Our ED providers are not employed by our organization and do not have admitting privileges so they never write the admission order. They enter an ED disposition of Admit and an IP Attending provider is notified. Sometimes the IP Attending might see the patient while they are still in the ED and write admission orders that are signed and held and released when they arrive on the floor, otherwise the IP Attending writes them after the see the patient once they are on the floor. Once patient placement receives the admission request and assigns a bed, a transport request is entered for the transportation team. Prior to QRDA I believe we had an option to use the ED Disposition vs. the admit order. Epic told us that as of 2014 CMS requires that this decision be documented through an order. Can you give us rationale on this change and why an ED event/ disposition could not count as the decision to admit time? How are other hospitals doing this that don't employ their own ED providers? We set up the measure but have no patients that are making it into the measure because of this workflow.