Consider separating when/where into the local Workflow versus Practice Guideline. Not sure how well HCO's would respond to guideline organizations telling them how to actually do their work (e.g. a medication reccommendation targeted to a mid-level/advanced practice provide versus a clinical pharmacist feels like a organizational decision)

Add Metric/Measure for "Did it happen?" on recommendation. For instance, given a recommendation was made (denominator criteria), was it actually done (numerator) for a process measurement. Also, the Plan:Goal parameter for a Recommendation could similarly constitute the numerator criteria for an intermediate outcome measurement.