Guidance will add clarity for measure developers and implementers without requiring a change to QDM structure. There is no impact on tooling (MAT, Bonnie, Cypress) unless a new version of QDM is created. A new version requires update to HL7 standards CQL-based HQMF, QRDA category I and all of the tools noted. There is currently only 1 potential gap in QDM that could require a new version - I.e., adding the relatedTo attribute to Procedure, Performed, Laboratory Test, Performed, and Physical Exam, Performed. There is only one instance in existing eCQMs that will benefit from that change and CQL expression workarounds exist for that instance.