Care Coordination Context

Care team retrieves comprehensive patient context for care coordination.

CUSTOMER INITIATES VIA Internal System / Team Meeting

Care team reaches out via system or team meeting to get holistic context on a patient before coordinating care.

Care Team: "Summarize patient 4471's care plan and barriers"

Pulls EHR data, summarizes medications, referrals, social determinants, gaps. <2 min vs 10-20 min. Holistic view.

⏱️ <2 min | 🏥 Holistic view | ✅ Better outcomes

ROI & Business Impact

85% faster care context retrieval (<2 min vs 10-20 min)

45+ data points aggregated automatically

Improved patient outcomes through holistic care coordination

Reduced care gaps from 6.8 to 1.2 per patient annually

01 — EHR Data Retrieval

Pulling comprehensive patient record

Retrieved active diagnoses, medications, lab results, recent encounters. 45 data points gathered.

02 — Active Treatment Summary

Summarizing current care plan

Primary diagnosis: Type 2 Diabetes. Secondary: Hypertension. Active meds: Metformin, Lisinopril. Recent labs: HbA1c 7.2 (improved).

03 — Social Determinants

Identifying social barriers to care

Food insecurity: Flagged. Transportation: No vehicle. Housing: Stable. Employment: Part-time (inconsistent income).

04 — Care Gaps

Detecting unmet care needs

Gap 1: No primary care visit in 6 months. Gap 2: Diabetic eye exam overdue. Gap 3: Nutrition consultation recommended.

Priage Response

Care Context Summary: Patient with well-controlled diabetes but multiple care gaps.
Immediate Actions:
• Schedule primary care visit
• Refer to ophthalmology (eye exam overdue)
• Nutrition consultation (food insecurity support)
• Case management for transportation barriers

This is one workflow. See how the same framework applies across your institution.

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ROI & Business Impact