It's true that EHRs already provide decision support - but they can only provide decision support with respect to information they already know.  Payers may well be aware of information (e.g. based on submitted claims) that the EHR has no knowledge of.  As such, there's still value in providing this sort of decision support. That said, it would be worth being explicit that a payer should only provide decision support around contraindications, duplicate therapy, etc. if they know that they have information that is not already present in the EHR and where this information is not going to be provided from the payer via an alternative mechanism (e.g. NCPDP).  We should make that clear in the spec.  (Note that contraindications is not limited to drug-drug interactions - there are a wide variety of contraindication types that don't involve medications at all.)   We will make explicit: provision of decision support outside the coverage and documentation requirements space is optional (for both server and client) servers that provide decision support for non-coverage/documentation areas SHALL check that the EHR does not have the information within its store that would allow it to detect the issue itself.  If the information already exists in the EHR, then the obligation is on the EHR to manage the issue detection and reporting in its own manner and payer systems should not get involved.