I have seen what I think is a problem when Cypress generates QRDA Cat 1 documents for ED 1, ED 2 and/or ED 3. The problem occurs only if one or more of the generated documents contains two ED visits where both visits fall into the IPP, but only one of the two visit falls into the Measure Population. In this case, I think the supplemental data should be counted twice for the IPP population, since all EH QMs are encounter based. In other words, if a white female has two visits to the ED and they both fall into the IPP then “White” and “Female” should be counted twice when calculating the supplemental data for the IPP. Unless I’m missing something, Cypress counts it only once.

Attached are 5 Cypress generated files that demonstrate this problem. They were created to test ED 3. Also attached is 1) a screen shot of the Cypress testing output for the associated QRDA Cat 3 and 2) a screen shot of the Browser view of the Wellsoft generated QRDA Cat 3 being tested. In the Cypress QRDA Cat 1 files, you will see that Ray Flowers had two ED visits, one on 1/13/2012 12:00pm and one on 3/30/2012 11:00am. Both encounters fall into the IPP for ED 3, but only 1/13/2012 12:00pm falls into the Measure Population. Bob McCormick also has a visit that falls into the IPP and Measure Population. This would give a total of 3 IPPs, which is recognized by Cypress in the total count. However, Cypress only expects 2 race, ethnicity and sex entries.

As always, thanks for looking into this.

• John