We have determined several patients are not passing the numerator due to the following logic:
AND :
OR : Laboratory Test, Result: INR (result >= 2.0 ) <= 1 day starts after start of MOST RECENT : Occurrence A: Medication, Administered: Parenteral Anticoagulant
OR :
AND : Laboratory Test, Result: INR (result < 2.0 ) <= 1 day starts after start of MOST RECENT : Occurrence A: Medication, Administered: Parenteral Anticoagulant

We have found that patients who receive a parenteral medication (Medication, Administered) following discharge will fail the measure even though all conditions of overlap therapy have been met.

Due to our clinical perspective and logic interpretation, we think the intent of the measure was to look for the “Most Recent” Medication, Administered: Parenteral Anticoagulant during a qualifying Encounter, Performed: Encounter Inpatient. Based on this interpretation, the patient should pass the Numerator test.

However, when interpreting the logic as written, the parenteral medication is not restricted to the current encounter but considers the entire patient record. Was this the intent of the measure or is there another reason we are not aware of?

This issue is described in more detail in the following Jira ticket: Bonnie-39.