When trying to configure the Exclusion criteria, there are pieces of the top Guidance that do not match the bottom portion of the espec. We need to have these clarified in order to configure the measure to the CMS's intent.

Just to be clear: The assessments and the results do not need to happen on the same visit and at the same time?

_"We use "first" to indicate that there is at least one assessment during the measurement period.​ "_ - This statement is going to confuse a lot of people as when will EHRs know when to truly look for the First event to happen versus any event that qualifies for the measure?

1. Denominator Exclusion Guidance:
_"The following risk factors may occur any time in the patient's history but must be active during the measurement period:
Smoker (current during the measurement period)"

Bottom Espec States:
_"Current Tobacco User

{ First(["Assessment, Performed": "Tobacco Use Screening"] TobaccoScreen
where TobaccoScreen.result in "Current Tobacco Smoker"
and TobaccoScreen.authorDatetime during "Measurement Period"
sort by authorDatetime"_

Question Here: Is this truly the First Assessment in the Measurement Period with the First Result in the Measurement Period all completed on same visit?

2. Denominator Exclusion Guidance:
"Alcohol consumption (> two units per day (one unit is 12 oz. of beer, 4 oz. of wine, or 1 oz. of liquor))"
Bottom Espec States:
Average of More Than Two Drinks Per Drinking Day
_{{color:red} First(["Assessment, Performed": "Average Number of Drinks per Drinking Day"] AverageDrinks
where AverageDrinks.authorDatetime during "Measurement Period"
and AverageDrinks.result > 2
sort by authorDatetime

Question Here: Is this truly the First Assessment in the Measurement Period with the First Result in the Measurement Period all completed on same visit?