measure.group.population.description",
      "min": 0,
      "definition": "The human readable description of this population criteria.",
      "isModifier": false,
      "short": "The human readable description of this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.group.population.description",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "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": "cqm-4",
        "human": "Group population criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace.",
        "xpath": "exists(f:value)",
        "source": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/measure-cqfm",
        "severity": "warning",
        "expression": "expression.contains('.').not()"
      } ],
      "path": "Measure.group.population.criteria",
      "min": 1,
      "definition": "The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this population criteria.",
      "isModifier": false,
      "short": "The criteria that defines this population",
      "type": [ {
        "code": "Expression"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population.criteria",
      "comment": "In the case of a continuous-variable or ratio measure, this may be the name of a function that calculates the value of the individual observation for each patient or event in the population. For these types of measures, individual observations are reported as observation resources included in the evaluatedResources bundle for each patient. See the MeasureReport resource or the Quality Reporting topic for more information.",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.group.population.criteria"
      },
      "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": "Measure.group.stratifier",
      "requirements": "A measure should provide stratification information if appropriate for the measure content.",
      "min": 0,
      "definition": "The stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.",
      "isModifier": false,
      "short": "Stratifier criteria for the measure",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.group.stratifier",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.stratifier"
      },
      "isSummary": false
    }, {
      "path": "Measure.group.stratifier.id",
      "requirements": "A measure should provide stratification information if appropriate for the measure content.",
      "min": 1,
      "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"
        } ]
      } ],
      "mustSupport": true,
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.stratifier.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": "Measure.group.stratifier.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"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.stratifier.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
    }, {
      "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": "Measure.group.stratifier.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored even if unrecognized",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.stratifier.modifierExtension",
      "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": "BackboneElement.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
      "isSummary": true
    }, {
      "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": "Measure.group.stratifier.code",
      "min": 0,
      "definition": "Indicates a meaning for the stratifier. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.",
      "isModifier": false,
      "short": "Meaning of the stratifier",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "max": "1",
      "id": "Measure.group.stratifier.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.code"
      },
      "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": "Measure.group.stratifier.description",
      "min": 0,
      "definition": "The human readable description of this stratifier criteria.",
      "isModifier": false,
      "short": "The human readable description of this stratifier",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.group.stratifier.description",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.description"
      },
      "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": "cqm-5",
        "human": "Group stratifier criteria SHOULD be simple expression names found within the primary library for the measure. The criteria SHOULD NOT include a namespace.",
        "xpath": "exists(f:value)",
        "source": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/measure-cqfm",
        "severity": "warning",
        "expression": "expression.contains('.').not()"
      } ],
      "path": "Measure.group.stratifier.criteria",
      "min": 0,
      "definition": "The name of a valid referenced CQL expression (MUST NOT be namespaced) that defines this stratifier criteria.",
      "isModifier": false,
      "short": "How the measure should be stratified",
      "type": [ {
        "code": "Expression"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.stratifier.criteria",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.criteria"
      },
      "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": "Measure.group.stratifier.component",
      "min": 0,
      "definition": "A component of the stratifier criteria for the measure report, specified as either the name of a valid CQL expression defined within a referenced library or a valid FHIR Resource Path.",
      "isModifier": false,
      "short": "Stratifier criteria component for the measure",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "*",
      "id": "Measure.group.stratifier.component",
      "comment": "Stratifiers are defined either as a single criteria, or as a set of component criteria.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.stratifier.component"
      },
      "isSummary": false
    }, {
      "path": "Measure.group.stratifier.component.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": "Measure.group.stratifier.component.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": "Measure.group.stratifier.component.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"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.stratifier.component.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
    }, {
      "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": "Measure.group.stratifier.component.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored even if unrecognized",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.stratifier.component.modifierExtension",
      "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": "BackboneElement.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
      "isSummary": true
    }, {
      "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": "Measure.group.stratifier.component.code",
      "min": 0,
      "definition": "Indicates a meaning for the stratifier component. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing stratifiers to be correlated across measures.",
      "isModifier": false,
      "short": "Meaning of the stratifier component",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "max": "1",
      "id": "Measure.group.stratifier.component.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.component.code"
      },
      "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": "Measure.group.stratifier.component.description",
      "min": 0,
      "definition": "The human readable description of this stratifier criteria component.",
      "isModifier": false,
      "short": "The human readable description of this stratifier component",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.group.stratifier.component.description",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.component.description"
      },
      "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": "Measure.group.stratifier.component.criteria",
      "min": 1,
      "definition": "An expression that specifies the criteria for this component of the stratifier. This is typically the name of an expression defined within a referenced library, but it may also be a path to a stratifier element.",
      "isModifier": false,
      "short": "Component of how the measure should be stratified",
      "type": [ {
        "code": "Expression"
      } ],
      "max": "1",
      "id": "Measure.group.stratifier.component.criteria",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.group.stratifier.component.criteria"
      },
      "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": "Measure.supplementalData",
      "requirements": "A measure should provide supplemental data appropriate for the measure content.",
      "min": 0,
      "definition": "The supplemental data criteria for the measure report, specified as either the name of a valid CQL expression within a referenced library, or a valid FHIR Resource Path.",
      "isModifier": false,
      "short": "What other data should be reported with the measure",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.supplementalData",
      "comment": "Note that supplemental data are reported as observations for each patient and included in the evaluatedResources bundle. See the MeasureReport resource or the Quality Reporting topic for more information.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.supplementalData"
      },
      "isSummary": false
    }, {
      "path": "Measure.supplementalData.id",
      "requirements": "A measure should provide supplemental data appropriate for the measure content.",
      "min": 1,
      "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"
        } ]
      } ],
      "mustSupport": true,
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.supplementalData.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": "Measure.supplementalData.extension",
      "min": 0,
      "definition": "An Extension",
      "isModifier": false,
      "short": "Extension",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "max": "*",
      "id": "Measure.supplementalData.extension",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      },
      "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": "Measure.supplementalData.extension",
      "min": 0,
      "definition": "Indicates what types of report the element on which it appears should be included in. If no values are specified, the default behavior is that elements are included in all report types.",
      "isModifier": false,
      "short": "The type of report the element should be included in",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType" ]
      } ],
      "sliceName": "includeInReportType",
      "max": "*",
      "id": "Measure.supplementalData.extension:includeInReportType",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "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": "Measure.supplementalData.modifierExtension",
      "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](http://hl7.org/fhir/extensibility.html#modifierExtension).",
      "min": 0,
      "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
      "isModifier": true,
      "short": "Extensions that cannot be ignored even if unrecognized",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.supplementalData.modifierExtension",
      "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": "BackboneElement.modifierExtension"
      },
      "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
      "isSummary": true
    }, {
      "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": "Measure.supplementalData.code",
      "min": 0,
      "definition": "Indicates a meaning for the supplemental data. This can be as simple as a unique identifier, or it can establish meaning in a broader context by drawing from a terminology, allowing supplemental data to be correlated across measures.",
      "isModifier": false,
      "short": "Meaning of the supplemental data",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "preferred",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-supplemental-data"
      },
      "max": "1",
      "id": "Measure.supplementalData.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.supplementalData.code"
      },
      "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": "Measure.supplementalData.usage",
      "min": 0,
      "definition": "An indicator of the intended usage for the supplemental data element. Supplemental data indicates the data is additional information requested to augment the measure information. Risk adjustment factor indicates the data is additional information used to calculate risk adjustment factors when applying a risk model to the measure calculation.",
      "isModifier": false,
      "short": "supplemental-data | risk-adjustment-factor",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "preferred",
        "valueSet": "http://terminology.hl7.org/ValueSet/measure-data-usage"
      },
      "max": "*",
      "id": "Measure.supplementalData.usage",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.supplementalData.usage"
      },
      "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": "Measure.supplementalData.description",
      "min": 0,
      "definition": "The human readable description of this supplemental data.",
      "isModifier": false,
      "short": "The human readable description of this supplemental data",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.supplementalData.description",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.supplementalData.description"
      },
      "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": "Measure.supplementalData.criteria",
      "min": 1,
      "definition": "The criteria for the supplemental data. This is typically the name of a valid expression defined within a referenced library, but it may also be a path to a specific data element. The criteria defines the data to be returned for this element.",
      "isModifier": false,
      "short": "Expression describing additional data to be reported",
      "type": [ {
        "code": "Expression"
      } ],
      "max": "1",
      "id": "Measure.supplementalData.criteria",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.supplementalData.criteria"
      },
      "isSummary": false
    } ]
  },
  "status": "active",
  "id": "7b91f2c9-cf3b-4b28-8012-f3e4ec486e39",
  "kind": "resource",
  "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
  "version": "4.0.0",
  "differential": {
    "element": [ {
      "id": "Measure",
      "path": "Measure",
      "mustSupport": false
    }, {
      "id": "Measure.text",
      "max": "1",
      "min": 1,
      "path": "Measure.text",
      "mustSupport": true,
      "requirements": "A published measure must provide human-readable narrative description of the measure contents."
    }, {
      "id": "Measure.extension:supplementalDataGuidance",
      "max": "*",
      "min": 0,
      "path": "Measure.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance" ]
      } ],
      "sliceName": "supplementalDataGuidance",
      "mustSupport": true
    }, {
      "id": "Measure.identifier",
      "max": "*",
      "min": 3,
      "path": "Measure.identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "type",
          "type": "value"
        } ]
      },
      "mustSupport": true,
      "requirements": "A published measure must be able to specify additional identifiers such as endorser and publisher identifiers for the measure."
    }, {
      "id": "Measure.identifier:versionIndependentIdentifier",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier",
      "short": "Measure guid",
      "sliceName": "versionIndependentIdentifier",
      "definition": "The version-independent globally unique identifier for the measure (GUID).",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionIndependentIdentifier.use",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.use",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "official",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionIndependentIdentifier.type",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.type",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "version-independent",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      }
    }, {
      "id": "Measure.identifier:versionIndependentIdentifier.system",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.system",
      "type": [ {
        "code": "uri"
      } ],
      "fixedUri": "urn:ietf:rfc:3986",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionIndependentIdentifier.value",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.value",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionSpecificIdentifier",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier",
      "short": "Measure version guid",
      "sliceName": "versionSpecificIdentifier",
      "definition": "The version-specific globally unique identifier for the measure (GUID).",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionSpecificIdentifier.use",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.use",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "official",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionSpecificIdentifier.type",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.type",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "version-specific",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      }
    }, {
      "id": "Measure.identifier:versionSpecificIdentifier.system",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.system",
      "type": [ {
        "code": "uri"
      } ],
      "fixedUri": "urn:ietf:rfc:3986",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:versionSpecificIdentifier.value",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.value",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:shortName",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier",
      "short": "Short name",
      "sliceName": "shortName",
      "definition": "The short name for the measure (e.g. CMS104v4).",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:shortName.use",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.use",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "usual",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:shortName.type",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.type",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "short-name",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      }
    }, {
      "id": "Measure.identifier:shortName.value",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.value",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:endorserIdentifier",
      "max": "*",
      "min": 0,
      "path": "Measure.identifier",
      "short": "Endorser identifier",
      "sliceName": "endorserIdentifier",
      "definition": "An identifier assigned by the measure endorser.",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:endorserIdentifier.use",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.use",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "official",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:endorserIdentifier.type",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.type",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "endorser",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      }
    }, {
      "id": "Measure.identifier:endorserIdentifier.system",
      "max": "1",
      "min": 0,
      "path": "Measure.identifier.system",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:endorserIdentifier.value",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.value",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:endorserIdentifier.assigner",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.assigner",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:publisherIdentifier",
      "max": "*",
      "min": 0,
      "path": "Measure.identifier",
      "short": "Publisher identifier",
      "sliceName": "publisherIdentifier",
      "definition": "An identifier assigned by the measure publisher.",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:publisherIdentifier.use",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.use",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "official",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:publisherIdentifier.type",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.type",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "patternCodeableConcept": {
        "coding": [ {
          "code": "publisher",
          "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type"
        } ]
      }
    }, {
      "id": "Measure.identifier:publisherIdentifier.system",
      "max": "1",
      "min": 0,
      "path": "Measure.identifier.system",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:publisherIdentifier.value",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.value",
      "mustSupport": true
    }, {
      "id": "Measure.identifier:publisherIdentifier.assigner",
      "max": "1",
      "min": 1,
      "path": "Measure.identifier.assigner",
      "mustSupport": true
    }, {
      "id": "Measure.title",
      "max": "1",
      "min": 1,
      "path": "Measure.title",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "requirements": "A published measure must specify a human-friendly title."
    }, {
      "id": "Measure.status",
      "max": "1",
      "min": 1,
      "path": "Measure.status",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "active",
      "mustSupport": false,
      "requirements": "A published measure must have a status of active."
    }, {
      "id": "Measure.date",
      "max": "1",
      "min": 1,
      "path": "Measure.date",
      "type": [ {
        "code": "dateTime"
      } ],
      "mustSupport": true,
      "requirements": "A published measure must specify the date the measure content was last changed."
    }, {
      "id": "Measure.publisher",
      "max": "1",
      "min": 1,
      "path": "Measure.publisher",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false,
      "requirements": "A published measure must provide publisher information."
    }, {
      "id": "Measure.contact",
      "max": "*",
      "min": 1,
      "path": "Measure.contact",
      "type": [ {
        "code": "ContactDetail"
      } ],
      "mustSupport": true,
      "requirements": "A published measure must provide contact information for the publisher."
    }, {
      "id": "Measure.useContext",
      "path": "Measure.useContext",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "code",
          "type": "value"
        } ]
      },
      "mustSupport": true
    }, {
      "id": "Measure.useContext:qualityProgram",
      "max": "1",
      "min": 0,
      "path": "Measure.useContext",
      "sliceName": "qualityProgram",
      "mustSupport": true
    }, {
      "id": "Measure.useContext:qualityProgram.code",
      "max": "1",
      "min": 1,
      "path": "Measure.useContext.code",
      "type": [ {
        "code": "Coding"
      } ],
      "mustSupport": true,
      "patternCoding": {
        "code": "program",
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type"
      }
    }, {
      "id": "Measure.useContext:qualityProgram.value[x]",
      "max": "1",
      "min": 1,
      "path": "Measure.useContext.value[x]",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "valueSet": "http://hl7.org/fhir/us/cqfmeasures/ValueSet/quality-programs",
        "description": "The quality programs"
      },
      "mustSupport": true
    }, {
      "id": "Measure.purpose",
      "path": "Measure.purpose",
      "definition": "Explanation of why this measure is needed and why it has been designed as it has.",
      "mustSupport": true,
      "requirements": "A published measure should provide a clear description of the purpose of the measure."
    }, {
      "id": "Measure.usage",
      "path": "Measure.usage",
      "short": "Allows measure developers to provide additional guidance so that implementers can more easily interpret and implement components of the measure.",
      "mustSupport": true,
      "requirements": "A published measure should provide clinical usage notes for the measure."
    }, {
      "id": "Measure.copyright",
      "path": "Measure.copyright",
      "mustSupport": true,
      "requirements": "A published measure should provide copyright information for the measure content."
    }, {
      "id": "Measure.approvalDate",
      "path": "Measure.approvalDate",
      "mustSupport": true,
      "requirements": "A published measure must indicate the date the measure content was approved by the publisher."
    }, {
      "id": "Measure.lastReviewDate",
      "path": "Measure.lastReviewDate",
      "mustSupport": true,
      "requirements": "A published measure must indicate when the measure content was last reviewed."
    }, {
      "id": "Measure.effectivePeriod",
      "path": "Measure.effectivePeriod",
      "mustSupport": true,
      "requirements": "A published measure should provide an indication of the period during which the measure content can be effectively applied."
    }, {
      "id": "Measure.effectivePeriod.extension:anchor",
      "max": "1",
      "min": 0,
      "path": "Measure.effectivePeriod.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodAnchor" ]
      } ],
      "sliceName": "anchor",
      "mustSupport": true
    }, {
      "id": "Measure.effectivePeriod.extension:duration",
      "max": "1",
      "min": 0,
      "path": "Measure.effectivePeriod.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectivePeriodDuration" ]
      } ],
      "sliceName": "duration",
      "mustSupport": true
    }, {
      "id": "Measure.topic",
      "path": "Measure.topic",
      "mustSupport": true,
      "requirements": "A published measure should provide relevant topics for the measure content."
    }, {
      "id": "Measure.author",
      "path": "Measure.author",
      "mustSupport": true
    }, {
      "id": "Measure.editor",
      "path": "Measure.editor",
      "mustSupport": true
    }, {
      "id": "Measure.reviewer",
      "path": "Measure.reviewer",
      "mustSupport": true
    }, {
      "id": "Measure.endorser",
      "path": "Measure.endorser",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact",
      "path": "Measure.relatedArtifact",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "type",
          "type": "value"
        } ]
      },
      "mustSupport": true,
      "requirements": "A published measure should provide related information such as supporting evidence, citations, and documentation."
    }, {
      "path": "Measure.relatedArtifact",
      "requirements": "A published measure should indicate which measure it is replacing, if any.",
      "min": 0,
      "definition": "Reference to a predecessor measure that this measure is replacing.",
      "short": "Previous measure?",
      "mustSupport": true,
      "sliceName": "predecessor",
      "max": "1",
      "id": "Measure.relatedArtifact:predecessor"
    }, {
      "id": "Measure.relatedArtifact:predecessor.type",
      "max": "1",
      "min": 1,
      "path": "Measure.relatedArtifact.type",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "predecessor",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:predecessor.resource",
      "max": "1",
      "min": 1,
      "path": "Measure.relatedArtifact.resource",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Measure" ]
      } ],
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:citation",
      "max": "*",
      "min": 0,
      "path": "Measure.relatedArtifact",
      "short": "Reference/citation",
      "sliceName": "citation",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:citation.extension:isPrimaryCitation",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-isPrimaryCitation" ]
      } ],
      "sliceName": "isPrimaryCitation",
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:citation.extension:publicationStatus",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-publicationStatus" ]
      } ],
      "sliceName": "publicationStatus",
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:citation.extension:publicationDate",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-publicationDate" ]
      } ],
      "sliceName": "publicationDate",
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:citation.type",
      "max": "1",
      "min": 1,
      "path": "Measure.relatedArtifact.type",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "citation",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:derived-from",
      "max": "*",
      "min": 0,
      "path": "Measure.relatedArtifact",
      "short": "URL or canonical reference to other resources that a measure is derived from",
      "sliceName": "derived-from",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:derived-from.type",
      "max": "1",
      "min": 1,
      "path": "Measure.relatedArtifact.type",
      "type": [ {
        "code": "code"
      } ],
      "fixedCode": "derived-from",
      "mustSupport": true
    }, {
      "id": "Measure.relatedArtifact:derived-from.label",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.label",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:derived-from.display",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.display",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:derived-from.url",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.url",
      "type": [ {
        "code": "url"
      } ],
      "short": "Should be permalink otherwise include an \"accessed date\"",
      "mustSupport": false
    }, {
      "id": "Measure.relatedArtifact:derived-from.resource",
      "max": "1",
      "min": 0,
      "path": "Measure.relatedArtifact.resource",
      "type": [ {
        "code": "canonical",
        "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Measure" ]
      } ],
      "short": "Should be permalink otherwise include an \"accessed date\"",
      "mustSupport": false
    }, {
      "id": "Measure.disclaimer",
      "path": "Measure.disclaimer",
      "mustSupport": true,
      "requirements": "A published measure should provide legal disclaimer relating to the use of the measure content."
    }, {
      "id": "Measure.rationale",
      "path": "Measure.rationale",
      "definition": "Provides a succinct statement of the need for the measure. Usually includes statements pertaining to importance criterion: impact, gap in care, and evidence.",
      "mustSupport": false
    }, {
      "id": "Measure.definition",
      "max": "*",
      "min": 0,
      "path": "Measure.definition",
      "mustSupport": false
    }, {
      "id": "Measure.definition.extension:definitionTerm",
      "max": "1",
      "min": 1,
      "path": "Measure.definition.extension",
      "type": [ {
        "code": "Extension",
        "profile": [ "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-definitionTerm" ]
      } ],
      "sliceName": "definitionTerm",
      "mustSupport": false
    }, {
      "id": "Measure.guidance",
      "max": "0",
      "min": 0,
      "path": "Measure.guidance",
      "mustSupport": false
    } ]
  },
  "contact": [ {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cqi",
      "system": "url"
    } ]
  } ],
  "baseDefinition": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/measure-cqfm"
}