The attached patient includes a diagnosis of depression that begins at 3/1/12 at 10 AM. A screening for depression is then recorded at 11 AM, 60 minutes later. Because the screening happened after the diagnosis, Cypress expects the patient to be excluded.

However, this patient assumes and requires that the diagnosis start date and the screening documentation be recorded to a precision of minutes. But this level of precision is almost never available in real-world scenarios and is not required by the HQMF standard.

If the precision recorded is to the hour or minute, this patient is excluded from the measure because they have a pre-existing diagnosis of depression. If the precision is day, then the patient is not excluded because “Occurrence A of Diagnosis, Active: Depression diagnosis" starts before start of "Occurrence A of Risk Category Assessment: Adult Depression Screening” evaluates to false.

Cypress requires that the patient be excluded. This test patient is invalid and should be replaced.