Hello,

Can you please provide guidance on the following:

1. The Numerator guidance states the following:
   1. Emergency department encounters with a diagnosis of STEMI:
       - where time from ED arrival to fibrinolysis is 30 minutes or fewer;
      OR 

• where PCI is performed within 90 minutes of arrival for non-transfer patients; 
  OR
  - where the patient is transferred within 45 minutes of ED arrival.{}

                                Question: If a patient is transferred from an ED encounter type/location to an Inpatient encounter type/location in the same facility and has a discharge disposition of "Acute Care Facility" does this scenario meet the intent of the measure? 

2. Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter
"ED Encounter with STEMI Diagnosis" EDwSTEMI
  with ["Procedure, Performed": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
    such that Global."NormalizeInterval" ( CranialorSpinalSurgery.relevantDatetime, CranialorSpinalSurgery.relevantPeriod ) starts 90 days or less before start of EDwSTEMI.relevantPeriod

Question: When determining 90 days, is the first day of the EDwSTEMI encounter considered day 1 or is it 90 FULL days or less before start of the encounter (encounter start date - not date and time)?

3. Similar question as above:

Major Surgical Procedure 21 Days or Less Before End of ED Encounter
"ED Encounter with STEMI Diagnosis" EDwSTEMI
  with ["Procedure, Performed": "Major Surgical Procedure"] MajorSurgery
    such that Global."NormalizeInterval" ( MajorSurgery.relevantDatetime, MajorSurgery.relevantPeriod ) starts 21 days or less before 
    end of EDwSTEMI.relevantPeriod

Question: When determining 21 days, is the last day of the EDwSTEMI encounter  considered day 1 or is it 21 FULL days or less before end of the encounter (discharge date - not date and time)?