I think you mean the IPP, when you say “the denominator for the measure states that MOST RECENT: "Occurrence A of Physical Exam, Finding ….”. The logic : AND: MOST RECENT: "Occurrence A of Physical Exam, Finding: Systolic Blood Pressure (result)" during "Occurrence A of Encounter, Performed: Blood Pressure Visit" indicates four distinct items: – an Encounter took place that was a Blood Pressure visit, – a Physical Exam with a Systolic BP reading had a result that was recorded. – The two are within the same occurrence ‘A’ – i.e., occurred concurrently – and bound by a timing relationship ‘during’ – the LHS being the recording of a Systolic BP result and the RHS being the Encounter of a BP visit. In other words, the logic is stating that even if the Systolic BP result was within the same occurrence, it has to be time-bound within that Encounter. So, a result recorded after the Encounter has either begun, or has ended, even if it is tied to the same occurrence is not permissible. Note that the start and end time/date can be concurrent with the beginning or the end of the Encounter. So, to answer your first question, if a “during” operator is used, say, “during the Measurement period”, a procedure, diagnosis or observation has to occur “no earlier than the start of the MP”, or “no later than the end of the MP”, and “can occur beginning or ending with the MP”. Please note that the additional modifiers, “start during” or “end during”, will determine whether the procedure, diagnosis or observation has to consider the MP start date or MP end date while evaluating the logic. Regarding your second question, we recognize that Encounter End is not well defined both in ambulatory and hospital settings in the QDM. A current topic of discussion in the QDM user group is to find a better definition for recorded date time for Diagnoses, in particular. We welcome your input in the discussion and on the JIRA ticket QDM-99 https://jira.oncprojectracking.org/browse/QDM-99 . Let us know if this helps or you need further clarification.