For the STEMI eCQM we had a scenario where there were two separate encounters that had overlapping times ---one is a Clinic Encounter, one is an Emergency encounter.  The Clinic encounter had a STEMI diagnosis on the coding profile.  The Emergency encounter did not have any STEMI diagnosis on the coding profile.  

The timing of the STEMI diagnosis in the clinic from a timing perspective did happened between the patient's ED arrival time and ED department time.  There were no STEMI diagnosis associated with the ED encounter.  Should patients qualify for the STEMI measure if we find STEMI coding across all encounter types if the coding falls between ED arrival and ED departure? 

If not (which we believe our previous Jira https://oncprojectracking.healthit.gov/support/browse/CQM-6520 indicated), could the specifications be updated to clarify this?  This line is causing confusion where some are interpreting it that we SHOULD include STEMI diagnosis from any encounter type if the timing of when the diagnosis is documented is between ED arrival and ED depart . Could this be clarified to state that the STEMI dx would still need to be associated with the Emergency Encounter? 
such that ( DxSTEMI.prevalencePeriod starts during EDEncounter.relevantPeriod )
and EDEncounter.relevantPeriod during "Measurement Period"