Modify the individual and summary MeasureReport profiles with the following: Modify the invariant on improvementNotation to ensure it is only required if scoring is specified at the root. Add extension-measureScoring to the group, with an invariant that ensures scoring is either specified only at the root, or on all groups Add an extension for improvementNotation to allow it to be specified on groups, with an invariant to ensure that if scoring is specified on the group, improvementNotation must be (if the scoring type is other than cohort) Relax the cardinality of populations to 0..* (i.e. remove the cardinality specification from the profile), and add an invariant to ensure that cardinality is >= 1 if the scoring is other than composite