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{
 "resourceType": "StructureDefinition",
 "id": "ext-R5-MeasureReport.improvementNotation",
 "text": {
 "status": "extensions",
 "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated Narrative: StructureDefinition ext-R5-MeasureReport.improvementNotation<a name=\"ext-R5-MeasureReport.improvementNotation\"> </a><a name=\"hcext-R5-MeasureReport.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,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\"/></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-MeasureReport.improvementNotation-definitions.html#Extension\" title=\"R5: `MeasureReport.improvementNotation` (new:CodeableConcept)\">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><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 (new) This is a modifier extension </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-MeasureReport.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-MeasureReport.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-MeasureReport.improvementNotation-definitions.html#Extension.value[x]\" title=\"Whether improvement in the measure is noted by an increase or decrease in the measure score.\">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>): The improvement notation of the measure report (e.g. increase or decrease)</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-MeasureReport.improvementNotation",
 "version": "0.1.0",
 "name": "ExtensionMeasureReport_ImprovementNotation",
 "title": "R5: increase | decrease (new)",
 "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: `MeasureReport.improvementNotation` (new:CodeableConcept)",
 "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 `MeasureReport.improvementNotation` as defined in FHIR R5\r\nin FHIR STU3.\r\n\r\nThe source element is defined as:\r\n`MeasureReport.improvementNotation` 0..1 `CodeableConcept`\r\n\r\nAcross FHIR versions, the element set has been mapped as:\r\n* R5: `MeasureReport.improvementNotation` 0..1 `CodeableConcept`\n* R4B: `MeasureReport.improvementNotation` 0..1 `CodeableConcept`\n* R4: `MeasureReport.improvementNotation` 0..1 `CodeableConcept`\r\n\r\nFollowing are the generation technical comments:\r\nElement `MeasureReport.improvementNotation` has a context of MeasureReport based on following the parent source element upwards and mapping to `MeasureReport`.\nElement `MeasureReport.improvementNotation` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).",
 "fhirVersion": "3.0.2",
 "mapping": [
 {
 "identity": "rim",
 "uri": "http://hl7.org/v3",
 "name": "RIM Mapping"
 }
 ],
 "kind": "complex-type",
 "abstract": false,
 "contextType": "resource",
 "context": [
 "MeasureReport"
 ],
 "type": "Extension",
 "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
 "derivation": "constraint",
 "snapshot": {
 "element": [
 {
 "id": "Extension",
 "path": "Extension",
 "short": "R5: increase | decrease (new)",
 "definition": "R5: `MeasureReport.improvementNotation` (new:CodeableConcept)",
 "comment": "Element `MeasureReport.improvementNotation` has a context of MeasureReport based on following the parent source element upwards and mapping to `MeasureReport`.\nElement `MeasureReport.improvementNotation` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score. Note also that a MeasureReport instance includes the improvementNotation as defined by the Measure being reported. It is duplicated in the MeasureReport because it is a critical aspect of interpreting the measure score but it is not intended to reflect whether the measure report is an increase or decrease. It helps interpret if the measure score is an increase or decrease, I.e., moving in the direction of the desired outcome.",
 "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": true
 },
 {
 "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-MeasureReport.improvementNotation",
 "mapping": [
 {
 "identity": "rim",
 "map": "N/A"
 }
 ]
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "short": "increase | decrease",
 "definition": "Whether improvement in the measure is noted by an increase or decrease in the measure score.",
 "comment": "This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score. Note also that a MeasureReport instance includes the improvementNotation as defined by the Measure being reported. It is duplicated in the MeasureReport because it is a critical aspect of interpreting the measure score but it is not intended to reflect whether the measure report is an increase or decrease. It helps interpret if the measure score is an increase or decrease, I.e., moving in the direction of the desired outcome.",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension.value[x]",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "binding": {
 "strength": "required",
 "description": "The improvement notation of the measure report (e.g. increase or decrease)",
 "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 (new)",
 "definition": "R5: `MeasureReport.improvementNotation` (new:CodeableConcept)",
 "comment": "Element `MeasureReport.improvementNotation` has a context of MeasureReport based on following the parent source element upwards and mapping to `MeasureReport`.\nElement `MeasureReport.improvementNotation` has no mapping targets in FHIR STU3. Typically, this is because the element has been added (is a new element).\nThis element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score. Note also that a MeasureReport instance includes the improvementNotation as defined by the Measure being reported. It is duplicated in the MeasureReport because it is a critical aspect of interpreting the measure score but it is not intended to reflect whether the measure report is an increase or decrease. It helps interpret if the measure score is an increase or decrease, I.e., moving in the direction of the desired outcome.",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension",
 "min": 0,
 "max": "*"
 },
 "isModifier": true
 },
 {
 "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-MeasureReport.improvementNotation"
 },
 {
 "id": "Extension.value[x]",
 "path": "Extension.value[x]",
 "short": "increase | decrease",
 "definition": "Whether improvement in the measure is noted by an increase or decrease in the measure score.",
 "comment": "This element is typically defined by the measure, but reproduced here to ensure the measure score can be interpreted. The element is labeled as a modifier because it changes the interpretation of the reported measure score. Note also that a MeasureReport instance includes the improvementNotation as defined by the Measure being reported. It is duplicated in the MeasureReport because it is a critical aspect of interpreting the measure score but it is not intended to reflect whether the measure report is an increase or decrease. It helps interpret if the measure score is an increase or decrease, I.e., moving in the direction of the desired outcome.",
 "min": 0,
 "max": "1",
 "base": {
 "path": "Extension.value[x]",
 "min": 0,
 "max": "1"
 },
 "type": [
 {
 "code": "CodeableConcept"
 }
 ],
 "binding": {
 "strength": "required",
 "description": "The improvement notation of the measure report (e.g. increase or decrease)",
 "valueSetUri": "http://hl7.org/fhir/uv/xver/ValueSet/R5-measure-improvement-notation-for-R3|0.1.0"
 }
 }
 ]
 }
}

name : ExtensionMeasureReport_ImprovementNotation

{

}