Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We created a test case to replicate the scenario and time stamps described in the inquiry where the first and second encounters were defined as the following: Encounter 1: ED admission occurred on 2/19 at 10:12AM ED discharge occurred on the same day at 11:00AM A STEMI diagnosis was not documented in the EHR Encounter 2: ED admission occurred at 11:08AM A STEMI diagnosis that occurred during the ED encounter was documented in the EHR PCI occurred at 11:47AM   Results of the test case revealed that the first encounter was not included in the measure denominator because the patient did not have a STEMI during the ED encounter. However, the second encounter met denominator and numerator criteria because the STEMI occurred during the ED encounter, and the patient received PCI treatment (at 11:47AM) within 90 minutes of ED arrival time (11:08AM). To ensure that only the second encounter properly triggers the measure’s numerator and denominator, we recommend (i) ensuring that the first encounter’s end date/time of 11:00AM is accurately documented in the EHR so that each encounter is documented as distinct from the other, and (ii) that the facility location startTime and stopTimes that the patient arrived and departed from the ED are accurately documented in the EHR in relation to each ED encounter.

If a patient has an ED visit where no STEMI is diagnosed and then comes back later for another ED visit where it is diagnosed, the PCI will be done on that visit not the original one causing inaccurate data for analysis. Here is an example: Patient arrives at the ED on 2/19/2025 @ 10:12 AM and is discharged at 11:00 AM with no Encounter diagnosis for STEMI. Patient returns to the ED 8 minutes later and is admited to the ED at 11:08 AM with a STEMI diagnosis. PCI is done at 11:47 AM which is within the 90 minutes of the second ED arrival. The SQL logic that our organization is using to capture the data is looking at the first ED visit instead of the second ED visit because they are interpreting the logic as Global.EmergencyDepartmentArrivalTime to mean both ED encounters since they were on the same day. Thus, they pull the first time as the arrival time. This does not make sense in the real world. Why would we do a PCI on a patient with no STEMI diagnosis in anticipation that they will return later in the day with a STEMI diagnosis and need one? Are we interpreting the Global.EmergencyDepartmentArrivalTime correctly?