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  1. eCQM Issue Tracker
  2. CQM-1781

we would appreciate guidance regarding the updates to ED-1 in the July 2015 eCQM specifications, regarding ED date/time..

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      The date and time ​intended to be used to represent the arrival date and time for the mean time from ED Arrival to ED Departure in the Measure Observation is the date and time when the patient arrives at the ED "location" (or department) in the hospital. The date and time ​intended to be used to represent the departure date time included in the Measure Observation is the date and time when the patient leaves the ED "location" (department) in the hospital.
       
      Even if the patient goes to another "location" (department) within that same facility, the date and time when the patient left the ED is the correct time to use.
       
      In order to make this clearer, the data elements used in the Measure Observation will be changed to use the QDM attributes called Facility Location Arrival Datetime and Facility Location Departure Datetime. The definitions of these attributes have also been improved in QDM to add clarity.

      Update to solution March 2016:
      Because this measure is looking at the median time from ED admit to ED discharge for patients admitted to the facility, the inpatient encounter must be preceded by the ED visit. However, the inpatient admit time may not be synonymous with the ED discharge time. This has been addressed in the 2016 Annual Update for this measure by moving the timing constraint for the ED visit from the Measure Population to the Initial Population. In addition, the ED admission date/time and discharge date/time in the Measure Observation have been updated to ED facility location arrival datetime and ED facility location departure datetime. ​
       The ED visit start should be based on arrival to the ED, the timestamp in the EHR that most closely captures the date and time the patient arrives to the ED. The ED visit end should be based on when the patient physically leaves the ED, the timestamp in the EHR that most closely captures the date and time the patient leaves the ED.
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      The date and time ​intended to be used to represent the arrival date and time for the mean time from ED Arrival to ED Departure in the Measure Observation is the date and time when the patient arrives at the ED "location" (or department) in the hospital. The date and time ​intended to be used to represent the departure date time included in the Measure Observation is the date and time when the patient leaves the ED "location" (department) in the hospital.   Even if the patient goes to another "location" (department) within that same facility, the date and time when the patient left the ED is the correct time to use.   In order to make this clearer, the data elements used in the Measure Observation will be changed to use the QDM attributes called Facility Location Arrival Datetime and Facility Location Departure Datetime. The definitions of these attributes have also been improved in QDM to add clarity. Update to solution March 2016: Because this measure is looking at the median time from ED admit to ED discharge for patients admitted to the facility, the inpatient encounter must be preceded by the ED visit. However, the inpatient admit time may not be synonymous with the ED discharge time. This has been addressed in the 2016 Annual Update for this measure by moving the timing constraint for the ED visit from the Measure Population to the Initial Population. In addition, the ED admission date/time and discharge date/time in the Measure Observation have been updated to ED facility location arrival datetime and ED facility location departure datetime. ​  The ED visit start should be based on arrival to the ED, the timestamp in the EHR that most closely captures the date and time the patient arrives to the ED. The ED visit end should be based on when the patient physically leaves the ED, the timestamp in the EHR that most closely captures the date and time the patient leaves the ED.

      We would appreciate guidance regarding the updates to ED-1 in the July 2015 eCQM specifications. More specifically, what dates are intended to be used to represent the ED Visit discharge date time and admission date time included in the Measure Observation section below.

      Population Criteria
      Initial Population = ◦AND: Occurrence A of $EncounterInpatient

      •Measure Population = ◦AND: Initial Population
      ◦AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient

      •Measure Population Exclusions = ◦None

      •Measure Observation = ◦Median of: ◾Datetime difference of: ◾"Occurrence A of Encounter, Performed: Emergency Department Visit (discharge datetime)"
      ◾"Occurrence A of Encounter, Performed: Emergency Department Visit (admission datetime)"

      •Stratifications = ◦Stratification 1 = ◾AND NOT: "Diagnosis, Active: Psychiatric/Mental Health Patient (ordinality: Principal)" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"

      ◦Stratification 2 = ◾AND: "Diagnosis, Active: Psychiatric/Mental Health Patient (ordinality: Principal)" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"

      As we all know, workflows vary across healthcare organizations, in some cases, a patient seen in the ED that is admitted for inpatient care will have 2 encounters created, one for the ED encounter and one for the Inpatient encounter (2 encounter scenario). In other cases, a single encounter may be used and in this case the patient registration record is updated from an ED to Inpatient encounter type and transferred from the ED location to an acute care nurse unit (single encounter scenario).

      Example > Single encounter scenario

      Patient arrives via ambulance to the ED on 11/13/2015 at 0900.
      Patient is registered and the registration transaction occurs on 11/13/2015 at 0930. The registration includes this info:
      Arrival Dt/Tm of 11/13/2015 0900
      Encounter Type: ED
      Location: ED unit
      Decision to admit occurs and an admit order is placed on 11/13/2015 at 1030. The patient registration info is updated to include:
      Encounter Type changed from ED to IP
      Inpatient Admit Dt/Tm 11/13/2015 1030
      Location: ED unit (doesn’t change because patient hasn’t been moved physically to an inpatient bed)
      Arrival Dt/Tm: 11/13/2015 0900 (doesn’t change)
      At 1130, the patient is physically moved to an acute care unit. The patient registration info is updated to include:
      Location: ED unit is changed to applicable nurse unit, room, and bed, e.g. 1North, 101, A
      Encounter Type, Inpatient Admit Dt/Tm, and Arrival Dt/Tm stay the same.
      Note: there is no discrete date/time entered for time of transfer in registration, but rather there is a transaction date/time recorded of when the unit was changed on the registration record.
      Note: In a single encounter scenario there is no discrete ED discharge dt/tm captured when a patient is transferred to an inpatient unit.

      In this example, what should be used for Encounter, Performed: Emergency Department Visit (admission datetime)? In comparison to the HIQR chart-abstracted measures, we think of admission dt/tm to mean when the patient was admitted for acute inpatient care, however in these eCQM specifications, this does not appear to be the purpose. In this example, would this be the Arrival Dt/Tm or the time the registration transaction took place and the patient was identified with an ED encounter type?

      Also in this example, what should be used for Encounter, Performed: Emergency Department Visit (discharge datetime)? As noted above, in a single encounter scenario, there is no discharge transaction that takes place when the patient is moved from ED to Inpatient. In this example, would this be the transaction dt/tm when the encounter type is changed from ED to IP or would this be the transaction dt/tm when the location is changed from ED unit to inpatient unit?

      A JIRA was logged by another person that is related:

      https://jira.oncprojectracking.org/browse/CQM-1645?jql=text%20~%20%22departure%22

      However the response uses the same terms that were used to define the measure, which does not provide clarity.

            JLeflore Mathematica EH eCQM Team
            cerlld Lynn Baldwin (Inactive)
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