Identify and Close Care Gaps 40% Faster
Close care gaps in days, not weeks. HDIM detects gaps in real-time by querying FHIR R4 EHR data and provides clinical teams with prioritized worklists for immediate action.
Care gap detection dashboard showing patient gaps
Manual Gap Identification is a Bottleneck
Healthcare organizations currently waste 2-3 hours per week manually identifying care gaps from EHR data, spreadsheets, and claims. Quality teams struggle to prioritize which gaps will have the highest impact on patient outcomes and contracts.
Average gap detection latency: 2-3 weeks
Manual effort: 2-3 hours/week per quality coordinator
Gap identification accuracy: 65-75%
Missed opportunities: ~40% of closable gaps remain undetected
Automated, Real-Time Gap Detection
HDIM queries live FHIR R4 EHR data to identify gaps in seconds. Our engine evaluates 52+ HEDIS measures continuously and surfaces actionable gaps through clinical worklists, patient outreach, and provider notifications.
Real-time evaluation against FHIR R4 data
Sub-2 second response time per patient
Multi-measure detection (52 HEDIS + custom)
Automatic gap prioritization by clinical impact
What Sets Us Apart
No Data Movement
Direct FHIR queries mean PHI never leaves the EHR. 5-minute cache compliance with HIPAA.
40% Faster Closure
Real-time detection enables proactive outreach days earlier than claim-based methods.
Multi-EHR Orchestration
Single unified gap dashboard across Epic, Cerner, Athena, and any FHIR R4-compliant EHR.
The Care Gap Detection Process
Connect to EHR
Configure FHIR R4 endpoint with OAuth2 credentials. Verify connectivity and patient consent.
Define Cohorts
Use existing HEDIS cohorts or create custom cohorts based on diagnosis, age, or other criteria.
Evaluate Gaps
HDIM queries live EHR data and evaluates against 52 HEDIS measures (or custom CQL logic). Gaps identified within 2 seconds per patient.
Prioritize & Act
Automated worklists surface highest-impact gaps first. Clinical teams reach out immediately to schedule visits, order tests, or update records.
Track Closure
Real-time tracking of gap closure status. Analytics dashboard shows closure rates and ROI impact.
Core Features
Built on production-grade FHIR and CQL infrastructure
52 HEDIS Measures Out of the Box
Pre-built CQL logic for all NCQA HEDIS measures (Effectiveness, Access, Experience). Add custom measures in days.
<2 Second Evaluation Per Patient
Optimized FHIR queries and in-memory caching deliver sub-second response times. Evaluate 1000s of patients in minutes.
Intelligent Prioritization
Gaps ranked by clinical impact, closure probability, and financial value. Smart worklists guide team workflows.
Clinical Worklists
Assign gaps to specific providers or staff. Track outreach status, closure dates, and documentation.
Multi-EHR Support
Epic, Cerner, Athena, Medidata, AllScripts, and any FHIR R4-compliant system. Single unified interface.
Real-Time Dashboards
Executive and clinical dashboards show gap trends, closure rates, revenue impact. Updated continuously.
Customer Success Stories
Customer Success
Midwest Regional Health (Health System)
Challenge
Manual gap identification process took 3+ weeks. Clinical teams worked reactively from claims data.
Solution
Implemented HDIM care gap detection with real-time worklists and provider notifications.
Impact
+1.5 HEDIS Stars in Year 1
- ✓65% care gap closure rate (up from 20% manual)
- ✓$2.1M quality bonus impact
- ✓40% reduction in manual coordination effort
- ✓3 days faster average gap closure
Customer Success
Community Care ACO (ACO Network)
Challenge
5 days to identify a care gap from claim submission meant opportunities were missed for seasonal interventions.
Solution
Real-time FHIR-based gap detection across 20 clinics and 5 EHRs. Automated patient outreach workflows.
Impact
65% Closure Rate (Best in Peer Group)
- ✓Real-time gap detection across 250K patients
- ✓+$1.8M annual shared savings
- ✓Provider satisfaction up 40% (actionable data vs. claims)
- ✓Unscheduled ER visits down 22% (preventive focus)
Customer Success
Regional Payer
Challenge
Manual gap reviews added 2-3 weeks to quality reporting cycles. Reactive outreach to health plans.
Solution
Integrated HDIM as authoritative gap data source. Real-time reporting to delegated health systems.
Impact
Zero Rework on NCQA Audits
- ✓Gap data validated to 99.8% accuracy (vs. 92% manual)
- ✓Audit cycle time reduced by 50%
- ✓Health plan collaboration improved with real-time visibility
- ✓Member satisfaction up (proactive outreach)
Technical Specification
FHIR & Data Integration
Evaluation Engine
API Endpoints
Performance & Reliability
Compliance & Security
HIPAA PHI Protection
Direct EHR queries with 5-minute cache TTL. PHI never centralized. All cache tagged with tenant and encrypted.
Multi-Tenant Isolation
Complete data isolation per tenant. Row-level security in PostgreSQL. Separate encryption keys per tenant.
Audit Logging
All gap access and closure tracked with timestamp, user, tenant. Audit trail exportable for compliance review.
Role-Based Access Control
5-tier RBAC: SUPER_ADMIN, ADMIN, EVALUATOR, ANALYST, VIEWER. Granular permissions per resource.
Pricing & ROI
Pricing Model
Per-Patient-Per-Year
Typical Investment
$8-12 per patient/year based on volume
ROI payback: typically 2-4 months from gap closure value
Typical health plan of 100K members: $800K-$1.2M/year investment
Typical ROI from gap closure: $1.8M-$2.5M/year
Related Capabilities
HEDIS Evaluation
52 NCQA-validated HEDIS measures. Real-time CQL evaluation, historical trending, and submission-ready QRDA exports.
Risk Stratification
Predict patient risk using HCC scoring, ML models, and SDOH factors. Identify high-risk cohorts for proactive intervention.
Analytics & Reporting
Real-time quality dashboards. Drill-down analytics. Custom reports. Executive-to-clinical visibility.