S:  Upon reviewing some patients qualifying for the hybrid measure data elements we found a few scenarios that need clarification. 

B:  Our hospital systems use one electronic health record (EHR) that combines clinic visits and hospital encounters into one EHR system.  Our EHR also contains data for our entire enterprise that comprises of separate CCNs numbers and locations.   

A:  Upon validation we have found the following for patients who aren't a direct admission, per specification: "If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission." -  

 Patient has a clinic appointment on 10/28/21 for her scheduled surgery the next day (10/29/21).  She arrives to the hospital as a surgical admit.  She transfers to the operating room and is changed to an inpatient status.  She then goes on to the surgical unit after surgery and eventually discharges from the hospital.   

Her clinic visit contained data for her blood pressure and weight that was within 24 hours prior to her inpatient admission to the hospital the next day.   

 Patient arrives to the emergency department at hospital A.  Hospital A is within our health system.  The patient was deemed too sick and required a higher level of care at a different hospital within our health system (different CCN) and was transferred from hospital A's ED to hospital B's procedural area and eventually inpatient location.   These organizations are in the same health system and EHR, but have different CCN #s.   

Her emergency department visit contained labs and vitals signs that was withing 24 hours prior to her inpatient admission to hospital B. 

R:  The specification logic indicates, "This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location." 

So, this being said, our questions are as follows: 

1.  For scenario 1 since the specification does NOT indicate clinic location (only indicates emergency department or hospital outpatient location) do we exclude an clinic lab/vital signs? 

2.  For scenario 2 (and scenario 1) do we exclude lab and vital signs if the data provided is NOT form the "same facility" (same CCN #)?   

 Also, a scenario that we haven't necessarily seen, but could see are patients that are transferred into our health system sites that are not included in our EHR.  We may or may not receive data in our healthcare information exchange (HIE) portion of our EHR.  Is this a place we are required to query for the core clinical data elements?

--Please note I did review CHM-50 – Hybrid HWR 2021 hospital outpatient locations clarification that indicated that we are to "query all vital signs and laboratory results that meet the time frame requirements, irrespective of location."  However, I did want to confirm these specific scenarios as discussed above and I noted that this ticket was unresolved.   

Thanks for your clarification and consideration.