Thank you for your follow-up question.
Yes, you are correct that the timing calculation here uses “interval” operator. However, a key word “day of” is applied in the “1 day or less on or after day of start”, where it is counting the calendar by day not by hour. Therefore, the = Interval [global.”ToDate”(04/05/2019 10:00 AM), global.”ToDate”( (04/05/2019 10:00 AM + 2 day)), means the Comfort measures starts from any time on the day of admission (including prior to admission time) to 1 day after admission datetime and will qualify for the condition.
Your example should return True as Bonnie shows.

Thanks for the explanation. It seems however the eCQMs may not be using the same method of timing calculations in different elements within the measures.

Could you help explain what would be the result for the following logic in the example provided below?

VTE-1

Intervention Comfort Measures on Day of or Day After Start of Hospitalization

        "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter

               with "Intervention Comfort Measures" ComfortMeasures

                              such that Coalesce(start of ComfortMeasures.relevantPeriod, ComfortMeasures.authorDatetime)1 day or less on or after day of start of Global."Hospitalization"(QualifyingEncounter)

 __ 

Example 2

Inpatient start: 04/05/2019 10:00 AM
Comfort measures start: 04/05/2019 4:00 AM (comfort measures starts before inpatient start)

 If you apply the interval calculation as you have described above, I would think it would evaluate to

= Interval [04/05/2019 10:00 AM, (04/05/2019 10:00 AM *+ 1*)]

= Interval [04/05/2019 10:00 AM, (04/*06*/2019 10:00 AM)]

Which means if the Comfort Measures starts on or after 04/05/2019 10:00 AM and on or before 04/06/2019 10:00 AM then this logic should return true.

However, in this example the Comfort Measure Start is not in this range, so it should return false.

The Bonnie tool returns true. That would mean that it is not following the interval calculation method described above for this logic. In which case it would mean that different logic elements are expecting different ways of calculating the timing but no specific guidance is provided for calculation of each one.

What is the expectation for this type of calculation? How will TJC and CMS (QualityNet) calculate this? And if there is an implicit assumption for different calculation methods for timing statements in different logic elements how can the community know what those assumptions are? This could lead to a lot of confusion.

Thanks in advance for your review.

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

To add to the commentary on CYPRESS-1737, I've further updated that ticket. Cypress does calculate according to the CQL, but the CQL in this case actually evaluates to false if there are greater than 60 minutes between the end of the first referenced interval and the start of the second referenced interval.
X "1 hour or less before or on" Y, according to CQL logic, indicates that X should be between Y and Y- 1 hour, so if X is 61 minutes before Y, this would evaluate to false. This is how Cypress calculates this statement.

There is further CQL explanation of this type of logic here:
https://cql.hl7.org/02-authorsguide.html#timing-relationships

For reference - I have created a separate ticket - https://oncprojectracking.healthit.gov/support/browse/CQM-3642- for other similar time calculation issues.

Albert, as FYI - 

We have also logged the question to Cypress (Cypress QRDA Validation Utility) https://oncprojectracking.healthit.gov/support/browse/CYPRESS-1737 and the tool is evaluating the measure according the CQL guidance, following the 'hour' no 'minutes' calculation for ED end to IP start timing. 

We agree the 'intent' is to consider '60min', but the measures have been released using 'hour'. Therefore, changes on how to evaluate the timing calculation should be done directly in the measure CQL logic (replace 1 hour with 60min) in future releases. On previous submissions, the timing calculation has been done based on 'hour' guidance. 

Thanks.

Agree that AMI-8a and ED-2 have critical calculations that either require or suggest measurement in minutes rather than hours.  The other measures refer to an ED visit that occurs within an hour of pertinent inpatient visit when the critical measured events happen.  On these latter measures, the exact timing of the ED visit relative to the inpatient visit is less critical.

In the case of AMI-8a, it is clear that the calculation needs to be in minutes and <=90 minutes is the critical time factor for the PCI intervention.  Although the logic states "hour or less" it's clear that 60 minutes or less indicate the most recent ECG.

Will followup with input from measure developers and CQL experts.

I'm re-posting this comment for reference my the measure developers and CQL experts - I believe the following Denominator logic in AMI-8a falls in the same category as the ED Visit logic discussion above. Please consider both these items when reviewing the logic. Anxiously waiting for a response.

I'll ask the measure developers and CQL experts, but from what I see in the original ticket, the submissions are being made, or are planning on being made, in median hours, not median minutes.  Either way, it's important to avoid a submission that rounds all times down to the hour, allowing submitters to exceed the recommended time (an hour or less) by nearly double (less than two hours).

This type of ambiguity within the definition of the logic in the specifications and the clinical expectation is going to cause a lot of confusion and mismatched results when files are submitted to CMS and TJC.

Can someone clarify what CMS (QualityNet) is expecting - as in when a file submitted to CMS has an episode with 119 minutes (or 61 minutes) difference between end of ED and start of Inpatient, will QualityNet calculate it using minutes (and therefore remove the episode from the population) or will they calculate using hours (and therefore include the episode in the population)?

Everyone will also need to find out TJC expectations for the above since file are also submitted to TJC.