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{
 "resourceType": "StructureDefinition",
 "id": "cqm-improvementNotation",
 "text": {
 "status": "extensions",
 "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated Narrative: StructureDefinition cqm-improvementNotation<a name=\"cqm-improvementNotation\"> </a><a name=\"hccqm-improvementNotation\"> </a><a name=\"cqm-improvementNotation-en-US\"> </a><table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"The logical name of the element\">Name</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Information about the use of the element\">Flags</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Minimum and Maximum # of times the element can appear in the instance\">Card.</a></th><th style=\"width: 100px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Reference to the type of the element\">Type</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Additional information about the element\">Description &amp; Constraints</a><a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></th></tr><tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_element.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-cqm-improvementNotation-definitions.html#Extension\" title=\"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).\">Extension</a><a name=\"Extension\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/extensibility.html#Extension\">Extension</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">increase | decrease</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_primitive.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Primitive Data Type\" class=\"hierarchy\"/> <a href=\"StructureDefinition-cqm-improvementNotation-definitions.html#Extension.url\">url</a><a name=\"Extension.url\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/datatypes.html#uri\">uri</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">&quot;http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation&quot;</td></tr>\r\n<tr style=\"border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_datatype.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Data Type\" class=\"hierarchy\"/> <a href=\"StructureDefinition-cqm-improvementNotation-definitions.html#Extension.value[x]\">value[x]</a><a name=\"Extension.value_x_\"> </a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Value of extension Binding: <a href=\"http://terminology.hl7.org/5.5.0/ValueSet-measure-improvement-notation.html\" title=\"http://terminology.hl7.org/ValueSet/measure-improvement-notation\">MeasureImprovementNotation</a> (<a href=\"http://hl7.org/fhir/R4/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\">required</a>): Indicates how to interpret the calculated score of the measure </td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"> <a href=\"https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views\" title=\"Legend for this format\"><img src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
 },
 "extension": [
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
 "valueCode": "cqi"
 }
 ],
 "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation",
 "version": "1.0.0",
 "name": "CQMImprovementNotation",
 "title": "CQM Improvement Notation",
 "status": "active",
 "experimental": false,
 "date": "2024-12-16T21:50:47+00:00",
 "publisher": "HL7 International / Clinical Quality Information",
 "contact": [
 {
 "telecom": [
 {
 "system": "url",
 "value": "http://www.hl7.org/Special/committees/cqi"
 }
 ]
 }
 ],
 "description": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).\n\n**Additional Guidance: improvementNotation**\n\n`Reference range` with definition of score within a defined interval (or a “passing score” over or under a certain threshold) indicates better quality to the improvement notation value set. Please provide comments on this additional code and if there are other codes needed in this value set.\n\nPlease provide comments on this additional code and if there are other codes needed in the improvement notation value set.\n\nIf an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use? Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.",
 "jurisdiction": [
 {
 "coding": [
 {
 "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
 "code": "001"
 }
 ]
 }
 ],
 "purpose": "**Purpose**\n\nMeasure consumers and implementers must be able to determine how to interpret a measure score.",
 "fhirVersion": "4.0.1",
 "mapping": [
 {
 "identity": "rim",
 "uri": "http://hl7.org/v3",
 "name": "RIM Mapping"
 }
 ],
 "kind": "complex-type",
 "abstract": false,
 "context": [
 {
 "type": "element",
 "expression": "Measure.group"
 }
 ],
 "type": "Extension",
 "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
 "derivation": "constraint",
 "snapshot": {
 "element": [
 {
 "id": "Extension",
 "path": "Extension",
 "short": "increase | decrease",
 "definition": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension",
 "min": 0,
 "max": "*"
 },
 "condition": [
 "ele-1"
 ],
 "constraint": [
 {
 "key": "ele-1",
 "severity": "error",
 "human": "All FHIR elements must have a @value or children",
 "expression": "hasValue() or (children().count() > id.count())",
 "xpath": "@value|f:*|h:div",
 "source": "http://hl7.org/fhir/StructureDefinition/Element"
 },
 {
 "key": "ext-1",
 "severity": "error",
 "human": "Must have either extensions or value[x], not both",
 "expression": "extension.exists() != value.exists()",
 "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
 "source": "http://hl7.org/fhir/StructureDefinition/Extension"
 }
 ],
 "isModifier": false
 },
 {
 "id": "Extension.id",
 "path": "Extension.id",
 "representation": [
 "xmlAttr"
 ],
 "short": "Unique id for inter-element referencing",
 "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Element.id",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
 "valueUrl": "string"
 }
 ],
 "code": "http://hl7.org/fhirpath/System.String"
 }
 ],
 "isModifier": false,
 "isSummary": false,
 "mapping": [
 {
 "identity": "rim",
 "map": "n/a"
 }
 ]
 },
 {
 "id": "Extension.extension",
 "path": "Extension.extension",
 "slicing": {
 "discriminator": [
 {
 "type": "value",
 "path": "url"
 }
 ],
 "description": "Extensions are always sliced by (at least) url",
 "rules": "open"
 },
 "short": "Additional content defined by implementations",
 "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
 "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.",
 "alias": [
 "extensions",
 "user content"
 ],
 "min": 0,
 "max": "*",
 "base": {
 "path": "Element.extension",
 "min": 0,
 "max": "*"
 },
 "type": [
 {
 "code": "Extension"
 }
 ],
 "constraint": [
 {
 "key": "ele-1",
 "severity": "error",
 "human": "All FHIR elements must have a @value or children",
 "expression": "hasValue() or (children().count() > id.count())",
 "xpath": "@value|f:*|h:div",
 "source": "http://hl7.org/fhir/StructureDefinition/Element"
 },
 {
 "key": "ext-1",
 "severity": "error",
 "human": "Must have either extensions or value[x], not both",
 "expression": "extension.exists() != value.exists()",
 "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
 "source": "http://hl7.org/fhir/StructureDefinition/Extension"
 }
 ],
 "isModifier": false,
 "isSummary": false,
 "mapping": [
 {
 "identity": "rim",
 "map": "n/a"
 }
 ]
 },
 {
 "id": "Extension.url",
 "path": "Extension.url",
 "representation": [
 "xmlAttr"
 ],
 "short": "identifies the meaning of the extension",
 "definition": "Source of the definition for the extension code - a logical name or a URL.",
 "comment": "The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.",
 "min": 1,
 "max": "1",
 "base": {
 "path": "Extension.url",
 "min": 1,
 "max": "1"
 },
 "type": [
 {
 "code": "uri"
 }
 ],
 "fixedUri": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation",
 "isModifier": false,
 "isSummary": false,
 "mapping": [
 {
 "identity": "rim",
 "map": "N/A"
 }
 ]
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "short": "Value of extension",
 "definition": "Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension.value[x]",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "constraint": [
 {
 "key": "ele-1",
 "severity": "error",
 "human": "All FHIR elements must have a @value or children",
 "expression": "hasValue() or (children().count() > id.count())",
 "xpath": "@value|f:*|h:div",
 "source": "http://hl7.org/fhir/StructureDefinition/Element"
 }
 ],
 "isModifier": false,
 "isSummary": false,
 "binding": {
 "strength": "required",
 "description": "Indicates how to interpret the calculated score of the measure",
 "valueSet": "http://terminology.hl7.org/ValueSet/measure-improvement-notation"
 },
 "mapping": [
 {
 "identity": "rim",
 "map": "N/A"
 }
 ]
 }
 ]
 },
 "differential": {
 "element": [
 {
 "id": "Extension",
 "path": "Extension",
 "short": "increase | decrease",
 "definition": "Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).",
 "min": 0,
 "max": "1"
 },
 {
 "id": "Extension.url",
 "path": "Extension.url",
 "type": [
 {
 "code": "uri"
 }
 ],
 "fixedUri": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-improvementNotation"
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "binding": {
 "strength": "required",
 "description": "Indicates how to interpret the calculated score of the measure",
 "valueSet": "http://terminology.hl7.org/ValueSet/measure-improvement-notation"
 }
 }
 ]
 }
}

name : CQMImprovementNotation

{

}