​Thank you for your question. Currently, the eCQM does not have a stand-alone denominator exception that can cover this fallout. However, the eCQM does have a denominator exception for medical reason for not providing antithrombotic therapy. We will consider adding a stand-alone exception for elevated INR in a future version update.

We are proposing to add a denominator exception to accout for an INR value greater than 3.5​. We are suggesting the following changes: 1. Add INR value set (2.16.840.1.113883.3.117.1.7.1.213) to denominator exceptions. Description: This set of values contains codes for laboratory test for INR, or International Normalized Ratio. Inclusion criteria: Only includes codes which represent laboratory test of INR. These are LOINC codes. 2. Proposed Logic in red: Denominator Exception: "No Antithrombotic Ordered During Hospitalization" union “Encounter with an INR >3.5”   Encounter with an INR>3.5 TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter             where ["Laboratory Test, Performed: “INR”] INR such that INR.resultDatetime such that Antithrombotic.relevantPeriod starts 1 day or less on or after day of start of Global."Hospitalization"(IschemicStrokeEncounter) return INR.result as Quantity)>3.5mg/dl    Rationale: This is to better align with the Chart Abstracted Measures.