The measure PC-01: Elective Delivery numerator looks for history of specific procedures or diagnoses, which the reporter stated is not possible to capture as the documentation would have to occur prior to the delivery encounter. The topic for discussion with CRP is, given the constraints described below, what recommendations do implementers have to improve the feasibility of capturing patient history in an eCQM? In cases such as this measure, the clinical intent is specifically to capture history and not current conditions or procedures. There are not consistent ways within standards to represent history. For example, there are not "history of" ICD-10 and SNOMED codes we can rely on for these data elements. Therefore, if patient history of these procedures is documented during this encounter, we cannot differentiate whether the intent was to document history or if the condition was present/procedure performed during the encounter. The logic you provide is not from the exclusions, it is actually part of the measure numerator and is used to define cases in which a cesarean birth is performed prior to the onset of labor and in the absence of prior uterine surgeries. If you do not have the ability to capture start times prior to the encounter, you may have more numerator cases than you would expect, as the numerator may include cesarean birth cases where there is missing data for prior uterine surgeries. The question for CRP: How is patient history modeled in the EHR? How does the EHR differentiate between current conditions and procedures, and history?