Cypress 2.7.0 is being updated to accommodate the additional logic specified (e.g. valid INR intervals) in the SQL addition. The Cypress 2.7.0 test patients will be updated accordingly.

-Dave Czulada

Thanks, that'd be great! I'd prefer to have machine readable requirements as I'm sure you guys would as well.

Cypress cannot validate based on the guidance notes. I'll see if I can contact the measure developers about this issue.

Has there been any official statement made regarding whether or not Cypress will be validating based on what's in the guidance notes rather than what the actual XML defines? Is there any reason the requirements of the guidance notes (if these are what is truly required) could not be made into machine readable XML requirements just like the rest of the measures?

I second with Kyle.
I have got the same issue. I strictly followed all the instruction in “CMS179v2_Supplemental_SQL_Logic_Reference.pdf”, and that patient should be excluded.
So my average TTR is also 0% instead of 100% in Cypress tool.
And the specifications said
"Please note that the logic expressions in the body section of the HQMF of this measure should not be used to calculate this clinical quality measure."

Robert,

Please open an issue based around this. The Guidance section in the measure definition states the logic expression in the body of should NOT be used to calculate this clinical quality measure.

Guidance Notes:

> “Please note that the logic expressions in the body section of the HQMF of this measure should not be used to calculate this clinical quality measure. They are only provided to represent the data elements needed for the calculation. In order to calculate this clinical quality measure correctly, only use the narrative specifications contained in the header section of the HQMF and the annotated database query found in the supplemental file named “CMS179v2_Supplemental_SQL_Logic_Reference.pdf”

Kyle,

Here is the logic presented in CMS179v2

Initial Patient Population =
    AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
    AND:
        AND NOT: "Occurrence A of Diagnosis, Active: Atrial Fibrillation/Flutter" ends before start of "Measurement Period"
        AND: "Occurrence A of Diagnosis, Active: Atrial Fibrillation/Flutter" starts before start of "Measurement Period"
    AND:
        AND: "Medication, Active: Warfarin (cumulative medication duration >= 180 day(s))" starts before start of "Measurement Period"
        AND:
            AND NOT: "Occurrence A of Medication, Active: Warfarin" ends before start of "Measurement Period"
            AND: "Occurrence A of Medication, Active: Warfarin" starts before or during "Measurement Period"
    AND:
        OR: "Encounter, Performed: Face-to-Face Interaction"
        OR: "Encounter, Performed: Office Visit"
        during "Measurement Period"
    AND:
        OR NOT: "Occurrence A of Diagnosis, Active: Valvular Heart Disease" starts before or during "Measurement Period"
        OR: "Occurrence A of Diagnosis, Active: Valvular Heart Disease" ends before start of "Measurement Period"
Measure Population =
    AND: "Initial Patient Population"
    AND: Count >= 3 of:"Laboratory Test, Result: INR (result)" during "Measurement Period"

There is nothing in the logic definition that states 56 days. It may say something in the description about it but unless the measure authors actually place it in the logic it will not get picked up and will not be implemented. All of the measures are based strictly off of the coded logic sections in the HQMF. If anything this is an error in the measure definition in that the developers did not actually implement in the logic what they described in the description. We can certainly open an issue based around that.