Our platform validates healthcare data quality BEFORE HEDIS calculations using FHIR queries. Discover errors early—when you can still fix them—not after the NCQA submission fails.
FHIR (Fast Healthcare Interoperability Resources)
The open standard that lets healthcare systems exchange data—like HTTPS for medical records
Data at Rest Validation
Checking data quality in the database BEFORE running calculations or submitting reports
HEDIS (Healthcare Effectiveness Data and Information Set)
Quality measures used by Medicare/Medicaid to evaluate healthcare organizations
NCQA (National Committee for Quality Assurance)
Organization that certifies quality reporting and accepts HEDIS submissions
Step 1: Collect data for 3 months
Manual chart reviews, hoping data is complete
Step 2: Submit to NCQA
Package files, cross fingers, send submission
Step 3: NCQA rejects submission
❌ Missing patient demographics
❌ Invalid diagnosis codes
❌ Test dates outside measurement period
❌ Provider NPI not found
Step 4: Deadline passed—can't fix
Measurement period closed, STAR rating impacted
Result: Like Elevance's $375M loss—discovered too late to prevent
Step 1: FHIR queries validate data daily
Automated checks run continuously
Step 2: Errors flagged immediately
✓ Patient missing birthdate → Alert provider
✓ Invalid ICD-10 code → Fix in EHR now
✓ Lab result missing → Order test today
✓ Provider needs credentialing → Start process
Step 3: Fix while measurement period open
Plenty of time to correct issues and close care gaps
Step 4: Clean submission accepted
NCQA submission passes validation, STAR rating protected
Result: Prevent losses by catching errors when you can still fix them
Requirement: Diabetic patients must have HbA1c test within measurement year
# FHIR Query to Find Tests
GET /Observation?
patient=Patient/12345&
code=4548-4&
date=ge2024-01-01&
date=le2024-12-31
• code=4548-4 → LOINC code for HbA1c test
• date range → Must be in 2024 measurement period
• Returns → All matching lab results with values
Validation Checks:
Patient exists with diabetes diagnosis
FHIR Condition resource validates diagnosis
HbA1c test has valid LOINC code
4548-4 is the correct standardized code
Test date within measurement period
Between January 1 - December 31, 2024
Result value properly formatted
e.g., "7.2%" or "55 mmol/mol" with units
✓ Data validated BEFORE calculation
If test missing, alert provider to order it NOW
Requirement: Adults 45-75 need colonoscopy within 10 years OR FIT test annually
# Check for Colonoscopy
GET /Procedure?
patient=Patient/67890&
code=44388,44389,45378&
date=ge2015-01-01
# OR Check for FIT Test
GET /Observation?
patient=Patient/67890&
code=27396-1,29771-3&
date=ge2024-01-01
Complex Validation Logic:
Patient age 45-75 on Dec 31, 2024
Calculated from FHIR Patient.birthDate
Valid CPT codes for colonoscopy
44388, 44389, 45378 accepted by NCQA
10-year lookback for colonoscopy
OR 1-year lookback for FIT test
Provider credentialed for procedure
FHIR Practitioner validates NPI and specialty
⚠ If neither test found
Care gap identified → Trigger outreach workflow NOW
NCQA rejects 15-30% of initial submissions due to data quality errors. Our FHIR validation catches these BEFORE submission.
Common errors caught:
Elevance lost $375M when their rating dropped from 3.75 to 3.5 stars due to data quality issues discovered too late.
How validation helps:
Manual chart reviews take 200+ hours/month and still miss errors. FHIR queries validate in seconds with 100% consistency.
Time savings:
See how FHIR queries catch data errors early when you can still fix them