Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We understand the intent of your inquiry is to determine what EHR date/timing information is required to document a STEMI diagnosis. The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. A patient with a STEMI diagnosis may be captured in the measure in two ways, as indicated by the measure logic definition below found in the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]: ED Encounter with STEMI Diagnosis "ED Encounter During MP" EDEncounterinMP     where (exists (["Diagnosis": "STEMI"] DxSTEMI       where DxSTEMI.prevalencePeriod starts during EDEncounterinMP.relevantPeriod))     or (exists( EDEncounterinMP.diagnoses EncounterDiagnosis       where EncounterDiagnosis.code in "STEMI" ))   First, a STEMI diagnosis can be pulled directly from the ED encounter if a STEMI diagnosis was coded at any point during the encounter. Second, the patient can have a diagnosis pulled from a claim, problem list, or other source in the EHR as long as the prevalencePeriod of the STEMI diagnosis started during the ED encounter relevantPeriod. PrevalencePeriod is an attribute of the “Diagnosis” datatype and signifies the onset dateTime to abatement dateTime of the STEMI diagnosis. RelevantPeriod is an attribute of the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time). To differentiate between active and historic diagnoses in the problem list, it’s important for both the onset and abatement times to be populated in the EHR and mapped to the appropriate QDM data elements to avoid misattribution. We encourage you to ensure that the timing components associated with the measure are captured accurately, even if the STEMI diagnosis is being pulled from a source other than the encounter diagnosis. We highlight that it is the intent of the measure to capture a confirmed STEMI diagnoses during the ED encounter. Therefore, as long as the time stamp used confirms that a STEMI diagnosis occurred during the ED encounter during the measurement period, the encounter should be captured in the measure denominator. This is especially the case if the STEMI diagnosis is being pulled from the ED encounter diagnosis field in the EHR otherwise known as the “Encounter, Performed” datatype’s diagnosis attribute.

Due to the specifications of STEMI (OP-40), requiring a date/time of the STEMI diagnosis to include/exclude patients and the limitation of coding systems not being able to capture a time of diagnosis, only date. What should be documented by hospital staff for the time of diagnosis of STEMI. Some suggestions STEMI code activation, the signing of the first note with the diagnosis listed, and documentation of the EKG being read.