Hoping to get a clarification on this item which I think could potentially be an issue.

For the Adverse Event” logic in OP-40 (CMS996v4) (See below), the only date/time used in “relevantDateTime” and the definition returns true if the adverse event relevantDateTime is before encounter end date/time.

Issue:

This could potentially cause an incorrect eCQM calculation (for encounters after the first ED encounter in the quarter) if there were multiple ED encounters during the quarter.

Example:

Let’s take an example where the QRDA CAT I xml file for a patient (75 years old) in a quarter has 2 ED encounters with STEMI.

ED Encounter 1 – (Has Encounter Diagnosis of STEMI)

• Encounter Start – 01/15/2024 8 AM
• Encounter End – 01/19/2024 10 AM
• Adverse Event to Thrombolytic Medication - relevantDateTime 01/16/2024 9 AM

Outcome –

• Adverse Effect to Thrombolytic Medications Before End of ED Encounter will be true and patient will be Excluded as expected.
  • Adverse Event relevantDateTime (01/16/2024 9 AM) ends before encounter end date/time (01/19/2024 10 AM)
• This is the expected result so no problem.

ED Encounter 2 – (Has Encounter Diagnosis of STEMI)

• Encounter Start – 02/15/2024 8 AM
• Encounter End – 02/18/2024 10 AM
• No Adverse Event to Thrombolytic Medication

Outcome –

• Adverse Effect to Thrombolytic Medications Before End of ED Encounter will be true again and patient will be Excluded but this time this would not be the expected result. Why?
  • There is no adverse event to thrombolytics with the 2^nd ED encounter.
  • But based on the definition logic, the system would find the Adverse Event relevantDateTime (01/16/2024 9 AM) in the QRDA CAT I xml file from the first encounter and use it to evaluate the “ends before encounter end date/time” (02/18/2024 10 AM) logic when evaluating the second encounter. And the definition will return true (since 01/16/2024 is before 02/18/2024), and the patient will be excluded from the second encounter but this time incorrectly so.
• I would think that this would not be the expected result. Since there was no adverse event to Thrombolytic during the second encounter, the case should NOT be excluded. But in this case, it would. And this would be a problem for any subsequent ED encounter with STEMI after the first Encounter where the patient has this adverse event. OR Is the intent that once there is an adverse event of a type in one encounter, it is considered an adverse event for all subsequent encounters?

Could you please review the above and let me know if I am interpreting this correctly?

Thanks for your review and response.