We have a measure that appears to test properly at the patient level in the Numerator.

The problem is at the Numerator. Each UNION has a timing element of ends before start of. It tests properly at the patient level, but does not turn "blue" at the measure level. All of the NUMER testing indicates the measure is working as intended.

NUMERATOR:(STATUS: TRUE)
TOGGLE NUMERATOR

• AND :(status: true)
o OR :(status: true)
 UNION OF:
 Medication, Active: Calcium And Vitamin D For Male Urology Care(status: true)

 UNION OF:
 Laboratory Test, Performed: Calcium, Total(status: true)
 Laboratory Test, Performed: Vitamin D, 25 Hydroxy, Total(status: true)
 ends before start ofMedication, Active: Osteoporosis Medications For Urology Care(status: true)
o OR :(status: true)
 UNION OF:
 Medication, Active: Calcium And Vitamin D For Male Urology Care(status: true)

 UNION OF:
 Laboratory Test, Performed: Calcium, Total(status: true)
 Laboratory Test, Performed: Vitamin D, 25 Hydroxy, Total(status: true)
 ends before start of Medication, Order: Osteoporosis Medications For Urology Care
As you see, the ends before start of turns green at the patient level.

However, at the measure summary level, we get the following:
AND :
• OR :
o UNION OF:
 Medication, Active: Calcium And Vitamin D For Male Urology Care(status: covered)

 UNION OF:
 Laboratory Test, Performed: Calcium, Total(status: covered)
 Laboratory Test, Performed: Vitamin D, 25 Hydroxy, Total(status: covered)
 ends before start of Medication, Active: Osteoporosis Medications For Urology Care(status: covered)
• OR :
o UNION OF:
 Medication, Active: Calcium And Vitamin D For Male Urology Care(status: covered)

 UNION OF:
 Laboratory Test, Performed: Calcium, Total(status: covered)
 Laboratory Test, Performed: Vitamin D, 25 Hydroxy, Total(status: covered)
 ends before start of Medication, Order: Osteoporosis Medications For Urology Care
The ends before start of does not turn blue and our %coverage is 95%. This is the only part of the measure that does not appear to work.
We are trying to express: The patient is actively on calcium and Vitamin D and had a Calcium and Vitamin D level completed prior to the start of osteoporosis medication.