About CDQ (Care Data Quality)

CDQ (Care Data Quality) is a population health intelligence platform that continuously monitors every enrolled patient against structured, evidence-backed care pathways — and surfaces missed labs, overdue follow-ups, lapsed medications, and unordered referrals to the right care team members before they become readmissions, adverse events, or missed quality bonuses.

The Problem

Health systems have evidence-based guidelines for nearly every chronic condition. What they lack is a systematic, always-on mechanism to follow every patient against those guidelines simultaneously. Labs go unordered. Referrals fall through. Post-discharge follow-ups are missed. HEDIS gaps accumulate silently — and by the time a gap surfaces, it may already be a readmission, a missed quality bonus, or an adverse outcome.

What CDQ Does

CDQ (Care Data Quality) is a clinical pathway intelligence engine that monitors every enrolled patient against structured, evidence-backed care pathways — and surfaces deviations before they become adverse events.

The system automatically:

  • Enrolls patients into one or more pathways based on ICD-10 diagnoses, active medications, lab results, or ADT discharge events
  • Evaluates each patient on a defined schedule (daily for transitions of care; weekly/quarterly for chronic conditions)
  • Detects deviations when a required step is overdue, missing, or outside the evidence-based threshold
  • Prioritizes deviations by clinical severity (critical / high / moderate / low)
  • Escalates automatically — abnormal lab results trigger referral steps, cross-enrollment, or care team alerts without manual intervention
  • Traces every step back to the specific guideline section and HEDIS measure that mandates it

Why Health Systems Need It

Pain Point CDQ Solution
HEDIS measure gaps (HBD, CBP, KED, EED, COL-E, BCS-E, TRC-HF…) Structured pathways mapped to each measure; gap detection fires before the measurement year closes
CMS readmission penalties (HRRP — HF, PNA, surgical) Dedicated 30-day transitions of care pathways with day-by-day step tracking from discharge
Care coordination across specialists Cross-pathway enrollment: a CKD result in the diabetes pathway auto-enrolls the patient in the CKD pathway
High-ED-utilizer costs ED Frequent Utilizer pathway activates within 72 hours of a 3rd ED visit
Medication therapy gaps (statins, GDMT for HF, anticoagulation for AFib) Medication audit steps with severity flags trigger care team alerts when prescriptions are missing
Behavioral health integration Co-occurring condition pathways (Diabetes + Depression, Anxiety, OUD-MOUD) with collaborative care step sequences
Manual reporting burden Pathway completion and deviation data is machine-generated, HEDIS-denominator-aware, and ready for analytics

How It Works

flowchart TD
    A[ADT Event, Lab Result, or ICD-10 Code] --> B[Enrollment Engine evaluates criteria]
    B --> C[Patient enrolled in one or more Pathways]
    C --> D[Pathway Engine runs on schedule]
    D --> P[Checks each required step]
    D --> Q[Evaluates lab and vital thresholds]
    D --> R[Runs conditional escalation logic]
    P --> E[Deviations surfaced in Review Queue]
    Q --> E
    R --> E
    E --> F[Care Team acts and marks step complete]
    F --> G[Analytics Dashboard tracks outcomes]

    style A fill:#dbeafe,stroke:#1a3a5c,color:#1a3a5c
    style D fill:#f0f3f8,stroke:#1a3a5c,color:#1a3a5c
    style P fill:#f0f3f8,stroke:#2d7dd2,color:#1a3a5c
    style Q fill:#f0f3f8,stroke:#2d7dd2,color:#1a3a5c
    style R fill:#f0f3f8,stroke:#2d7dd2,color:#1a3a5c
    style E fill:#fef3c7,stroke:#92400e,color:#92400e
    style G fill:#dcfce7,stroke:#166534,color:#166534

39 pre-built pathways across three clinical tiers:

  • Tier 1 High-Impact Core (11) — Diabetes, Hypertension, Heart Failure, CKD, Colorectal Cancer Screening, Breast Cancer Screening, HF Transitions of Care, MDD, AFib, Dyslipidemia, Annual Wellness Visit
  • Tier 2 Population Health Expansion (14) — Cervical Cancer, Lung Cancer LDCT, COPD, Asthma, Obesity, Tobacco Cessation, Pneumonia TOC, Post-Surgical TOC, Adult Immunizations, OUD-MOUD, SDOH Screening, Prediabetes, SNF-to-Home, Hypertension Screening
  • Tier 3 Complex & Specialty (14) — Well-Child/Pediatric, Alcohol Use Disorder, Joint Replacement, Bariatric Surgery, Colonoscopy, Cardiac Catheterization, Gynecologic Surgery, Cataract Surgery, Frequent ED Utilizer, Anxiety, Complex Care/High-Risk, Advance Care Planning, Maternal/Prenatal, Comorbid Diabetes+Depression

Platform Features

Customisable Pathways

  • Add, remove, or resequence steps for your clinical protocols without software releases
  • Deviation severity thresholds are configurable (e.g., adjust the HbA1c threshold that triggers an endocrinology escalation)
  • New pathways can be authored and loaded without software releases

Evidence Traceability

  • Every step linked to a specific guideline section (e.g., ADA 2025 §6.1, KDIGO 2024 §2.2, ACC/AHA 2022 §7.3) and HEDIS/CMS measure
  • Reference links displayed in the care team UI alongside each deviation
  • Audit-ready documentation of clinical rationale for every flagged gap

Conditional Escalation Logic

  • Lab value thresholds trigger automatic protocol changes (e.g., BNP > 400 → urgent cardiology referral within 3 days)
  • Cross-pathway enrollment without manual re-entry
  • Real-time alerts for time-sensitive deviations (MOUD lapse, post-discharge no-show, critical lab result)

Severity-Tiered Review Queue

  • Care teams see a prioritised worklist — critical deviations surface first
  • Each deviation shows: patient name, pathway, step, days overdue, guideline reference

Analytics and Reporting

  • Measure completion rates by pathway, provider, panel, and time period
  • HEDIS-reportable numerator/denominator tracking
  • Deviation trend analysis for population health program management

Integration Model

CDQ connects to existing clinical infrastructure rather than replacing it:

Data Source Used For
ADT events (HL7 / FHIR) Enrollment trigger for transitions of care pathways
Lab results (HL7 / FHIR) Step completion detection and threshold evaluation
ICD-10 diagnosis codes Enrollment criteria and conditional logic
Medication fills (claims or EHR) Medication audit steps and prescribing gap detection
Vital signs Blood pressure, BMI, weight measurements
Appointment / encounter data Visit completion tracking

What This Is Not

CDQ is not a clinical decision support tool that pops up alerts during the clinical encounter. It is a population-level deviation detection system — it works between encounters, at the care coordinator and quality team level, to ensure patients who have drifted from the care pathway are identified and re-engaged before adverse events occur.

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CDQ (Care Data Quality) — Built on evidence. Designed for operational reality.