Smile CDR v2024.02.PRE
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23.2.1Care Gaps

A gap in care refers to a discrepancy or gap in a patient's care that has been identified through analysis of their medical records, history, and current health status.

These gaps can include missing or incomplete information, unmet health needs, and opportunities for preventative care or intervention. Identifying and addressing care gaps can help improve the quality of care provided to patients, reduce healthcare costs, and ultimately lead to better health outcomes.

Example: This woman was supposed to have a breast cancer screening this year but did not. Let’s reach out to her and get that scheduled.

Please refer to the Implementation Guide for more information.

A Gaps in Care Report is designed to communicate actual or perceived gaps in care between systems, such as the payer’s system and provider’s EMR. The report provides opportunities for providers to provide missing care and/or to communicate care provision data to payers. The report may also provide information for upcoming care opportunities, prospective gaps.

The gaps in care flow is between a provider and a measurement organization’s system performing analytics.

The Gaps in Care Reporting uses the DEQM Individual MeasureReport Profile. This allows the Gaps in Care Reporting to use the same machinery as the Individual Reporting to calculate measures and represent the results of individual calculation.

Smile CDR implements the $care-gaps operation. Gaps

The $care-gaps operation is used to run a Gaps in Care Report. care gaps on Smile CDR

Smile CDR is integrated with $care-gaps operations and following are the steps to identify open gap on sample data following the remediation step to generate a report for closed gap.

All the sample files used below are available on hapi-fhir code base under resources folder.

  1. Submit payer content
POST CaregapsColorectalCancerScreeningsFHIR-bundle.json
  1. Submit payer org data
POST CaregapsAuthorAndReporter.json
  1. Submit provider data
POST$submit-data CaregapsPatientData.json
  1. Provider runs care-gaps operation to identify open gap.
  1. Provider fixes gaps
POST$submit-data CaregapsSubmitDataCloseGap.json
  1. Provider runs care-gaps operation to identify the gap is closed.