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Work the Care Gaps list

Care Gaps Analysis shows every open care gap across your population — screenings, follow-ups, and other needed services that haven't happened yet — so your team can prioritize and close them.

Before you start​

  • You need the Quality, Pop Health, or Program Administrator role.
  • In the left menu, go to Quality & Analytics → Care Gaps Analysis.

Steps​

  1. Start with the summary cards at the top: Total Patients, Care Gaps (gaps needing attention), At Risk (patients to monitor closely), and Resolved (closed this month).
  2. Work through the four tabs:
    • Physician Assignments — the full gap list with Patient Name, Gap, Priority (High / Medium / Low), and Status (Open / In Progress / Scheduled / Resolved). Use Assign in the Actions column to route a gap to a physician.
    • Data Access — attribution problems that block gap closure. Select a card — Non-Licensed PCPs, Inactive PCPs, Missing PCPs, or Missing Rendering — to see the affected patients and providers underneath.
    • Programs — patients grouped by care program. Select a program card to list the patients enrolled in it, with their age and enrollment status.
    • Care Gap Closure — gaps grouped by stage: Open Gaps (use Schedule to book the needed service), In Progress (use Document to record what was done), and Resolved.
  3. Sort your work by priority: clear High priority open gaps first, then move down the list.

Tips / Troubleshooting​

  • The Data Access tab is worth checking regularly — a gap often can't be closed simply because the patient has no assigned primary care provider on record.
  • While the amber Demo data notice is showing, the gaps and patients on this page are sample data.