FHIR Ballot changes for 5.0.0-ballot

input/pages/capabilities.md

@@ -34,14 +34,3 @@ In addition, the following example capability statement illustrates the use of t
 * [**Example Measure Calculation Service**](CapabilityStatement-measure-calculation-service-example.html)
 
 See the capability statements defined in the [Data Exchange for Quality Measures](https://hl7.org/fhir/us/davinci-deqm/) implementation guide for the Submitting and Receiving System roles.
-
-## Operations
-* [**[base]/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**Library/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**Library/[id]/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**Library/$data-requirements**](OperationDefinition-Library-data-requirements.html)
-* [**Measure/[id]/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**Measure/$data-requirements**](OperationDefinition-Measure-data-requirements.html)
-* [**MeasureReport/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**MeasureReport/[id]/$cqfm.package**](OperationDefinition-cqfm-package.html)
-* [**ValueSet/$expand**](OperationDefinition-ValueSet-expand.html)

input/pages/changes.md

@@ -14,7 +14,7 @@ This page details changes made in each version of the Quality Measure IG
 * **Applied**: Hard to tell what is new content ([FHIR-39895](https://jira.hl7.org/browse/FHIR-39895))([Applied here](index.html))
 * **Applied**: ImprovementNotation Allowed Values ([FHIR-42116](https://jira.hl7.org/browse/FHIR-42116))([Applied here](index.html)), and ([here](StructureDefinition-cqfm-improvementNotation.html))
 * **Applied**: PLease add 'Operations' as a an options on the FHIR artifacts menu ([FHIR-42715](https://jira.hl7.org/browse/FHIR-42715))([Applied here](index.html#how-to-read-this-guide)), and ([here](operations.html))
-* **Applied**: Clarify ratio measure Numerator definition ([FHIR-42826](https://jira.hl7.org/browse/FHIR-42826))([Applied here](measure-conformance.html#proportion-measure-table)), and ([here](measure-conformance.html#ratio-measure-table)) 
+* **Applied**: Clarify ratio measure Numerator definition ([FHIR-42826](https://jira.hl7.org/browse/FHIR-42826))([Applied here](measure-conformance.html#proportion-measure-table)), and ([here](measure-conformance.html#ratio-measure-table))
 * **Applied**: Clarify or Correct Conformance Requirement 3.4 ([FHIR-42894](https://jira.hl7.org/browse/FHIR-42894))([Applied here](measure-conformance.html#conformance-requirement-3-13))
 * **Applied**: Enable QMIG to Handle Population-based Measures ([FHIR-42898](https://jira.hl7.org/browse/FHIR-42898))([Applied here](measure-conformance.html#conformance-requirement-3-8)), and ([here](measure-conformance.html#proportion-measures))
 * **Applied**: Allow for use of multiple expressions in a population ([FHIR-42907](https://jira.hl7.org/browse/FHIR-42907)) ([Applied here](StructureDefinition-measure-cqfm.html))
@@ -26,7 +26,12 @@ This page details changes made in each version of the Quality Measure IG
 * **Applied**: Correct invalid json in StructureDefinition-cqfm-fhirQueryPattern.json ([FHIR-43086](https://jira.hl7.org/browse/FHIR-43086))([Applied here](StructureDefinition-cqfm-fhirQueryPattern.html))
 * **Applied**: Allow multiple quality programs and bind value set as example ([FHIR-43320](https://jira.hl7.org/browse/FHIR-43320))([Applied here](StructureDefinition-publishable-library-cqfm.html)) and ([here](StructureDefinition-publishable-measure-cqfm.html))
 * **Applied**: Correct short description about appliesTo extension ([FHIR-43358](https://jira.hl7.org/browse/FHIR-43358))([Applied here](StructureDefinition-computable-measure-cqfm.html))
-
+* **Applied**: Removed operations section from the capabilities page ([FHIR-43629](https://jira.hl7.org/browse/FHIR-43629))([Applied here](https://hl7.org/fhir/us/cqfmeasures/2024Jan/capabilities.html))
+* **Applied**: Updated the description of the Capabilities page on home page ([FHIR-43628](https://jira.hl7.org/browse/FHIR-43628))([Applied here](https://hl7.org/fhir/us/cqfmeasures/2024Jan/#how-to-read-this-guide))
+* **Applied**: Removed section 1.3.3.1 FHIR Version Support and updated summary to reflect the current state of the IG ([FHIR-43767](https://jira.hl7.org/browse/FHIR-43767))([Applied here](https://hl7.org/fhir/us/cqfmeasures/2024Jan))
+* **Applied**: Updated the Quality Improvement Ecosystem paragraph to increase readability ([FHIR-44070](https://jira.hl7.org/browse/FHIR-44070))([Applied here](https://hl7.org/fhir/us/cqfmeasures/2024Jan/#quality-improvement-ecosystem))
+* **Applied**: Updated the text and image in data model standard landscape section to remove DEQM and HEDIS and replaced with Measure Content IG ([FHIR-44530](https://jira.hl7.org/browse/FHIR-44530))([Applied here](https://hl7.org/fhir/us/cqfmeasures/2024Jan/#data-model-standards-landscape))
+* **Applied**: Created an improvementNotationGuidance extension in the FHIR extensions pack and added to Publishable Measure at root and group level. ([FHIR-43463](https://jira.hl7.org/browse/FHIR-43463))([Applied here](https://hl7.org/fhir/us/cqfmeasures/StructureDefinition-publishable-measure-cqfm.html))
 
 ### STU4 Publication for FHIR R4 (v4.0.0)
 

input/pages/data-model-standards-landscape.md

@@ -15,11 +15,10 @@ although it enables a variety of interoperability use cases, the profiles do not
 represent all of the requirements for quality improvement. The QI-Core profiles
 are derived from US Core and provide this additional functionality.
 
-There are occasional instances where additional specificity or functionality
-is required explicitly for quality measurement, or a particular component within
-a quality measure. In these cases, additional profiles are defined within the
-changes DEQM, or by stakeholders such as measure developers or implementers. A general example of this could be the development of profiles for specific measures, such as the ones that reference the Healthcare Effectiveness Data and Information Set (HEDIS) Implementation Guide (currently no link available).
-
+There are occasional instances where additional specificity or functionality is
+required explicitly for quality measurement, or a particular component within a
+quality measure. In these cases, creation of measure content IG can be considered
+to facilitate measure development.
 
 The following diagram depicts this data model standards landscape:
 
@@ -59,24 +58,9 @@ to specify only terminology narrowing constraints. The FHIR Clinical Reasoning
 module and CQL enable the representation of data requirements for quality
 measures and decision support artifacts.
 4.  **Promote data-related profiles.** When it becomes necessary to define a data-related profile at the
-measurement-specific level (in DEQM or HEDIS for example), steps should be taken
+measurement-specific level (in Measure Content IG for example), steps should be taken
 to promote that profile to the broadest consensus group possible.
 
-##### 1.3.3.1 FHIR Version Support
-{: #fhir-version-support}
-
-There are three broadly used and fully published versions of the FHIR
-specification:
-
--  **FHIR DSTU2** - This version has broad support among US-based
-vendors as it is the basis for the Argonaut profiles. Most major vendors today
-support some subset of this version of FHIR
--    **FHIR STU3** - This is
-the version that US Core, QI Core, and many other implementation guides are
-based on. There is broad vendor support for this version.
--  **FHIR R4** - This is the first normative release of FHIR, including several of the
-foundational, conformance, and administrative resources going normative.
-
 In addition to _what_ data is reported, use cases frequently require the
 communication of _when_, _where_ and _how_ to report. See the
 [Electronic Case Reporting (eCR) implementation guide](http://hl7.org/fhir/us/ecr/2018Sep/design-considerations.html#fhir-design-considerations)

input/pages/index.md

@@ -39,9 +39,9 @@ Where possible, new and updated content are highlighted with green text and back
 ### Summary
 {: #summary}
 
-The Fast Healthcare Interoperability Resource (FHIR) Quality Measure Implementation Guide (this IG) describes an approach to representing Quality Measures (QMs) using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) in the US Realm. However, this Implementation Guide can be usable for multiple use cases across domains, and much of the content is likely to be usable outside the US Realm.
+The Fast Healthcare Interoperability Resource (FHIR) Quality Measure Implementation Guide (QM IG), describes an approach to representing Quality Measures (QMs) using the FHIR Clinical Reasoning Module and Clinical Quality Language (CQL) in the US Realm. However, this Implementation Guide can be usable for multiple use cases across domains, and much of the content is likely to be relevant outside the US Realm.
 
-The implementation guide is based upon the previous generation of QM representation standards, the HL7 V3-based Health Quality Measure Format (HQMF) and accompanying implementation guides. As an HL7 FHIR Implementation Guide, changes to this specification are managed by the sponsoring Clinical Quality Information Work Group and are incorporated as part of the standard balloting process.
+This IG is built upon on [FHIR Version R4](http://hl7.org/fhir/R4/index.html) and accounts for content in previous generations of QM standards, the HL7 V3-based Health Quality Measure Format (HQMF) and accompanying implementation guides using FHIR. As an HL7 FHIR Implementation Guide, changes to this specification are managed by the sponsoring Clinical Quality Information Work Group and are incorporated as part of the standard balloting process.
 
 #### Examples
 {: #examples}
@@ -64,7 +64,7 @@ Measures IG
 -  **[Profiles](profiles.html)**: This page lists the set of profiles defined for use by QMs
 -  **[Extensions](extensions.html)**: This page lists the set of extensions defined for use by QMs
 -  **[Terminology](terminology.html)**: This page lists value sets and code systems defined in this IG
--  **[Capabilities](capabilities.html)**: This page defines services and operations in support of authoring, publishing, and distributing QMs 
+-  **[Capabilities](capabilities.html)**: This page defines the workflows and roles for QMs and contains the capability statements
 <div class="new-content" markdown="1">
 
 -  **[Operations](operations.html)**: This page defines services and operations in support of authoring, publishing, and distributing QMs

input/pages/quality-improvement-ecosystem.md

@@ -1,26 +1,19 @@
 #### Quality Improvement Ecosystem
 {: #quality-improvement-ecosystem}
 
-As shown in step 1 in the diagram below, the Quality Improvement Ecosystem
-begins with information, preferably evidence-based from research, public health
-surveillance, and data mining and other analyses performed by third parties such
-as academic institutions or payers. Such information indicates existing status and knowledge about a
-given clinical topic. In step 2, stakeholders, such as professional societies,
-public health agencies, and governmental bodies, publish such information to assure awareness among consumers,
-healthcare practitioners, and healthcare organizations about what is known and
-suggested methods for managing the clinical topic. Ideally, suggested management
-efforts are captured and documented in guidelines based on collaboration among
-clinical subject matter experts, terminologists, informaticists, clinicians and
-consumers.  In step 3, these clinical guidelines are translated into clinical
-decision support (CDS) artifacts to incorporate relevant, evidence based, and patient-specific clinical
-recommendations and actions directly within clinical workflow. To adequately
-impact clinical care for clinicians and patients requires local implementation
-activities as shown in Step 4.  CDS is not intended to replace clinician judgment, but rather to provide information to assist care team members in managing the complex and expanding volume of biomedical and person-specific data needed to make timely, informed, and higher quality decisions based on current clinical science. Ideally, the clinical guidelines and CDS include methods for evaluating what successful implementation means, (i.e., whether the clinical care ultimately provided included processes that addressed the intent of the guideline and if it achieved the desired outcomes). Further information on CDS and its optimization of care delivery can be found [here](https://www.healthit.gov/sites/default/files/page/2018-04/Optimizing_Strategies_508.pdf).
-In step 5, to close the loop and enable continuous improvement, the results of such measurement
-analytics must be reported for aggregate review. Step 6, "Reporting" serves the
-purpose of evaluating clinical performance and outcomes, whether it be internally
-for health care organizations, or for third parties such as public health or for payers.
-Ultimately, this information may then serve as part of the evidence base shown in step 1.  
+The diagram below shows the quality improvement ecosystem.  Each step is discussed in order:<br>
+<br>
+Step 1: Researcher and public health surveillance – this step begins with information, preferably evidence-based from research, public health surveillance, and data mining and other analyses performed by third parties such as academic institutions or payers. Such information indicates existing status and knowledge about a given clinical topic.<br>
+<br>
+Step 2: Clinical practice guidelines – in this step stakeholders, such as professional societies, public health agencies, and governmental bodies, publish such information to assure awareness among consumers, healthcare practitioners, and healthcare organizations about what is known and suggested methods for managing the clinical topic. Ideally, suggested management efforts are captured and documented in guidelines based on collaboration among clinical subject matter experts, terminologists, informaticists, clinicians and consumers.<br>
+<br>
+Step 3: Clinical decision support – in this step, the clinical guidelines developed in step 3 are translated into clinical decision support (CDS) artifacts to incorporate relevant, evidence based, and patient-specific clinical recommendations and actions directly within clinical workflow.<br>
+<br>
+Step 4: Clinical Care - To adequately impact clinical care for clinicians and patients requires local implementation activities as shown in CDS is not intended to replace clinician judgment, but rather to provide information to assist care team members in managing the complex and expanding volume of biomedical and person-specific data needed to make timely, informed, and higher quality decisions based on current clinical science. Ideally, the clinical guidelines and CDS include methods for evaluating what successful implementation means, (i.e., whether the clinical care ultimately provided included processes that addressed the intent of the guideline and if it achieved the desired outcomes). Further information on CDS and its optimization of care delivery can be found [here](https://www.healthit.gov/sites/default/files/page/2018-04/Optimizing_Strategies_508.pdf).<br>
+<br>
+Step 5: Measurement and Analytics – this step closes the loop and enables continuous improvement; the results of such measurement analytics must be reported for aggregate review.<br>
+<br>
+Step 6: Reporting – this step serves the purpose of evaluating clinical performance and outcomes, whether it be internally for health care organizations, or for third parties such as public health or for payers. Ultimately, this information may then serve as part of the evidence base shown in step 1.<br>
 
 <details open>
 <summary>

input/profiles/StructureDefinition-publishable-measure-cqfm.json

@@ -576,6 +576,38 @@
         "path": "Measure.endorser",
         "mustSupport": true
       },
+      {
+        "id": "Measure.extension:improvementNotationGuidance",
+        "path": "Measure.extension",
+        "sliceName": "improvementNotationGuidance",
+        "min": 0,
+        "max": "1",
+        "type": [
+          {
+            "code": "Extension",
+            "profile": [
+              "http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance"
+            ]
+          }
+        ],
+        "mustSupport": true
+      },
+      {
+        "id": "Measure.group.extension:improvementNotationGuidance",
+        "path": "Measure.group.extension",
+        "sliceName": "improvementNotationGuidance",
+        "min": 0,
+        "max": "1",
+        "type": [
+          {
+            "code": "Extension",
+            "profile": [
+              "http://hl7.org/fhir/StructureDefinition/cqf-improvementNotationGuidance"
+            ]
+          }
+        ],
+        "mustSupport": true
+      },
       {
         "id": "Measure.relatedArtifact",
         "path": "Measure.relatedArtifact",