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Clinical Measures for Care Gaps
Integrated Care Management supports creating care gaps from clinical measures. An Omniscript evaluates a measure against a patient’s data and if the measure isn’t satisfied, the Omniscript automatically creates a care gap record. To close an open care gap, care managers can reevaluate the measure after a patient has received the required care.
Required Editions
Available in: Lightning Experience Available in: Enterprise and Unlimited Editions with Health Cloud |
A clinical measure is a structured and computable definition of a health-related measure used for assessing a patient’s health status and the quality of care provided.
For example, a measure states that patients with diabetes who have a fasting blood sugar level above 126 mg/dL must take insulin shots 4 times a day, every day. Charles Green is a patient with type 2 diabetes, whose fasting blood sugar levels have been consistently above 130 mg/dL every day for the past 3 months. A care manager evaluates this measure against Charles’ data in Health Cloud using a flow and finds that Charles has been taking only 2 shots a day. Therefore, Charles has a gap in the care he receives. To record this gap, the flow automatically creates a care gap record for Charles. The care gap status is set to Open. The care manager tells Charles that he must start taking 4 insulin shots a day.
Charles is now consistently taking all the shots he needs every day to manage his diabetes. This new data is recorded in Health Cloud and the care manager evaluates the same measure for Charles again. The measure is satisfied and the care gap status is now Closed.
Let’s say the care manager runs the same measure against another patient, Elena Nieto, who is diagnosed with prediabetes. Elena’s fasting blood sugar levels have been consistently 115 mg/dL for the past 3 months. Since one of the measure criteria is to evaluate patients with a fasting blood sugar level higher than 126 mg/dL, Elena isn’t eligible for this measure. The flow creates a care gap record with the status set to Excluded.
You can implement your own trigger-based logic that’s in accordance with the business needs of your organization to evaluate a measure. You can implement this logic using flows, Business Rules Engine, Apex-based triggers, or OmniStudio Integration Procedures. To update the care gap status, use the updateCareGapStatus invocable action in your implementation.
Here’s a video to help you get started.
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Set Up a Measure to Evaluate Care Gaps.
- Define a Clinical Measure
Create a clinical measure record to define a clinical measure so that care managers can evaluate it against a patient’s data in Health Cloud using an Omniscript. The Omniscript automatically creates a care gap based on the evaluation. - Create Clinical Measure Criteria
A clinical measure has specific criteria that provide a standardized framework to evaluate care gaps. Create a clinical measure criteria record for each criterion. A clinical measure criteria record represents the computable criteria of a measure that a patient’s data is evaluated against. You can associate a clinical measure criteria record with a clinical measure or a clinical measure criteria group. - Create a Clinical Measure Criteria Group
Create a clinical measure criteria group and associate it with a clinical measure. A clinical measure criteria group represents a group of computable criteria for a clinical measure. - Create a Care Gap Criteria Result
Create a care gap criteria result and associate it with a clinical measure criteria and a care gap. A care gap criteria result represents the evaluated result of a clinical measure criteria.
