​ Thank you for the inquiry. Question 1: If a patient is sent to the ED from one of the outpatient clinics located at our facility (under same CCN), should this patient be excluded from the ED-2 initial population? Response 1: The ED-2/CMS 111 exclusion aims to exclude patients who have an admission source specified in the “Hospital Settings” (2.16.840.1.113762.1.4.1111.126) value set. The purpose of this value set is to identify concepts of inpatient or outpatient hospital admission sources. Patients are excluded if the admission source is coded as one of these: 225728007 Accident and Emergency department (environment) 33022008 Hospital-based outpatient department (environment) 69362002 Hospital-based ambulatory surgery facility (environment) 73770003 Hospital-based outpatient emergency care center (environment) 284548004 Hospital department (environment) 440654001 Inpatient environment (environment) 22232009 Hospital (environment)   Question 2: If a patient in the ED who meets initial population criteria receives an assessment where the outcome is decision to admit at 1/1/2022 0100, then an admission order placement at 1/1/2022 0400, which would be used as the 'decision to admit' time? (We are a bit confused by the measure flow as to whether there is a hierarchy that places assessment above other means of decision to admit, despite which time is closest to admission) Response 2: The initial population of the measure intends to capture the most recent decision to admit (assessment or order) that occurred during the most recent ED Visit. There is no hierarchy. Question 3: If a patient meeting all other initial population criteria has a decision to admit at 0100, followed by an admission to obs at 0200, followed by a decision to admit again at 0230 (all while in still the ED) followed by a departure for inpatient at 0300: a) is the patient included in the measure population b) what is the decision to admit time? c) Does the time calculation include the 30 minutes the patient was in observation status in the ED? Thanks so much for your help! Response 3: We begin by evaluating the most recent decision to admit that occurred in the ED Visit, per the scenario, this is at 0230 which is prior to patient departing the ED at 0300, presuming the patient ED Visit end time is within an hour of the inpatient admission time, the patient will be included in the initial population. Hope this is helpful.

We are seeking clarification on 2 elements of the ED-2 eCQM - Population exclusion & Decision to admit variables: 1) Population exclusion - if a patient is sent to the ED from one of the outpatient clinics located at our facility (under same CCN), should this patient be excluded from the ED-2 initial population? 2) If a patient in the ED who meets initial population criteria receives an assessment where the outcome is decision to admit at 1/1/2022 0100, then an admission order placement at 1/1/2022 0400, which would be used as the 'decision to admit' time? (We are a bit confused by the measure flow as to whether there is a hierarchy that places assessment above other means of decision to admit, despite which time is closest to admission) 3) If a patient meeting all other initial population criteria has a decision to admit at 0100, followed by an admission to obs at 0200, followed by a decision to admit again at 0230 (all while in still the ED) followed by a departure for inpatient at 0300: a) is the patient included in the measure population b) what is the decision to admit time? c) Does the time calculation include the 30 minutes the patient was in observation status in the ED? Thanks so much for your help!