Abstract: Systems, methods, and user interfaces provide integrated coordination of care. Care team coordination and collaboration is promoted by bringing together each of the necessary elements of a patient's plan into a single point of access. Current workflow silos that exist in the care planning space are eliminated. This allows seamless support for the many different care planning regulations across care settings and supports and involves the entire care team including the patient and personal care team.

Abstract: Systems, methods, and user interfaces provide integrated coordination of care. Care team coordination and collaboration is promoted by bringing together each of the necessary elements of a patient's plan into a single point of access. Current workflow silos that exist in the care planning space are eliminated. This allows seamless support for the many different care planning regulations across care settings and supports and involves the entire care team including the patient and personal care team.

Abstract: Systems, methods, and user interfaces are provided for providing automated suggestions to longitudinal care plans of patients based on gaps in care and automatically updating measures, goals, and/or activities that represent the gaps in care based on changes to registries or measure outcomes corresponding to the patients. After accessing a registry corresponding to a particular condition of a patient, it can be determined that the patient has a gap in care corresponding to the particular condition in a longitudinal care plan of a patient. At least one measure that addresses the gap in care can be identified and created on the longitudinal care plan of the patient. By monitoring a status of the measure for the patient, it can be determined the patient has completed the at least measure that addresses the gap in care. Based on the completed at least one measure, the longitudinal care plan of the patient can be updated.

Abstract: Systems, methods, and user interfaces provide integrated coordination of care. Care team coordination and collaboration is promoted by bringing together each of the necessary elements of a patient's plan into a single point of access. Current workflow silos that exist in the care planning space are eliminated. This allows seamless support for the many different care planning regulations across care settings and supports and involves the entire care team including the patient and personal care team.