Brief description of measure CMS996: ​Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED): Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival. Description of issue ​The Global Common Library, a shared CQL library across eCQMs, includes a function that defines ‘Emergency Department Arrival Time’ and applies the “Emergency Department Visit” value set (OID: 2.16.840.1.113883.3.117.1.7.1.292) as a location: /Returns the arrival time in the ED for the encounter./ define function "EmergencyDepartmentArrivalTime"(Encounter "Encounter, Performed" ):  start of First(("HospitalizationLocations"(Encounter))HospitalLocation                                where HospitalLocation.code in "Emergency Department Visit"                                sort by start of locationPeriod ).locationPeriod   The intent of this function is to return the arrival time in the ED for the encounter. However, the representation of the location code using the ‘Emergency Department Visit’ value set that includes one SNOMED-CT code with the ‘procedure’ semantic tag, does not align with how this is expected to be modeled using the Quality Data Model (QDM) (used for CQL eCQMs) or the QI-Core data model (used for FHIR eCQMs). Measure developers are considering whether this misalignment with the recommended terminology to capture a location should be addressed during this annual update, by any (though not mutually exclusive) of the following:   1. Add SNOMED-CT concept(s) with an ‘environment’ semantic tag as an alternate option      (NOTE: This does not align with The Blueprint terminology recommendation to represent this type of concept, nor does it align with the direction QI-Core/FHIR is moving.)    2. Replace the currently applied value set with the ‘Emergency department location’ value set (OID: 2.16.840.1.113762.1.4.1111.14) that contains 2 SNOMED-CT codes: 225728007 - Accident and Emergency department (environment); and 73770003 - Hospital-based outpatient emergency care center (environment)       (NOTE: This does not align with The Blueprint terminology recommendation to represent this type of concept, nor does it align with the direction QI-Core/FHIR is moving.)     3. Replace/add the HSLOC terminology to represent the location of emergency department visit       (NOTE: This aligns with The Blueprint terminology recommendation to represent this type of concept; however, it does not align with the direction QI-Core/FHIR is moving.) Measure developers are seeking input from implementers to determine whether to retain the current representation of the Emergency Department location within the Global Common Library, or to modify how this is captured and reported. In particular, measure developers are interested in responses to the following questions:     - Since implementers are already reporting this measure, would an update cause burden?Is there a benefit to updating?     - Is the information that is currently retrieved and submitted as arrival time actually referenced the encounter (procedure) start, which would be admission time?     - Or is arrival time being reported regardless of the code indicated in the value set? Goal of review Obtain clinical and technical feedback

Proposed solution ​Due to planned transitions to FHIR-based measures, measure developers are unsure whether to make a change at this point, or to keep the specification static in light of this being implemented for some time now. Input from the CRP community on the options noted above will help measure developers evaluate if a change at this time is beneficial, or if it would increase burden. Rationale for change This content has been present in eCQMs in the Global Common Library for several years, despite being misaligned with the terminology recommendations outlined in The Blueprint. However, it came to light with the recent publication of CMS996 for the Outpatient Quality Reporting program. In light of planned transitions to FHIR-based measures, measure developers are weighing the benefits and risks of leaving this issue in place to alleviate implementer burden associated with any change.