The focus of this white paper is the US Realm.  Will add explicit text to state this in conclusion using the following paragraph in the introductory section:   The guidance in this white paper is primarily applicable for the US Realm, specifically the FHIR Quality Measure Implementation Guide and DEQM which are both US Realm, mostly due to the the reliance on the QI-Core IG based on US Core.  There are no restrictions on the use of this material in the international realm and findings may be applicable outside the US.  The authors welcome input from the global community.