Thank you for your question regarding Venous Thromboembolism Prophylaxis (CMS0108v13). For the 1st question: Based on the provided scenario, the emergency department (ED) discharge is one minute after the Observation admission time. Therefore, the ED visit would not qualify the "Global.HospitalizationWithObservation(Encounter)". This is because the logic uses the condition “ends 1 hour or less on or before VisitStart”, which means the ED visit must conclude no later than the start of the Observation (or Inpatient) encounter, and within a 1-hour window prior. Therefore, if the ED visit ends after the Observation start time—even by one minute—it does not meet the criteria and would not be included in the Global.HospitalizationWithObservation interval. For the 2nd question: "Start of Hospitalization" could be ED, Observation or inpatient admission time, whichever is qualifying the function "Global.HospitalizationWithObservation(Encounter)". In the provided scenario, the ED visit would not qualify the "Global.HospitalizationWithObservation(Encounter)", but the Observation ends within 1 hour before inpatient admitDateTime. Therefore, the start of Hospitalization will be the "OB AdmitDataTime as 3/19/2025 5:37:13.

We are in the process of improving our capture in the QRDA file to include ED and OBS encounters prior to the inpatient acute care admission and have some questions to ensure we are using the correct calculations in our internal reporting system and would match the calculations on TJC DDSP platform.