Hello JIRA,

I have a couple of questions about the Hybrid measures and timing of the start time for collecting the Vital Signs and Laboratory test results.

On the written part of the specifications for CMS 529v2 it says:

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.

On the Definitions section, it describes the Inpatient encounter. (NOT an inpatient admission)

Inpatient Encounters

• from
• ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter,
• ["Patient Characteristic Payer": "Medicare payer"] Payer,
• ["Patient Characteristic Birthdate": "Birth date"] BirthDate
• where Global."HospitalizationWithObservationLengthofStay" ( InpatientEncounter ) < 365
• and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
• and Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of InpatientEncounter.relevantPeriod ) >= 65
• return InpatientEncounter

(The definition includes the observation portion of an inpatient encounter)

My questions are these:

1. Should the timing begin at the time the patient was admitted as an actual inpatient (which may be 2 days after the observation admission)
2. OR Should the timing begin at the time of the portion of the observation (status/ or class) Start time - in order to capture the vital signs and lab tests that might have been completed in the Emergency department?
3. And would the same answer hold true for the other hybrid measure CMS 844v2

The term Inpatient encounter includes the observation period. The verbiage Inpatient admission in the written description makes this ambiguous to either of the above scenarios.

Please advise,

Kim