​Thank you for your question. The assessments performed during observation, a status prior to admission, will not be counted in the numerator. We also understand that it would be important not to order additional consults to meet the measures. The Change Review Process evaluated potential solutions to address capturing this data and concluded that limitations to the standards used to define the measures, including the Quality Data Model and eCQM expression language, prevent efficient representation for these types of care. Plans to address this continue to be under discussion.​​

Patients are classified as observation initially but turned in to inpatient , Assessment for Rehab is done while on observation status. When the status was changed to inpatient (same hospital stay), assessment for rehab already performed while on observation status are not being captured and is showing as not compliant

If a patient is admitted to the hospital in "observation" status but later was changed to inpatient status, assessments performed during observation, will not be counted in the numerator. Same situation occurs in the following measures as well.   1. In STK-5, Antithrombotic Therapy administered in Observation will NOT be counted in the Numerator as current Hospitalizations function. 2. In STK-2, 3, 6, 8,10, VTE-1, 2 measures, Comfort Measure that were ordered, implemented, and documented during "observation" or "outpatient in bed" status do NOT count in the Denominator Exclusion. ​We evaluated potential solutions to address capturing this data and concluded that limitations to the standards used to define the measures, including the Quality Data Model and eCQM expression language, prevent efficient representation for these types of care. We propose to create a new function to include Observation as an Encounter, performed to capture a patient who was admitted to inpatient through the following scenario. · ED -> Observation -> Inpatient · Observation -> Inpatient

With Value set “Observation Services” -(2.16.840.1.113762.1.4.1111.143) is established in VSAC, we had discussion with ESAC on how to include Observation period into hospitalization period. With the new proposed function, a patient who is admitted to the hospital in "observation" status but later was changed to inpatient status will be captured and will be evaluated in the measure appropriately.   Current Function used in current measures:  Global.Hospitalization(Encounter "Encounter, Performed") ( singleton from ( ["Encounter, Performed": "Emergency Department Visit"] EDVisit where EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod ) ) X return if X is null then Encounter.relevantPeriod else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]   Proposed new Function to be used:  Global."Hospitalization with Observation” (Encounter "Encounter, Performed" ):     Encounter E         let    ObsVisit: Last(["Encounter, Performed": "Observation"] O      where O.relevantPeriod ends 1 hour or less on or before start of E.relevantPeriod   sort by end of relevantPeriod),   VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of E.relevantPeriod),   EDVisit: Last ( ["Encounter, Performed": "Emergency Department Visit"] ED         where ED.relevantPeriod ends 1 hour or less on or before VisitStart   sort by end of relevantPeriod )        return Interval[Coalesce(start of EDVisit.relevantPeriod, VisitStart), end of E.RelevantPeriod]