Thank you for your inquiry specific to CMS816 Hospital Harm – Severe Hypoglycemia (HH-1) and CMS871 Hospital Harm – Severe Hyperglycemia (HH-2). For both CMS816v3 and CMS871v3, the inpatient hospitalization includes time in the emergency department (ED) and/or observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other. The measure logic uses a function called “Global.HospitalizationWithObservation” to create this interval in order to include care provided to patients if they were in ED and/or observation prior to admission. The function is commonly used across several other measures, which is noted by the term ‘Global’ at the start of the function name. For more information on Global common functions, please review the Global Common Library, located on the eCQI Resource Center here: https://ecqi.healthit.gov/ecqi-tools-key-resources?url_title=global&category=All&role=All As an example to further clarify this interval in relation to CMS871, if the patient had an ED visit on 6/1/23 that ended at 9:00pm and was then admitted from there to inpatient within an hour (i.e., by 10:00pm), then the time in the ED is considered part of the entire inpatient hospitalization encounter. Looking at the additional criteria to meet the initial population for HH-2, which is at least one of the three criteria below, if the patient was diagnosed with diabetes while in the ED, or was administered the dose of insulin or other hypoglycemic medication while in the ED, or if had a glucose value >= 200 mg/dL while in the ED, then they would meet the criteria to be in the initial population. • A diagnosis of diabetes that starts before or during the encounter; or • Administration of at least one dose of insulin or any hypoglycemic medication during the encounter; or • Presence of at least one glucose value >=200 mg/dL at any time during the encounter Regarding your question about having an order for an inpatient/observation encounter, both measures use the codes found in the following value sets to identify in the EHR the encounter type: "Emergency Department Visit" ( OID 2.16.840.1.113883.3.117.1.7.1.292) "Observation Services" (OID 2.16.840.1.113762.1.4.1111.143) "Encounter Inpatient" (OID 2.16.840.1.113883.3.666.5.307) Regarding your comment about the 24-hour timing, this refers to the evaluation of the numerator criteria, where the first 24 hours of the encounter are excluded. Thank you.