Abstract: Mechanisms are provided for modifying a patient care plan or care provider workflow based on a patient risk assessment. The mechanisms analyze a patient medical record in a patient registry to identify at least one clinical measure for a corresponding patient and calculate a risk assessment value based on the at least one clinical measure value. The risk assessment value indicates a risk level for development of a medical condition or the occurrence of a medical event. The mechanisms select at least one of an action item or work flow to be performed to mitigate the risk level indicated by the risk assessment value based on the risk assessment value and a category of the risk assessment value. The mechanisms perform one or more operations for causing the action item to be performed or for performing the work flow.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.

Abstract: Mechanisms are provided for modifying a patient care plan or care provider workflow based on a patient risk assessment. The mechanisms analyze a patient medical record in a patient registry to identify at least one clinical measure for a corresponding patient and calculate a risk assessment value based on the at least one clinical measure value. The risk assessment value indicates a risk level for development of a medical condition or the occurrence of a medical event. The mechanisms select at least one of an action item or work flow to be performed to mitigate the risk level indicated by the risk assessment value based on the risk assessment value and a category of the risk assessment value. The mechanisms perform one or more operations for causing the action item to be performed or for performing the work flow.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.

Abstract: Mechanisms are provided for assisting medical practitioners to achieve incentive goals. The mechanisms generate a patient registry comprising a plurality of patient registry records where each patient registry record is associated with a corresponding patient and comprises personal and medical information about the corresponding patient. The mechanisms evaluate a registry of incentive goals for a medical practitioner based on the patient registry to determine an incentive goal whose criteria the medical practitioner has not yet met. The mechanisms determine an action to be performed by one or more patients to meet the criteria of the incentive goal and analyze the patient registry to identify a set of patients to perform the action. The mechanisms then generate an output identifying the set of patients.

Abstract: Mechanisms are provided for modifying a patient care plan or care provider workflow based on a patient risk assessment. The mechanisms analyze a patient medical record in a patient registry to identify at least one clinical measure for a corresponding patient and calculate a risk assessment value based on the at least one clinical measure value. The risk assessment value indicates a risk level for development of a medical condition or the occurrence of a medical event. The mechanisms select at least one of an action item or work flow to be performed to mitigate the risk level indicated by the risk assessment value based on the risk assessment value and a category of the risk assessment value. The mechanisms perform one or more operations for causing the action item to be performed or for performing the work flow.

Abstract: Mechanisms are provided for stratifying risk of a patient population. The mechanisms receive patient information for a plurality of patients in the patient population and perform a machine learning operation to train a risk scoring algorithm for scoring a risk of adverse conditions for the patient population using the patient information. The mechanisms determine, for each patient in the patient population, a risk score based on an application of the risk scoring algorithm to patient information for the patient. The mechanisms classify each patient into a risk classification category, in a plurality of risk classifications categories, based on a risk score generated by the application of the risk scoring algorithm to the patient information for the patient. The mechanisms generate an output indicating membership of patients in the plurality of risk classification categories.

Abstract: Mechanisms are provided for assisting medical practitioners to achieve incentive goals. The mechanisms generate a patient registry comprising a plurality of patient registry records where each patient registry record is associated with a corresponding patient and comprises personal and medical information about the corresponding patient. The mechanisms evaluate a registry of incentive goals for a medical practitioner based on the patient registry to determine an incentive goal whose criteria the medical practitioner has not yet met. The mechanisms determine an action to be performed by one or more patients to meet the criteria of the incentive goal and analyze the patient registry to identify a set of patients to perform the action. The mechanisms then generate an output identifying the set of patients.

Abstract: Mechanisms are provided for matching patients with care providers. Patient information for a current patient, from at least one patient information source, is analyzed and a medical need of the current patient is determined. Patient information for a plurality of other patients associated with a plurality of care providers is analyzed and, for each care provider in the plurality of care providers, a measure of strength for a type of medical care corresponding to the at least one medical need is determined, based on results of the analysis of patient information for the plurality of other patients associated with the care provider. At least one care provider is selected for inclusion in a care team for the current patient based on the determined strengths of each care provider in the plurality of care providers. A care team data structure comprising information about the at least one care provider is output.