Thank you for your feedback on the AMI-2 measure. With harmonization efforts, the solution for this ticket will also be reflected in the AMI-10 measure logic. While this ticket recommends that “occurrence” is not meaningful in the logic and recommends its removal, CQM-1090 documents an issue with the Comfort Measures element and the timing relationship utilized in the encounter, and recommends the continued use of “occurrence” in its proposed fix. The logic will be modified to add an additional logic statement to the encounter beginning in the ED that leads to an inpatient one: • AND: “Occurrence A of Encounter, Performed: Emergency Department Visit” <= 1 hour(s) ends before start of “Occurrence A of Encounter, Performed: Encounter Inpatient” • AND: “Occurrence A of Intervention, Performed: Comfort Measures” starts after start of “Occurrence A of Encounter, Performed: Emergency Department Visit” • AND: “Occurrence A of Intervention, Performed: Comfort Measures” starts before or during “Occurrence A of Encounter, Performed: Encounter Inpatient” This logic change complements the fix proposed in ticket CQM-1090 and satisfies the scenarios for patients with an ED encounter. This leads to an inpatient encounter where Comfort Measure documentation may occur in the ED and inpatient setting, and patients with only an inpatient encounter where Comfort Measure documentation occurs during the inpatient encounter. This solution satisfies the questions raised in CQM-1089 and CQM-1090 . The second OR clause in the denominator exclusion contains logic statements that capture Comfort Measures documentation starting during an inpatient encounter that does not include an ED encounter leading to an inpatient encounter. The patient’s encounter begins in the inpatient setting. The current logic using the “Occurrence A” qualifier to specify the Comfort Measures instance will be removed in the 2015 EH eCQM update. This solution should satisfy questions raised in CQM-1094 and CQM-1090 .