I looked at other tickets including CQM-1001 and I dont think this is addressed.

The numerator of this measure uses logic that does not meet the numerator guidance, which is as follows:

Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit.

The numerator logic in short hand is:

NOT Diagnostic Study <= 28 days starts after start of "Occurrence A of Diagnosis, Active: Low Back Pain"

If the intent to really to ensure that there is no imaging study the day of or 28 days after the encounter then the logic should be:

NOT Diagnostic Study <= 28 days starts after start of LBP encounter.

The reason to fix this is that there is a potential timing issue with using the start of the Occurence A of Low Back Pain as illustrated in this example.

First Low Back Pain started on 2/1/2015 at 14:00.
Encounter started 2/1/2015 at 13:30.
Xray takes place at 2/1/2015 at 13:45.

Notice the Xray is before the LBP diagnoses.

Technically by numerator guidance definition this should meet, but it won't if strictly creating software logic to the QDM logic in the specification. The measure logic is hopeful that the clinician's are documenting in a very specific order, but it is very likely that an order and xray takes place just shortly before the diagnosis can be updated in the problem list, etc.

For simplification and to help avoid adding specific burden on the order of events, the measure can have the intent satisfied by using the encounter in place of the Low Back Pain in the numerator. Instead of chaining the events one to the next, it makes more sense to link them all to the encounter in question.

I know there are other Jira tickets on the consequence of workflow and timing, but this is a good example of relaxing the specification without compromising the intent.