{
  "description": "The CQFM Ratio Measure Profile describes a ratio scoring measure",
  "_filename": "StructureDefinition-ratio-measure-cqfm.json",
  "package_name": "hl7.fhir.us.cqfmeasures",
  "date": "2019-02-13T00:00:00-05:00",
  "derivation": "constraint",
  "publisher": "Health Level Seven, Inc. - CQI WG",
  "fhirVersion": "3.0.2",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "name": "CQFMRatioMeasure",
  "mapping": [ {
    "uri": "http://hl7.org/fhir/workflow",
    "name": "Workflow Mapping",
    "identity": "workflow"
  }, {
    "uri": "http://hl7.org/fhir/w5",
    "name": "W5 Mapping",
    "identity": "w5"
  }, {
    "uri": "http://hl7.org/fhir/object-implementation",
    "name": "Object Implementation Information",
    "identity": "objimpl"
  }, {
    "uri": "http://hl7.org/v3",
    "name": "RIM Mapping",
    "identity": "rim"
  } ],
  "abstract": false,
  "type": "Measure",
  "experimental": "false",
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "1.0.0",
  "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": "DomainResource",
        "severity": "error",
        "expression": "contained.contained.empty()"
      }, {
        "key": "dom-1",
        "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
        "xpath": "not(parent::f:contained and f:text)",
        "source": "DomainResource",
        "severity": "error",
        "expression": "contained.text.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": "DomainResource",
        "severity": "error",
        "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
      }, {
        "key": "dom-3",
        "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
        "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
        "source": "DomainResource",
        "severity": "error",
        "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()"
      } ],
      "path": "Measure",
      "min": 0,
      "definition": "The Measure resource provides the definition of a quality measure.",
      "short": "A quality measure definition",
      "mapping": [ {
        "map": "Entity. Role, or Act",
        "identity": "rim"
      }, {
        "map": "Definition",
        "identity": "workflow"
      }, {
        "map": "clinical.general",
        "identity": "w5"
      } ],
      "mustSupport": false,
      "max": "*",
      "id": "Measure",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure"
      }
    }, {
      "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.",
      "short": "Logical id of this artifact",
      "type": [ {
        "code": "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
    }, {
      "path": "Measure.meta",
      "min": 0,
      "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
      "short": "Metadata about the resource",
      "type": [ {
        "code": "Meta"
      } ],
      "max": "1",
      "id": "Measure.meta",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.meta"
      },
      "isSummary": true
    }, {
      "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.",
      "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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.implicitRules"
      },
      "isSummary": true
    }, {
      "path": "Measure.language",
      "min": 0,
      "definition": "The base language in which the resource is written.",
      "short": "Language of the resource content",
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
          "valueReference": {
            "reference": "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.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/languages"
        }
      },
      "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"
      }
    }, {
      "path": "Measure.text",
      "min": 0,
      "definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
      "short": "Text summary of the resource, for human interpretation",
      "mapping": [ {
        "map": "Act.text?",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Narrative"
      } ],
      "alias": [ "narrative", "html", "xhtml", "display" ],
      "max": "1",
      "id": "Measure.text",
      "condition": [ "dom-1" ],
      "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 in formation is added later.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "DomainResource.text"
      }
    }, {
      "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.",
      "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.contained"
      }
    }, {
      "path": "Measure.extension",
      "min": 0,
      "definition": "An Extension",
      "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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (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",
      "requirements": "A published measure must have a canonical url defined.",
      "min": 0,
      "definition": "A comment containing additional documentation, a review comment, usage guidance, or other relevant information from a particular user.",
      "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": "Element",
        "severity": "error",
        "expression": "hasValue() | (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",
      "requirements": "A published measure must have a canonical url defined.",
      "min": 1,
      "definition": "The population basis specifies the type of elements in the population. For a subject-based measure, this would be boolean (because the population criteria define yes/no values for each individual subject). For a non-subject-based measure, this would be the type of elements in the population (such as encounters or procedures).",
      "short": "What type of population",
      "type": [ {
        "code": "Extension",
        "profile": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"
      } ],
      "mustSupport": true,
      "sliceName": "populationBasis",
      "max": "1",
      "id": "Measure.extension:populationBasis",
      "condition": [ "ele-1" ],
      "comment": "In Health Quality Measure Format, this was referred to as the Item Count metadata attribute.",
      "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": "Element",
        "severity": "error",
        "expression": "hasValue() | (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 for determining how the allocation for the measure specification should be performed.",
      "short": "Allocation guidance",
      "type": [ {
        "code": "Extension",
        "profile": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-allocation"
      } ],
      "mustSupport": false,
      "sliceName": "allocation",
      "max": "1",
      "id": "Measure.extension:allocation",
      "condition": [ "ele-1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      }
    }, {
      "path": "Measure.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. Usually modifier elements provide negation or qualification. In order 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.",
      "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"
      }
    }, {
      "path": "Measure.url",
      "requirements": "A published measure must have a canonical url defined.",
      "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. This SHALL be a URL, SHOULD be globally unique, and SHOULD be an address at which this measure is (or will be) published. The URL SHOULD include the major version of the measure. For more information see [Technical and Business Versions](http://hl7.org/fhir/STU3/resource.html#versions).",
      "short": "Logical URI to reference this measure (globally unique)",
      "mapping": [ {
        "map": "Definition.url",
        "identity": "workflow"
      }, {
        "map": "id",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "mustSupport": true,
      "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.url"
      },
      "isSummary": true
    }, {
      "path": "Measure.identifier",
      "requirements": "A published measure must have at least one identifier defined.",
      "min": 1,
      "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.",
      "short": "Additional identifier for the measure",
      "mapping": [ {
        "map": "Definition.identifier",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      }, {
        "map": "id",
        "identity": "w5"
      } ],
      "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, e.g., to 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.version",
      "requirements": "A published measure must specify a content 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.",
      "short": "Business version of the measure",
      "mapping": [ {
        "map": "Definition.version",
        "identity": "workflow"
      }, {
        "map": "id.version",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "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 refrence to a particular business version of the measure with the format [url]|[version].",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.version"
      },
      "isSummary": true
    }, {
      "path": "Measure.name",
      "requirements": "A published measure must specify a valid, machine-friendly name.",
      "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.",
      "short": "Name for this measure (computer friendly)",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.name",
      "comment": "The name is not expected to be globally unique. The name should be a simple alpha-numeric type name to ensure that it is computable friendly.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.name"
      },
      "isSummary": true
    }, {
      "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.",
      "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
    }, {
      "path": "Measure.status",
      "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": "status",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "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 a Value Set or Concept Map.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/publication-status"
        }
      },
      "max": "1",
      "id": "Measure.status",
      "comment": "Allows filtering of measures that are appropriate for use vs. not.  \nThis is labeled as \"Is Modifier\" because applications should not use a retired measure without due consideration.",
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.status"
      },
      "isSummary": true
    }, {
      "path": "Measure.experimental",
      "requirements": "Enables experimental content to be developed following the same lifecycle that would be used for a production-level measure.",
      "min": 0,
      "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": true,
      "short": "For testing purposes, not real usage",
      "mapping": [ {
        "map": "Definition.experimental",
        "identity": "workflow"
      }, {
        "map": "class",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "boolean"
      } ],
      "max": "1",
      "id": "Measure.experimental",
      "comment": "Allows filtering of measure that are appropriate for use vs. not. This is labeled as \"Is Modifier\" because applications should not use an experimental measure in production.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.experimental"
      },
      "isSummary": true
    }, {
      "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 if and 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.",
      "short": "Date this was last changed",
      "mapping": [ {
        "map": "Definition.date",
        "identity": "workflow"
      }, {
        "map": "when.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
    }, {
      "path": "Measure.publisher",
      "requirements": "A published measure must provide publisher information.",
      "min": 1,
      "definition": "The name of the individual or organization that published the measure.",
      "short": "Name of the publisher (organization or individual)",
      "mapping": [ {
        "map": "Definition.publisher",
        "identity": "workflow"
      }, {
        "map": "who.witness",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "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
    }, {
      "path": "Measure.description",
      "requirements": "A published measure must provide a concise description of the measure content.",
      "min": 1,
      "definition": "A free text natural language description of the measure from a consumer's perspective.",
      "short": "Natural language description of the measure",
      "mapping": [ {
        "map": "Definition.description",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": true,
      "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 profile is presumed to be the predominant language in the place the profile was created).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.description"
      },
      "isSummary": true
    }, {
      "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.",
      "short": "Why this measure is defined",
      "mapping": [ {
        "map": "Definition.purpose",
        "identity": "workflow"
      }, {
        "map": "no-gen-base",
        "identity": "objimpl"
      }, {
        "map": "why",
        "identity": "w5"
      } ],
      "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"
      }
    }, {
      "path": "Measure.usage",
      "requirements": "A published measure should provide clinical usage notes for the measure.",
      "min": 0,
      "definition": "A detailed description of how the measure is used from a clinical perspective.",
      "short": "Describes the clinical usage of the measure",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.usage",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.usage"
      }
    }, {
      "path": "Measure.approvalDate",
      "requirements": "A published measure must indicate the date the measure content was approved by the publisher.",
      "min": 1,
      "definition": "The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.",
      "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 / editorial corrections.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.approvalDate"
      }
    }, {
      "path": "Measure.lastReviewDate",
      "requirements": "A published measure must indicate when the measure content was last reviewed.",
      "min": 1,
      "definition": "The date on which the resource content was last reviewed. Review happens periodically after approval, but doesn't change the original approval date.",
      "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 is usually after the approval date.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.lastReviewDate"
      }
    }, {
      "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.",
      "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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.effectivePeriod.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "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"
      }
    }, {
      "path": "Measure.effectivePeriod.extension",
      "min": 0,
      "definition": "Specifies the anchor date for the effective period as defined by a starting date and a range.",
      "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"
      }
    }, {
      "path": "Measure.effectivePeriod.extension",
      "min": 0,
      "definition": "Specifies the reporting period for the measure.",
      "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"
      }
    }, {
      "path": "Measure.effectivePeriod.start",
      "min": 0,
      "definition": "The start of the period. The boundary is inclusive.",
      "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
    }, {
      "path": "Measure.effectivePeriod.end",
      "min": 0,
      "definition": "The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.",
      "short": "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 a end value of 2012-02-03.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Period.end"
      },
      "isSummary": true
    }, {
      "path": "Measure.useContext",
      "requirements": "A published measure should provide a clear indication of the expected contexts of use for the measure content.",
      "min": 0,
      "definition": "The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used to assist with indexing and searching for appropriate measure instances.",
      "short": "Context the content is intended to support",
      "mapping": [ {
        "map": "Definition.useContext",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "UsageContext"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.useContext",
      "comment": "When multiple useContexts are specified, there is no expectation whether all or any of the contexts apply.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.useContext"
      },
      "isSummary": true
    }, {
      "path": "Measure.jurisdiction",
      "requirements": "A published measure should indicate intended jurisdictions for the measure content.",
      "min": 0,
      "definition": "A legal or geographic region in which the measure is intended to be used.",
      "short": "Intended jurisdiction for measure (if applicable)",
      "mapping": [ {
        "map": "Definition.jurisdiction",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "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",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/jurisdiction"
        }
      },
      "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
    }, {
      "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 of the type of the measure that can be useful for filtering and searching.",
      "short": "E.g. Education, Treatment, Assessment, etc",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "DefinitionTopic"
        } ],
        "description": "High-level categorization of the definition, used for searching, sorting, and filtering",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/definition-topic"
        }
      },
      "max": "*",
      "id": "Measure.topic",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.topic"
      }
    }, {
      "path": "Measure.contributor",
      "requirements": "A published measure should provide information on contributors to the measure content.",
      "min": 0,
      "definition": "A contributor to the content of the measure, including authors, editors, reviewers, and endorsers.",
      "short": "A content contributor",
      "type": [ {
        "code": "Contributor"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.contributor",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.contributor"
      }
    }, {
      "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.",
      "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
    }, {
      "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.",
      "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"
      }
    }, {
      "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.",
      "short": "Additional documentation, citations, etc",
      "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"
      }
    }, {
      "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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.relatedArtifact.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "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.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"
      }
    }, {
      "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.",
      "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.extension:isPrimaryCitation",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "path": "Measure.relatedArtifact.type",
      "min": 1,
      "definition": "The type of relationship to the related artifact.",
      "short": "documentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of",
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "RelatedArtifactType"
        } ],
        "description": "The type of relationship to the related artifact",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/related-artifact-type"
        }
      },
      "max": "1",
      "id": "Measure.relatedArtifact.type",
      "base": {
        "max": "1",
        "min": 1,
        "path": "RelatedArtifact.type"
      },
      "isSummary": true
    }, {
      "path": "Measure.relatedArtifact.display",
      "min": 0,
      "definition": "A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.",
      "short": "Brief description of the related artifact",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact.display",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.display"
      },
      "isSummary": true
    }, {
      "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.",
      "short": "Bibliographic citation for the artifact",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact.citation",
      "comment": "Additional structured information about citations should be captured as extensions.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.citation"
      },
      "isSummary": true
    }, {
      "path": "Measure.relatedArtifact.url",
      "min": 0,
      "definition": "A url for the artifact that can be followed to access the actual content.",
      "short": "Where the artifact can be accessed",
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact.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
    }, {
      "path": "Measure.relatedArtifact.document",
      "min": 0,
      "definition": "The document being referenced, represented as an attachment. This is exclusive with the resource element.",
      "short": "What document is being referenced",
      "type": [ {
        "code": "Attachment"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact.document",
      "base": {
        "max": "1",
        "min": 0,
        "path": "RelatedArtifact.document"
      },
      "isSummary": true
    }, {
      "path": "Measure.relatedArtifact.resource",
      "min": 0,
      "definition": "The related resource, such as a library, value set, profile, or other knowledge resource.",
      "short": "What resource is being referenced",
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "1",
      "id": "Measure.relatedArtifact.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": "1",
        "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:library)",
        "severity": "warning",
        "expression": "library.exists()"
      } ],
      "path": "Measure.library",
      "requirements": "A published measure MUST provide one primary library reference containing population criteria definitions for the measure.",
      "min": 1,
      "definition": "A reference to a Library resource containing the formal logic used by the measure.",
      "short": "Logic used by the measure",
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/library-cqfm"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.library",
      "condition": [ "1" ],
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.library"
      }
    }, {
      "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.",
      "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
    }, {
      "path": "Measure.scoring",
      "requirements": "A published measure must indicate the scoring method used for the measure.",
      "min": 1,
      "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.",
      "short": "proportion | ratio | continuous-variable | cohort",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "ratio",
          "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "display": "Ratio"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasureScoring"
        } ],
        "description": "The scoring type of the measure",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-scoring"
        }
      },
      "max": "1",
      "id": "Measure.scoring",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.scoring"
      },
      "isSummary": true
    }, {
      "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.",
      "short": "opportunity | all-or-nothing | linear | weighted",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "CompositeMeasureScoring"
        } ],
        "description": "The composite scoring method of the measure",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/composite-measure-scoring"
        }
      },
      "max": "1",
      "id": "Measure.compositeScoring",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.compositeScoring"
      },
      "isSummary": true
    }, {
      "path": "Measure.type",
      "requirements": "A published measure must indicate the type of the measure.",
      "min": 1,
      "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.",
      "short": "process | outcome | structure | patient-reported-outcome | composite",
      "mapping": [ {
        "map": "Definition.subjectCode",
        "identity": "workflow"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasureType"
        } ],
        "description": "The type of measure (includes codes from 2.16.840.1.113883.1.11.20368)",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-type"
        }
      },
      "max": "*",
      "id": "Measure.type",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.type"
      },
      "isSummary": true
    }, {
      "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.",
      "short": "How is risk adjustment 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 an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.riskAdjustment"
      },
      "isSummary": true
    }, {
      "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.",
      "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
    }, {
      "path": "Measure.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.",
      "short": "Why does this measure exist",
      "type": [ {
        "code": "markdown"
      } ],
      "mustSupport": false,
      "max": "1",
      "id": "Measure.rationale",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.rationale"
      },
      "isSummary": true
    }, {
      "path": "Measure.clinicalRecommendationStatement",
      "min": 0,
      "definition": "Provides a summary of relevant clinical guidelines or other clinical recommendations supporting the measure.",
      "short": "Summary of clinical guidelines",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.clinicalRecommendationStatement",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.clinicalRecommendationStatement"
      },
      "isSummary": true
    }, {
      "path": "Measure.improvementNotation",
      "requirements": "A published measure must indicate the improvement notation used for the measure.",
      "min": 1,
      "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).",
      "short": "increase | decrease",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "binding": {
        "strength": "required",
        "description": "Improvement notation for a measure (e.g. increase or decrease)",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/us/cqfmeasures/ValueSet/improvement-notation"
        }
      },
      "max": "1",
      "id": "Measure.improvementNotation",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.improvementNotation"
      },
      "isSummary": true
    }, {
      "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.",
      "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)",
      "short": "xml:id (or equivalent in JSON)",
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.definition.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "path": "Measure.definition.extension",
      "min": 0,
      "definition": "An Extension",
      "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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (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 the term being defined in a definition element.",
      "short": "Term to define",
      "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",
      "short": "Primitive value for markdown",
      "type": [ {
        "_code": {
          "extension": [ {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-json-type",
            "valueString": "string"
          }, {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-xml-type",
            "valueString": "xsd:string"
          }, {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-rdf-type",
            "valueString": "xsd:string"
          } ]
        }
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.definition.value",
      "base": {
        "max": "1",
        "min": 0,
        "path": "string.value"
      }
    }, {
      "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 logic of the measure.",
      "min": 0,
      "definition": "Additional guidance for the measure including how it can be used in a clinical context, and the intent of the measure.",
      "short": "Additional guidance for implementers",
      "type": [ {
        "code": "markdown"
      } ],
      "max": "1",
      "id": "Measure.guidance",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.guidance"
      },
      "isSummary": true
    }, {
      "path": "Measure.set",
      "min": 0,
      "definition": "The measure set, e.g. Preventive Care and Screening.",
      "short": "The measure set, e.g. Preventive Care and Screening",
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "Measure.set",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.set"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group",
      "requirements": "A published measure must specify at least one population group.",
      "min": 1,
      "definition": "A group of population criteria for the measure.",
      "short": "Population criteria group",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "max": "*",
      "id": "Measure.group",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "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"
      }
    }, {
      "path": "Measure.group.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "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"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "2",
        "human": "Group identifiers SHOULD use the convention: \"group-\", where  corresponds with the group naming convention for the criteria within the group",
        "xpath": "exists(f:value)",
        "severity": "warning",
        "expression": "value.startsWith('group-')"
      } ],
      "path": "Measure.group.identifier",
      "min": 1,
      "definition": "A unique identifier for the group. This identifier will used to report data for the group in the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.identifier",
      "condition": [ "2" ],
      "base": {
        "max": "1",
        "min": 1,
        "path": "Measure.group.identifier"
      }
    }, {
      "id": "Measure.group.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.name"
      },
      "path": "Measure.group.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this group."
    }, {
      "id": "Measure.group.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.description"
      },
      "path": "Measure.group.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "Summary description",
      "definition": "The human readable description of this population group."
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 3,
      "definition": "A population criteria for the measure.",
      "short": "Population criteria",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "code",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "max": "6",
      "id": "Measure.group.population",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "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",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A population criteria for the measure.",
      "short": "Initial Population",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "sliceName": "initialPopulation",
      "max": "2",
      "id": "Measure.group.population:initialPopulation",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population:initialPopulation.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population:initialPopulation.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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population:initialPopulation.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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:initialPopulation.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "initial-population",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Initial Population"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population:initialPopulation.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population:initialPopulation.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population:initialPopulation.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:initialPopulation.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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A population criteria for the measure.",
      "short": "Denominator",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "sliceName": "denominator",
      "max": "1",
      "id": "Measure.group.population:denominator",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population:denominator.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population:denominator.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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population:denominator.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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:denominator.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "denominator",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Denominator"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population:denominator.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population:denominator.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population:denominator.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:denominator.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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 0,
      "definition": "A population criteria for the measure.",
      "short": "Denominator Exclusion",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "sliceName": "denominatorExclusion",
      "max": "1",
      "id": "Measure.group.population:denominatorExclusion",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population:denominatorExclusion.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population:denominatorExclusion.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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population:denominatorExclusion.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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:denominatorExclusion.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "denominator-exclusion",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Denominator Exclusion"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population:denominatorExclusion.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population:denominatorExclusion.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population:denominatorExclusion.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:denominatorExclusion.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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A population criteria for the measure.",
      "short": "Numerator",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "sliceName": "numerator",
      "max": "1",
      "id": "Measure.group.population:numerator",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population:numerator.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population:numerator.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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population:numerator.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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:numerator.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "numerator",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Numerator"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population:numerator.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population:numerator.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population:numerator.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:numerator.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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.population",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 0,
      "definition": "A population criteria for the measure.",
      "short": "Numerator Exclusion",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": false,
      "sliceName": "numeratorExclusion",
      "max": "1",
      "id": "Measure.group.population:numeratorExclusion",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.population"
      }
    }, {
      "path": "Measure.group.population.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.population:numeratorExclusion.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.group.population:numeratorExclusion.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"
      }
    }, {
      "path": "Measure.group.population.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "Measure.group.population:numeratorExclusion.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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.population.identifier",
      "requirements": "A published measure must specify at least one population for each population group.",
      "min": 1,
      "definition": "A unique identifier for the population criteria. This identifier is used to report data against this criteria within the measure report.",
      "short": "Unique identifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:numeratorExclusion.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.identifier"
      }
    }, {
      "path": "Measure.group.population.code",
      "requirements": "A published measure must specify the type of population criteria.",
      "min": 1,
      "definition": "The type of population criteria.",
      "short": "initial-population | numerator | numerator-exclusion | denominator | denominator-exclusion | denominator-exception | measure-population | measure-population-exclusion | measure-observation",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "numerator-exclusion",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Numerator Exclusion"
        } ]
      },
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasurePopulationType"
        } ],
        "description": "The type of population",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-population"
        }
      },
      "max": "1",
      "id": "Measure.group.population:numeratorExclusion.code",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.code"
      }
    }, {
      "id": "Measure.group.population:numeratorExclusion.name",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.name"
      },
      "path": "Measure.group.population.name",
      "type": [ {
        "code": "string"
      } ],
      "short": "Short name",
      "definition": "Optional name or short description of this population."
    }, {
      "id": "Measure.group.population:numeratorExclusion.description",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.population.description"
      },
      "path": "Measure.group.population.description",
      "type": [ {
        "code": "string"
      } ],
      "short": "The human readable description of this population criteria",
      "definition": "The human readable description of this population criteria."
    }, {
      "constraint": [ {
        "key": "3",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "The name of a valid referenced CQL expression (may be namespaced) that defines this population criteria",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.population:numeratorExclusion.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"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "Measure.group.stratifier",
      "requirements": "A published 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.",
      "short": "Stratifier criteria for the measure",
      "type": [ {
        "code": "BackboneElement"
      } ],
      "mustSupport": true,
      "max": "*",
      "id": "Measure.group.stratifier",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.group.stratifier"
      }
    }, {
      "path": "Measure.group.stratifier.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.group.stratifier.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "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. In order 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.",
      "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"
      }
    }, {
      "path": "Measure.group.stratifier.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "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"
      },
      "isSummary": true
    }, {
      "path": "Measure.group.stratifier.identifier",
      "requirements": "A published measure should provide stratification information if appropriate for the measure content.",
      "min": 1,
      "definition": "The identifier for the stratifier used to coordinate the reported data back to this stratifier.",
      "short": "The identifier for the stratifier used to coordinate the reported data back to this stratifier",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.stratifier.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.identifier"
      }
    }, {
      "constraint": [ {
        "key": "4",
        "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)",
        "severity": "warning",
        "expression": "value.startsWith(library).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.",
      "short": "How the measure should be stratified",
      "type": [ {
        "code": "string"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.group.stratifier.criteria",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.criteria"
      }
    }, {
      "id": "Measure.group.stratifier.path",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.group.stratifier.path"
      },
      "path": "Measure.group.stratifier.path",
      "type": [ {
        "code": "string"
      } ],
      "short": "Path to the stratifier",
      "definition": "The path to an element that defines the stratifier, specified as a valid FHIR resource path."
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "source": "Element",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "5",
        "human": "Supplemental data SHALL use either criteria or path",
        "xpath": "exists(f:value)",
        "severity": "warning",
        "expression": "criteria.exists() or path.exists()"
      } ],
      "path": "Measure.supplementalData",
      "requirements": "A published 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.",
      "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"
      }
    }, {
      "path": "Measure.supplementalData.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.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "Measure.supplementalData.id",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "path": "Measure.supplementalData.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "Measure.supplementalData.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"
      }
    }, {
      "path": "Measure.supplementalData.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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "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"
      },
      "isSummary": true
    }, {
      "path": "Measure.supplementalData.identifier",
      "requirements": "A published measure should provide supplemental data appropriate for the measure content.",
      "min": 1,
      "definition": "An identifier for the supplemental data.",
      "short": "Identifier, unique within the measure",
      "type": [ {
        "code": "Identifier"
      } ],
      "mustSupport": true,
      "max": "1",
      "id": "Measure.supplementalData.identifier",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.supplementalData.identifier"
      }
    }, {
      "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.",
      "short": "supplemental-data | risk-adjustment-factor",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "MeasureDataUsage"
        } ],
        "description": "The intended usage for supplemental data elements in the measure",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/measure-data-usage"
        }
      },
      "max": "*",
      "id": "Measure.supplementalData.usage",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Measure.supplementalData.usage"
      }
    }, {
      "id": "Measure.supplementalData.criteria",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.supplementalData.criteria"
      },
      "path": "Measure.supplementalData.criteria",
      "type": [ {
        "code": "string"
      } ],
      "short": "Expression describing additional data to be reported",
      "definition": "The criteria for the supplemental data. This must be the name of a valid expression defined within a referenced library, and defines the data to be returned for this element."
    }, {
      "id": "Measure.supplementalData.path",
      "max": "1",
      "min": 0,
      "base": {
        "max": "1",
        "min": 0,
        "path": "Measure.supplementalData.path"
      },
      "path": "Measure.supplementalData.path",
      "type": [ {
        "code": "string"
      } ],
      "short": "Path to the supplemental data element",
      "definition": "The supplemental data to be supplied as part of the measure response, specified as a valid FHIR Resource Path."
    } ]
  },
  "status": "active",
  "id": "92bdb372-77c9-4d72-b2cc-3474828a0c00",
  "kind": "resource",
  "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/ratio-measure-cqfm",
  "version": "1.0.0",
  "differential": {
    "element": [ {
      "id": "Measure",
      "path": "Measure",
      "mustSupport": false
    }, {
      "id": "Measure.scoring",
      "path": "Measure.scoring",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "ratio",
          "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
          "display": "Ratio"
        } ]
      }
    }, {
      "id": "Measure.group",
      "path": "Measure.group",
      "mustSupport": false
    }, {
      "id": "Measure.group.population",
      "max": "6",
      "min": 3,
      "path": "Measure.group.population",
      "slicing": {
        "rules": "open",
        "discriminator": [ {
          "path": "code",
          "type": "value"
        } ]
      },
      "mustSupport": false
    }, {
      "id": "Measure.group.population:initialPopulation",
      "max": "2",
      "min": 1,
      "path": "Measure.group.population",
      "short": "Initial Population",
      "sliceName": "initialPopulation",
      "mustSupport": false
    }, {
      "id": "Measure.group.population:initialPopulation.code",
      "max": "1",
      "min": 1,
      "path": "Measure.group.population.code",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "mustSupport": false,
      "fixedCodeableConcept": {
        "coding": [ {
          "code": "initial-population",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Initial Population"
        } ]
      }
    }, {
      "id": "Measure.group.population:denominator",
      "max": "1",
      "min": 1,
      "path": "Measure.group.population",
      "short": "Denominator",
      "sliceName": "denominator",
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