Thank you for your questions regarding CMS104v12 (Discharged on Antithrombotic Therapy). Please review the responses to your inquiries below. 1. The logic utilizes the "Medication, Discharge" data type. Information on this data type is available on page 41-42 of the QDM 5.6 Publication, which is located on the eCQI Resource Center ( https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf ). When utilizing the "Medication, Discharge" data type, the logic will look for the time stamp of a medication on a patient discharge medication list. This datatype is intended to express active medications ordered for post-discharge use. As such, the medication should be documented as a discharge medication. For example, a patient is, given enoxaparin during the encounter but prescribed aspirin at discharge. The medication could be a previous antithrombotic the patient was already on or a newly prescribed medication during the encounter. The measure does not use lookback period or the amount dispensed. 2. The denominator exception ‘documented reason for not prescribing antithrombotic therapy at discharge’ uses negation rationale and a standardized nomenclature of SNOMED. Depending on the organization, mapping can occur on the front end (standard terminology selected in the EHR) or the back end of the EHR (home terminology is displayed selected but is mapped to a standard term for reporting). For most organizations/EHRs, this information will need to be placed in a discrete field to pull for reporting. 3. There are no exceptions for a patient’s health plan type. Home medications should be documented in the patients record regardless of prescribing facility. A reason for not prescribing a medication should be documented in a discrete field and not just a progress note. 4. See answer 1. The medication can be prescribed anytime during the hospitalization. 5. Patients transferred to an acute care facility are excluded from the measure and other inpatient types, such as a rehab facility, are still included in the measure. The rationale is that patients discharged to other healthcare facilities, as well as home, are still treated, unless contraindicated for the individual patient, and should receive secondary stroke prevention therapies (antithrombotic/anticoagulation) after discharge from the hospital. Thank you.

Score is likely to be inaccurate due to the lack of clarity related to the term "CONTINUING to TAKE" in the numerator definition. And difficulty in capturing prescribing / dispensing information when patients have more than one health care plan, are transferred to another level of care within the same facility, and/or because the Value Sets use codes that are not very likely to be captured within the medical record and therefore Natural Language Processing (NLP) or some other work around would be needed to map the gap.