The intent of this measure is very useful for quality improvement but not without excluding patients who have diagnoses requiring the use of high risk meds. As it is currently written all providers in a multispecialty clinic or academic medical center who share a patient's medical record would most likely fail due to the patient being seen in one of many specialty clinics and having a high risk medication ordered due to a high risk diagnosis. Exclusions should be added to the denominator for diagnoses requiring high risk medications.