​​Thank you for your question on CMS111, Median Admit Decision Time to ED Departure Time for Admitted Patients. The initial population logic uses the define statement “ED Encounter with Decision to Admit” (shown below). This expression indicates that there is an inpatient encounter that is during the measurement period and is less than or equal to 120 days and then the “let” clause indicates that the LastEDEncounter has documentation that an admitAssessment was performed that resulted in the need to admit the patient and was during LastEDVisit period (admission to discharge). If an assessment was not performed during the ED visit, this part of the expression evaluates if an order to admit the patient was signed during the ED visit. Then evaluates if the ED location is documented using one of the codes in the “Emergency Department Visit” value set and lastly, if the ED location end time is documented, meaning the time the patient physically departed or left the ED. In the scenario provided, if the patient was physically in the ED at 1300 hours when the decision to admit assessment was performed and before discharge, then 1300 hours would be the decision to admit time. The logic assesses for the assessment first, if it meets the criteria then it is used. If there is no assessment, then the logic looks for an order. Please keep in mind that discharge time and departure time are not the same. Admit and discharge times are the start and stop times of an encounter. And arrival and departure are the time the patient physically arrived and physically departed the facility/department. define “ED Encounter with Decision to Admit”: /*Constrains the inpatient encounter to having an ED visit with a decision to admit (assessment or order) to inpatient and ED facility location period is not null*/ Global."Inpatient Encounter" EncounterInpatient   let LastEDVisit: LastEDEncounter(EncounterInpatient),   AdmitAssessment: "AdmitDecisionUsingAssessment"(EncounterInpatient)   where ( Global."NormalizeInterval" ( AdmitAssessment.relevantDatetime, AdmitAssessment.relevantPeriod ) starts during LastEDVisit.relevantPeriod       or ( "AdmitDecisionUsingEncounterOrder"(EncounterInpatient).authorDatetime during LastEDVisit.relevantPeriod )   )     and exists ( LastEDVisit.facilityLocations Location         where Location.code in "Emergency Department Visit"           and Global."HasEnd" ( Location.locationPeriod )     )