The majority of eMeasures utilize the inpatient encounter as the beginning date/time for the principal diagnosis. As an example, the Initial Patient Population for eMeasure 107 – Stroke Education includes the principal diagnosis of ischemic or hemorrhagic stroke that starts during inpatient encounter.

• Initial Patient Population =
o AND:
 OR: "Diagnosis, Active: Ischemic Stroke (ordinality: 'Principal Diagnosis')"
 OR: "Diagnosis, Active: Hemorrhagic Stroke (ordinality: 'Principal Diagnosis')"
 starts during "Occurrence A of Encounter, Performed: Non-Elective Inpatient Encounter"

However, eMeasure 55 and 111 include Reporting Stratum 3, which consist of all patients seen in the ED and admitted as an inpatient who have a diagnosis consistent with psychiatric/mental health disorders. The measure specification for these measures requires a principal diagnosis of psychiatric/mental health disorders that starts during the emergency department visit.
• Reporting Stratum 3 =
o AND: "Diagnosis, Active: Psychiatric/Mental Health Patient (ordinality: 'Principal Diagnosis')" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"

This creates a lack of harmony between the measures in looking at the same data element for two different time frames. In order to better align the measures, a suggestion may be to change the language in inpatient measures to “Starts before or during the inpatient encounter” and leave ED “Starts during the ED encounter” to resolve the issue.

Another greater overarching issue is that diagnosis codes do not have associated dates/times. This coding occurs after the patient discharge and is not correlated to a specific date/time, which hampers the use of this data element to verify the existence of a disease processes during a specified segment of the patient encounter. Please feel free to contact me with any questions.