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91������ does not support MIPS measure ID# TBD: “Zoster (Shingles) Vaccination.” While this measure represents an important clinical concept, the measure steward does not present detailed information on the measure specifications, opportunity for improvement, testing results, or evidence reviewed by the developers to form the basis of the measure, therefore; we cannot meaningfully assess the validity of this measure. That said, we do note some concerns for the developers to consider prior to submitting this measure to payment, accountability, and reporting programs for adoption. First, specifying the age parameter as >50 years could be problematic as vaccine availability rates across the country are low. Second, the fact that the specifications do not include any exclusion criteria is challenging. Developers should consider revising the specifications to include exclusion criteria for socio-economic and environmental factors affecting accessibility; patients with limited life-expectancy; and patient refusal. Third, developers should identify vaccines that meet the reporting requirements in the numerator details. Many patients refuse vaccination because they cannot afford treatment or, they cannot withstand the side effects of treatment or the pain associated with the injection. Finally, poor interoperability across electronic systems poses some burden on clinicians who report this measure.