Our set-up:

Cypress: 2.4.2
popHealth: 3.0.0 RC1

CMS 113/0469 Elective Delivery Issue
Numerator =
• AND:
• OR:
• AND: "Patient Characteristic: Gestational Age 37-38 weeks" = 0 day(s) starts before start of ("Procedure, Performed: Delivery Procedures" during "Occurrence A of Encounter, Performed: Inpatient Encounter")
• AND:
• OR NOT:
• OR: "Physical Exam, Finding: Active Labor" starts before start of ("Procedure, Performed: Cesarean Section" during "Occurrence A of Encounter, Performed: Inpatient Encounter")
• OR: "Diagnosis, Active: Spontaneous Rupture of Membranes" starts before start of ("Procedure, Performed: Cesarean Section" during "Occurrence A of Encounter, Performed: Inpatient Encounter")
• OR: "Procedure, Performed: Medical Induction of Labor"
• during "Occurrence A of Encounter, Performed: Inpatient Encounter"
• OR:
• OR NOT: "Patient Characteristic: Gestational Age 37-38 weeks" = 0 day(s) starts before start of ("Procedure, Performed: Delivery Procedures" during "Occurrence A of Encounter, Performed: Inpatient Encounter")
• OR: "Patient Characteristic: Gestational Age Unknown" = 0 day(s) starts before start of ("Procedure, Performed: Delivery Procedures" during "Occurrence A of Encounter, Performed: Inpatient Encounter")

If “Patient Characteristic: Gestational Age 37-38 weeks” Value Set (2.16.840.1.113883.3.117.1.7.1.287) is not present in the QRDA Cat 1 document, then the Numerator criteria will be satisfied since "Gestational Age" is in "OR NOT" condition. The QRDA cat 1 document generated by cypress does not have entry for "Patient Characteristic: Gestational Age 37-38 weeks". So this should satisfy the Numerator criteria. In popHealth, it is satisfying the Numerator criteria but while testing the same in Cypress with the popHealth generated QRDA Cat 3 document, we found that it is not satisfying for numerator and hence fails the test.

Both cypress and popHealth are using same measure bundle 2.4.0, hence the map function is same for the both. Our assumption is Cypress might be calculating upon different data for the patient other than the QRDA Cat 1 document which Cypress is providing for testing.

Any guidance on this issue will be highly appreciated.

Warm regards,
Rahul