​Thank you for your inquiry for CMS156v11, Use of High-Risk Medications in Older Adults ( https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS156v11-v2.html ). If the first digoxin prescription has 5 refills but does not exceed an average daily dose of 0.125 mg/day, the prescription would not meet numerator 1. In the instance that it does exceed average daily dose, it would count towards the numerator 1 even if it was "stopped" because the relevant logic only accounts for authorDatetime, the date/time the medication order (prescription) is authored, and not the end/stop time of a prescription. If the second digoxin prescription meets either of the following scenarios, it would meet numerator 1: (1) a digoxin prescription order exceeding 0.125 mg/day with at least one refill, or (2) a total of two digoxin prescriptions ordered on different days each exceeding 0.125 mg/day. The measure is specified to calculate average daily dose based on the quantity of pills, medication dose and the days supply recorded for the prescription in the EHR (see additional guidance below). Therefore, numerator 1 is met when the calculation deems the prescription as exceeding 0.125 mg/day and if the prescription has at least one refill (or if there are two prescriptions ordered on different days both exceeding 0.125 mg/day). "To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose."