This test patient ("C, Heart_Adult") data makes it challenging for some systems to calculate the result correctly.

For this test patient, "Diagnosis, Active: Depression" is start before start of "Risk Category Assessment: Adult Depression Screening" so this patient should be put into the denominator exclusion. This Cypress test patient and expected result for CMS2 is correct in terms of eCQM logic.

However, the time "Diagnosis, Active: Depression" started on the same date of "Risk Category Assessment" and just one hour before. For outpatient healthcare practice, the time granularity is usually at "day" level--All the clinical activities during the same day would account for only a single visit. Thus, some ambulatory systems do not record the exact time of diagnoses or other interventions, only the date.

The essence of this denominator exclusion is to exclude pre-existing depression. The situation that this Cypress patient with a diagnosis one hour before the screening, during the same day with the same provider, is less likely to happen. For an ambulatory system, it may not be able to accommodate this situation (or require an unnatural way to create data).

We had a hard time to get this patient into the right category. The same rule needs to put this patient (C, Heart_Adult) into Denominator Exclusion while the patient (B, GP_Peds) into Numerator. The data for "B, GP_Peds" makes more practical sense.