Quality Management contains both pay for performance (P4P) programs from different insurance providers as well as clinical guidelines. The list of programs, measures, and results are always in reference to a specific patient and provider. If a provider is not specified, the default provider is used (which is usually the provider that has seen this patient the most often). The system generally recalculates the measure results each morning, if the patient has an appointment that day or if the system detects a change in the patient data. This means that any changes to the patient chart or current encounter may not be reflected in the results. Users can manually force a refresh of the measure results. When this happens, two processes are launched. A synchronous one that only refreshes the results for the given provider, which will be current once the update call returns, and an asynchronous one for all providers. As these measure calculations are resource intensive, the system prevents you from running a refresh more often than once a minute. Please get the last refresh time to see if you actually need to refresh the patient data. The last refresh time is updated only after the full asynchronous call completes. There is another rate limiter that prevents users from running the refresh (it will return with a failure) as each run locks the patient for 18 seconds. The refresh can take a while on older (low practice ID) and larger practices, so please be patient. The results can have multiple statuses, including Needs Work, Satisfied, Satisfied (but can be Due Soon), Not Satisfied (but can be Out of Range so fixable), Excluded, or Snoozed. Only clinical guideline measures can be snoozed. The results can be filtered on whether it's a P4P or Clinical Guidelines measure, as well as two status categories -- All or Needs Attention. Needs Attention results include the statuses of Needs Work, Satisfied (Due Soon), or Not Satisfied (Out of Range). The remaining ones are part of 'All'.