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{
 "resourceType": "StructureDefinition",
 "id": "ext-R5-Measure.improvementNotation",
 "text": {
 "status": "extensions",
 "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated Narrative: StructureDefinition ext-R5-Measure.improvementNotation<a name=\"ext-R5-Measure.improvementNotation\"> </a><a name=\"hcext-R5-Measure.improvementNotation\"> </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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" 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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" 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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" 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=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; 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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" 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 : var(--ig-left,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-ext-R5-Measure.improvementNotation-definitions.html#Extension\" title=\"R5: `Measure.improvementNotation` additional types (CodeableConcept) additional types from child elements (coding)\">Extension</a><a name=\"Extension\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/STU3/extensibility.html#Extension\">Extension</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">R5: increase | decrease additional types </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 : var(--ig-left,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_element.gif\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Element\" class=\"hierarchy\"/> <a href=\"StructureDefinition-ext-R5-Measure.improvementNotation-definitions.html#Extension.url\">url</a><a name=\"Extension.url\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,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 : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a style=\"opacity: 0.5; opacity: 0.5\" href=\"http://hl7.org/fhir/STU3/datatypes.html#uri\">uri</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">&quot;http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.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 : var(--ig-left,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-ext-R5-Measure.improvementNotation-definitions.html#Extension.value[x]\" 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).\">value[x]</a><a name=\"Extension.value_x_\"> </a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,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 : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/STU3/datatypes.html#CodeableConcept\">CodeableConcept</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">increase | decrease Binding: <a href=\"ValueSet-R5-measure-improvement-notation-for-R3.html\" title=\"http://hl7.org/fhir/uv/xver/ValueSet/R5-measure-improvement-notation-for-R3\" class=\"binding\">R5MeasureImprovementNotationForR3 (0.1.0)</a> (<a href=\"http://hl7.org/fhir/STU3/terminologies.html#required\" title=\"To be conformant, the concept in this element SHALL be from the specified value set.\" class=\"binding\">required</a>): Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.</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,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\" 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": "fhir"
 },
 {
 "extension": [
 {
 "url": "packageId",
 "valueId": "hl7.fhir.uv.xver-r5.r3"
 },
 {
 "url": "version",
 "valueString": "0.1.0"
 },
 {
 "url": "uri",
 "valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3"
 }
 ],
 "url": "http://hl7.org/fhir/StructureDefinition/package-source"
 },
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
 "valueInteger": 0,
 "_valueInteger": {
 "extension": [
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
 "valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3"
 }
 ]
 }
 },
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
 "valueCode": "trial-use",
 "_valueCode": {
 "extension": [
 {
 "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
 "valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3"
 }
 ]
 }
 }
 ],
 "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.improvementNotation",
 "version": "0.1.0",
 "name": "ExtensionMeasure_ImprovementNotation",
 "title": "R5: increase | decrease additional types",
 "status": "active",
 "experimental": false,
 "date": "2026-03-17T21:02:03.8104715+00:00",
 "publisher": "FHIR Infrastructure",
 "contact": [
 {
 "name": "FHIR Infrastructure",
 "telecom": [
 {
 "system": "url",
 "value": "http://www.hl7.org/Special/committees/fiwg"
 }
 ]
 }
 ],
 "description": "R5: `Measure.improvementNotation` additional types (CodeableConcept) additional types from child elements (coding)",
 "jurisdiction": [
 {
 "coding": [
 {
 "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
 "code": "001",
 "display": "World"
 }
 ]
 }
 ],
 "purpose": "This extension is part of the cross-version definitions generated to enable use of the\r\nelement `Measure.improvementNotation` as defined in FHIR R5\r\nin FHIR STU3.\r\n\r\nThe source element is defined as:\r\n`Measure.improvementNotation` 0..1 `CodeableConcept`\r\n\r\nAcross FHIR versions, the element set has been mapped as:\r\n* R5: `Measure.improvementNotation` 0..1 `CodeableConcept`\n* R4B: `Measure.improvementNotation` 0..1 `CodeableConcept`\n* R4: `Measure.improvementNotation` 0..1 `CodeableConcept`\n* STU3: `Measure.improvementNotation` 0..1 `string`\r\n\r\nFollowing are the generation technical comments:\r\nElement `Measure.improvementNotation` is mapped to FHIR STU3 element `Measure.improvementNotation` as `SourceIsBroaderThanTarget`.\nThe mappings for `Measure.improvementNotation` do not cover the following types: CodeableConcept.\nThe mappings for `Measure.improvementNotation` do not cover the following types based on type expansion: coding.",
 "fhirVersion": "3.0.2",
 "mapping": [
 {
 "identity": "rim",
 "uri": "http://hl7.org/v3",
 "name": "RIM Mapping"
 }
 ],
 "kind": "complex-type",
 "abstract": false,
 "contextType": "resource",
 "context": [
 "Measure.improvementNotation"
 ],
 "type": "Extension",
 "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
 "derivation": "constraint",
 "snapshot": {
 "element": [
 {
 "id": "Extension",
 "path": "Extension",
 "short": "R5: increase | decrease additional types",
 "definition": "R5: `Measure.improvementNotation` additional types (CodeableConcept) additional types from child elements (coding)",
 "comment": "Element `Measure.improvementNotation` is mapped to FHIR STU3 element `Measure.improvementNotation` as `SourceIsBroaderThanTarget`.\nThe mappings for `Measure.improvementNotation` do not cover the following types: CodeableConcept.\nThe mappings for `Measure.improvementNotation` do not cover the following types based on type expansion: coding.",
 "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() | (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": "xml:id (or equivalent in JSON)",
 "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": [
 {
 "code": "string"
 }
 ],
 "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. 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.",
 "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"
 }
 ],
 "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/5.0/StructureDefinition/extension-Measure.improvementNotation",
 "mapping": [
 {
 "identity": "rim",
 "map": "N/A"
 }
 ]
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "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.value[x]",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "binding": {
 "strength": "required",
 "description": "Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.",
 "valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-measure-improvement-notation-for-R3|0.1.0"
 },
 "mapping": [
 {
 "identity": "rim",
 "map": "N/A"
 }
 ]
 }
 ]
 },
 "differential": {
 "element": [
 {
 "id": "Extension",
 "path": "Extension",
 "short": "R5: increase | decrease additional types",
 "definition": "R5: `Measure.improvementNotation` additional types (CodeableConcept) additional types from child elements (coding)",
 "comment": "Element `Measure.improvementNotation` is mapped to FHIR STU3 element `Measure.improvementNotation` as `SourceIsBroaderThanTarget`.\nThe mappings for `Measure.improvementNotation` do not cover the following types: CodeableConcept.\nThe mappings for `Measure.improvementNotation` do not cover the following types based on type expansion: coding.",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension",
 "min": 0,
 "max": "*"
 },
 "isModifier": false
 },
 {
 "id": "Extension.url",
 "path": "Extension.url",
 "min": 1,
 "max": "1",
 "base": {
 "path": "Extension.url",
 "min": 1,
 "max": "1"
 },
 "fixedUri": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.improvementNotation"
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "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.value[x]",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "binding": {
 "strength": "required",
 "description": "Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.",
 "valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-measure-improvement-notation-for-R3|0.1.0"
 }
 }
 ]
 }
}

name : ExtensionMeasure_ImprovementNotation

{

}