CLINICAL LEADERSHIP PATH

Real-time care gap detection across 52 HEDIS measures — from fragmented records to prioritized interventions.

HDIM evaluates quality measures as patient events arrive, not in overnight batches. Clinical teams see care gaps within seconds and get ranked next-best actions with transparent rationale.

See the FHIR Pipeline Performance Benchmarks

HEDIS measures supported

HDIM supports the full spectrum of HEDIS quality measures used in Medicare Advantage Star Ratings, Medicaid managed care, and commercial quality programs.

Preventive Screening

BCS (Breast Cancer Screening), CCS (Cervical Cancer Screening), COL (Colorectal Cancer Screening) — identify members overdue for age-appropriate cancer screenings.

Chronic Disease Management

CDC (Comprehensive Diabetes Care — HbA1c, eye exam, nephropathy), CBP (Controlling Blood Pressure), SPD (Statin Therapy for Diabetes) — monitor ongoing management of chronic conditions.

Behavioral Health

FUH (Follow-Up After Hospitalization for Mental Illness), FUM (Follow-Up After ED Visit for Mental Illness), ADD (ADHD Medication Follow-Up) — ensure timely behavioral health follow-up.

Medication Management

SPC (Statin Therapy for CVD), PBH (Persistence of Beta-Blocker Treatment), SAA (Adherence to Antipsychotics) — track medication adherence and persistence for high-risk populations.

How care gaps are detected

Each patient event triggers CQL evaluation against all applicable measures for their demographics and conditions. Gaps are surfaced in sub-second time.

1. Event arrives

A clinical event (encounter, lab result, prescription) enters the FHIR pipeline via EHR integration, ADT feed, or HIE subscription.

2. Measure fan-out

One patient event fans out to N active quality measures. A 65-year-old diabetic patient triggers CDC, BCS, COL, CBP, and SPD evaluations simultaneously.

3. Gap identification

CQL logic evaluates initial population, denominator, numerator, and exclusions. Unmet numerator criteria become actionable care gaps with clinical context.

4. Action delivery

Care gaps generate FHIR Task, CarePlan, or Communication resources delivered to care teams with ranked priority and intervention guidance.

Risk stratification in action

Risk stratification dashboard showing Critical, High, Moderate, and Low risk patient categories with scores — Patients categorized by risk level with condition tags, care gap counts, and trend indicators for clinical prioritization.

Clinical data flow

Event fabric showing patient data flowing through FHIR ingestion, CQL evaluation, and care gap detection — Event-driven pipeline: patient events flow through FHIR normalization, CQL measure evaluation, and care gap action generation.