Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure does not currently use timing of electrocardiograms (EKGs). This decision was based on clinical expert input and measure testing results, which indicate that EKG timing in electronic health record (EHR) documentation is unreliable. The measure developer will continue to evaluate feedback and recommendations during the annual update cycle and will work with CMS to update the measure as needed to align with clinical guidelines and workflow.

Is there a measure exclusion when the initial EKG does not show ST elevation but a subsequent EKG does? The clock starts at arrival for measure components like time to fibrinolytic and time to transfer. If 1st EKG isn't ST elevation it doesn't seem like a fair expectation to meet timed components.