Clinical Measures for Care Gaps

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.