​​Thank you for the inquiry on CMS111, Median Admit Decision Time to ED Departure Time for Admitted Patients. The intent of the measure is to capture the most recent (Last) time of the decision to admit. This can be captured with an assessment performed that indicates a result to "Admit Inpatient" or an encounter order that indicates "Decision to Admit to Hospital Inpatient". If there are multiple assessments with a result to "Admit Inpatient", the intent is to capture the most recent assessment that is during the ED and before the patient departed ED. If there are multiple orders with a "Decision to Admit to Hospital Inpatient" then the intent is to capture the most recent order with a "Decision to Admit to Hospital Inpatient". If both an encounter order and assessment performed both meet the criteria (during the ED encounter, prior to departing and concepts from the value sets), then the most recent assessment is used.