When submitting a lab or assessment result with an index result value the CDA specification says to use a REAL data type: 

“(3) Index values (a number without unit) uses the Real Number (REAL) data type. When a quantity does not have a proper unit, one can just send the number as a real number. Alternatively one can use a PQ with a dimensionless unit (e.g., 1 or %). An integer number should only be sent when the measurement is by definition an integer, which is an extremely rare case and then is most likely an ordinal (see below).”

If we find a result value that is an integer value and we use xsi:type=“INT” instead of “REAL” we are getting different results in HQR.  For example, if we take a patient that qualifies for the numerator for CMS108v10 due to an INR lab result of exactly 4, and change the QRDA type from REAL to INT, then the patient falls out of the numerator.  

In the case of the TJC measure ePC02v3, where the number of pregnancies is being determined (a value that is most definitely an integer), what should the value type be, REAL or INT?  Is there an enumerated list of codes or value sets that would drive when to use “INT” (e.g. do we have a list of the “extremely rare case(s)”)?

Just as additional context: 

1. When I load ePC02v3 to Bonnie and create a patient that makes the denominator, no matter which CQL data (Integer or Decimal) I choose for the Gravida assessment result the patient makes the denominator.
2. TJC is telling us that we must submit these results as xi:type = “INT” because “As per ePC-02 measure specification, it requires xsi:type as “INT””.  I am not aware of any CQL or QRDA rule that allows a measure specification to influence the CDA data types of the QRDA file.