Many responses to OP-40 questions about PCI time have mentioned the need to prioritize balloon inflation time. The answers infer the intent of the measure and a hierarchy for data collection. These answers are unfortunate because this is not technically supported by QDM v5.6 or FHIR today.

Example responses:
CQM-6980
CQM-6984

The affected measure logic as published in CMS996v4 is as follows:

"ED Encounter with STEMI Diagnosis" EDwSTEMI
  with ["Procedure, Performed": "Percutaneous Coronary Intervention"] PCI
    such that Global."NormalizeInterval" ( PCI.relevantDatetime, PCI.relevantPeriod ) starts 90 minutes or less after Global."EmergencyDepartmentArrivalTime" ( EDwSTEMI )

As stated in QDM v5.6, A "Procedure, Performed" relevantPeriod references a start and stop time for a procedure that occurs over a time interval. The startTime references the time the procedure begins and the stopTime references the time the procedure ends. In QDM, it is inappropriate to pick a surgical event as the relevantPeriod.

Additionally in FHIR, there is not clarity on how individual surgical events should be represented; however, it is clear that it should not just be thrown into a performedPeriod FHIR-48449.

As of RY 2025, OP-40 is unusable and will provide inconsistent results. EHRs must be certified to the Quality Data Model definitions for data elements, so providing guidance that data should be manipulated or adding data hierarchies is a misinterpretation of QDM.

We do not disagree with the intent to capture PCI Balloon time. This is clearly the intention for a Door-to-Ballon metric; however, to improve this measure, the PCI data element must be transformed to a specific observation of "PCI Balloon Time." Without this adjustment, this measure will remain unusable.