Thank you for your questions. Q: If those encounters existed and they are being processed for example through Stroke2 CMS104v3: Should both of these episodes of care be evaluated by the stroke algorithm, and produce distinct pass/fail/exclusion/exception results for each of these episodes? A: Yes, for episode of care measures, each episode in the measurement period should be evaluated. The measure logic in STK2 will determine which data captured during the measurement period are used to calculate the measure rates for each episode.   Q: If so is there someplace within documentation that clearly specifies this. Or is it by design Stroke2 CMS104v3 would limit which of those encounters (ie. through Occurrences) would be evaluated? A: Please refer to the 2016 Measure Logic Guidance document, eCQM Measure Logic Guidance v1.11 Update June 2015  Page 4, for a detailed description of Episode of Care based measures, and the application of Occurrences to episodes.   Q: We are also looking for clarification on how to interpret the Occurrence clauses in the STK algorithms as they apply to Non-Elective Inpatient Encounters. Do these occurrences apply to the contents of a QRDA files (as a whole), or do they apply to the contents of one or more episodes of care contained within the QRDA file? A: Please refer to the Section 4.3, Specific Occurrences, of the Measure Logic Guidance document mentioned above for a detailed explanation of how Occurrences are applied. In general, Occurrence will not apply to the contents of the QRDA file as a whole, they are applied to data elements within the measure logic.   Q: If the occurrences apply to the contents of an episode of care, then the terminology of “Occurrence A of $EncounterInpatientNonElective” seems to be misleading, as there can only be one Inpatient Encounter per episode of care for Inpatient measures. In episode-of-care measures, the episodes are always designated by a specific occurrence (refer to page 4 of the Logic Guidance document). Also, as previously stated there can be more than one Inpatient Encounter per episode of care. Further, a common misunderstanding of “Occurrence A” is to think of it as “Occurrence 1” (vs Occurrence 2, 3, or 4). In other words, there may be more than one Occurrence A per measurement period, as Occurrence A simply means “any (or all) occurrence that meet the population criteria.” A: In the case of the Stroke 2 initial population: •Initial Population = ◦AND: Age >= 18 year(s) at: Occurrence A of $EncounterInpatientNonElective ◦AND: Union of: ◾"Diagnosis, Active: Hemorrhagic Stroke (ordinality: Principal)" ◾"Diagnosis, Active: Ischemic Stroke (ordinality: Principal)" ◾starts during Occurrence A of $EncounterInpatientNonElective This could be restated narratively as:   “Occurrence A of $EncounterInpatientNonElective equals all encounters that meet the $EncounterInpatientNonElective criteria, where the patient is >=18 years of age at the start of the encounter, and which contain a principal diagnosis of ischemic or hemorrhagic stroke”   Q:Lastly, is there an option for hospitals to build QRDA files as patient based OR episode of care based, or are QRDA files always built as patient-based files? A: One QRDA I report per patient should be submitted for a CCN. If a second QRDA file is submitted for a patient at a CCN, then the first file is overwritten.