For ED-2 versions 3, 4, and 5 Encounter, Order: Decision to Admit to Hospital Inpatient has been limited to: Hospital Admission, emergency, from emergency room, accidental injury; Hospital Admission, emergency, from emergency room, medical nature; Hospital Admission, emergency, from emergency room; and Hospital Admission, for observation (added in version 4). As this issue has been brought forth in other JIRA tickets we are discussing with the measure steward to determine if adding other options such as admitted to inpatient; inpatient bed assignment; transferred to inpatient; and ED disposition of inpatient Admit align with measure intent. Then we would need to determine if these are standard structured data in the most EHRs and if there are QDM elements that could be mapped to these data. If this is determined to be a viable approach we will need to address in CRP. Thank you.

For ED-2 versions 3, 4, and 5 Encounter, Order: Decision to Admit to Hospital Inpatient has been limited to: Hospital Admission, emergency, from emergency room, accidental injury; Hospital Admission, emergency, from emergency room, medical nature; Hospital Admission, emergency, from emergency room; and Hospital Admission, for observation (added in version 4). Based on initial feedback from the field, we are considering expanding the decision to admit concept definition to include other options such as: admitted to inpatient; inpatient bed assignment; transferred to inpatient; and ED disposition of inpatient admit. As we review these concepts with the measure steward to determine the appropriateness for alignment with measure intent, we would like to obtain feedback from the field on the clinical relevance and technical feasibility of capturing these concepts, in particular whether there are standard structured data in EHRs to capture these concepts.

To provide the following additional guidance: Decision to Admit: First documentation of the decision to admit the patient from the ED. Specification: as admission processes vary at different hospitals, this can use the first documented time of any of the following: 1) admission order (this may be an operational order rather than the hospital admission to inpatient status order), 2) disposition order (must explicitly state to admit), 3) documented bed request, or 4) documented acceptance from admitting physician. This is not the “bed assignment time” or “report called time.” And to revised the IP Logic to add o AND: "Occurrence A of Encounter, Order: Decision to Admit to Hospital Inpatient" satisfies all: § starts during "Occurrence A of Encounter, Performed: Emergency Department Visit" § starts before start of “Occurrence A of Encounter Performed: Emergency Department Visit (facility location departure datetime) Thank you for all the comments in assisting with these enhancements.