https://jira.hl7.org/browse/FHIR-31753 and https://jira.hl7.org/browse/FHIR-34326 made changes to the ShareableCodeSystem profile http://hl7.org/fhir/shareablecodesystem.html for R5.

QMIG is based on R4 and derives the CQFM Publishable CodeSystem profile from the R4 ShareableCodeSystem profile.

Create CQFM ShareableCodeSystem profile which would be modeled after the FHIR-31753 and FHIR-34326 changes:

1. No cardinality constraint on CodeSystem.concept.

2. Create an invariant in CodeSystem that specifies 

If CodeSystem.content = {example, fragment or complete} then CodeSystem.concept must be present and must have at least one element. 

3. CodeSystem.caseSensitive to be mandatory and mustSupport.

4. CodeSystem.hierarchyMeaning to be mustSupport

5. Add an invariant 

If CodeSystem.concept.concept exists hierarchyMeaning is mandatory.

Make CQFM Publishable CodeSystem profile derived from the new CQFM Shareable CodeSystem profile instead of the R4 Shareable CodeSystem profile.

However, also see https://jira.hl7.org/browse/FHIR-37369 

If the R5 ShareableCodeSystem profile is moved into THO, and it is possible to derive from THO instead of creating the CQFM Shareable CodeSystem profile in QMIG, then the THO option would be preferable.