Hello,

Looking to get some clarification on timing of the Lab and Vital sign reporting.  As we are validating QRDA1 files we noted that some patients directly admitted to the hospitals have laboratory and vital sign values pulling into the QRDA 1 file that are dated and timed outside the admission start date/time.  We want to ensure that the laboratory and vital values being submitted are what is intended.  

1.  If a patient is a direct admission (meaning there is no transfer from an outpatient location to the inpatient start within that encounter) to the hospital do we FIRST review the EHR for lab or vital signs values within the 24 hour time period prior to the start of the admission?  As it says here in the spec in # 2 that if there are values prior to admission to capture those.  Then if there are none look for any vital signs within 2 hours after the start of admission and lab values within 24 hours after the admission?  Do I interpret that correctly?
2. If a patient is not a direct admit, came from an outpatient location or ED (transferred from the ED or outpatient location during the same encounter to inpatient) do we only look at the time frames listed in #2, the first resulted vitals and labs within 24 hours prior to the start of the inpatient admit date/time?  In this case the #1 time frames wouldn't be used at all.

1. 1. "`If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.
   2.  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. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted."