The Capabilities Behind Evidence-Connected Care
VitalEdge connects clinical evidence, encounter context, and care workflows into quality and care-gap tracking, compliance and auditability, reimbursement readiness, patient engagement, and interoperability — one architecture, not a bundle of point tools. RPM, RTM, CCM, PCM, and BHI are applications that run on top of it.
How the Capabilities Connect
Every capability below is a piece of one evidence and encounter architecture, not a standalone tool.
Clinical Workflow
Prioritize what needs attention, keep the full patient picture in view, and close gaps before they become problems.
Smart Triage Queue
Risk-based prioritization ranks alerts by clinical urgency with a 0–10 score, so the highest-risk patients surface first. One-click actions and bulk operations cut the time spent working a queue.
- Risk scores from 0–10 based on clinical urgency
- One-click resolve, call, or escalate actions
- Bulk operations for efficient triage
Patient Context
See a patient's vitals trends, active medications, conditions, and care gaps in one panel — without clicking through five tabs to answer “what's going on with this patient.”
- 7-day vitals trends at a glance
- Active medications and conditions
- Care gaps and assessment history
Care Gap Detection
Nightly, automated rule evaluation flags patients missing overdue screenings, off-target values, or lapsed adherence, so gaps surface before a scheduled visit — not at one.
- Configurable rule types — condition status, missed observations, medication adherence, and more, including HEDIS-aligned and custom logic
- Nightly automated detection runs
- Auto-closes when the underlying criteria are met
Care Pathway Orchestration
Multi-step, standardized pathways (diabetes, hypertension, chronic pain, heart failure, COPD, and more) that track a patient's progress step by step and can auto-enroll based on diagnosis.
Smart Documentation
Pre-built templates for encounter notes and progress summaries, auto-populated from vitals, assessments, and active alerts already on file for the patient.
Patient Engagement
Give patients, families, and outside providers a secure, direct line into the record and the care team.
Digital Assessments
Validated clinical instruments — PROMIS, PHQ-9, GAD-7, and condition-specific scales — delivered via web or mobile, with automatic scoring and trend analysis over time.
- PHQ-9, GAD-7, PROMIS, and condition-specific instruments
- Automatic scoring and interpretation
- Trend analysis over time
Patient Portal
Secure patient access to health data, pending assessments, and care-team communication. Installable as a Progressive Web App on Android and iOS, with autosaved offline drafts that submit automatically once connectivity returns.
- Health summary dashboard with vitals and trends
- Complete assessments from any device, online or offline
- Medications, history, and profile in one place
Patient-Carried PHR + QR Hand-Off
Patients carry their own longitudinal record and hand it to any provider with a revocable, consent-gated QR code — with a FHIR $everything download and the programs that provider's patient may qualify for surfaced alongside it.
Secure Messaging
Asynchronous messaging between patients, caregivers, and the care team — one thread per patient, fully audited, with no message content ever written to logs. Clinician review time can be captured as billable CCM/PCM/BHI care-management minutes.
Conversational Care Navigation
A patient-facing assistant that answers questions like “explain my record” or “what's due” — grounded strictly in that patient's own data, descriptive rather than diagnostic, with a deterministic emergency hand-off and a safe route to the care team for anything clinical.
Interactive Communication Tracking
CMS requires a live, real-time interactive touchpoint each month before certain RPM/RTM clinical-time codes can be billed — text or async chat doesn't satisfy it. Attested phone and video touchpoints are captured, gate the affected codes automatically, and prompt before the month closes.
Caregiver-Authored Life Plan
A durable, person-centered plan written by the family — strengths, goals, strategies, routines, contacts — kept as a private working draft and published to the clinical team as versioned snapshots, with per-section control over what the patient themselves sees.
Informant Assessment Hand-Off
Send a teacher or other outside informant a revocable, single-use link to complete one assessment for one patient — no account required, consent-gated and audited, with each result carrying the rater's identity so cross-informant scores are never silently compared.
Clinical Intelligence
Evidence-based context and prioritization for the care team, powered by clinical categorization logic — descriptive, not autonomous.
Evidence-Based Guidance
Real-time context from clinical categorization services — grounded in a patient's own recent data and published guideline thresholds (ACC/AHA, ADA, GINA, and others) — surfaces prioritized, descriptive guidance for the care team. It is not an automated diagnosis or prescription; a clinician decides what to do next.
- Evidence-based categorization across eight clinical domains (BP, diabetes, heart failure, COPD, and more)
- Care-pathway progress shown in context
- Prioritized, descriptive guidance — the clinician decides
Condition-Specific Clinical Dashboards
Eight clinical categorization engines turn raw readings into at-a-glance status, trends, and guidance — ACC/AHA blood pressure, diabetes glycemic control, heart-failure decompensation, COPD, asthma (GINA), AFib (CHA₂DS₂-VASc/HAS-BLED), chronic pain, and autism/ASD.
Medication Reconciliation
Compares what the pharmacy dispensed against what the clinician documented — surfacing undocumented medications and unfilled prescriptions as clinician-actioned candidates, never an automatic change to the regimen. Matching is code-first on RxNorm ingredient with a therapeutic-class fallback; the fill data runs on the same claims feed as the adherence tracking below, sandbox-validated pending live payer credentials.
Care Programs & Revenue Operations
RPM, RTM, CCM, PCM, and BHI all run on the same eligibility, billing-readiness, and time-tracking foundation — automated tracking, not manual reconciliation.
Five CMS care programs, one underlying architecture — adding a program means configuring it, not building a new system.
Billing Readiness
Real-time tracking of billing eligibility for every enrolled program, with per-code progress toward each CMS threshold and a monthly summary — so no billable patient gets missed and no month gets billed against an unmet requirement.
- Per-code progress tracking against CMS thresholds
- Configurable, database-driven program rules — not hardcoded per-payer logic
- CSV export for billing and finance teams
Time Tracking
Automatic start/stop timers capture clinical time as it happens, with activity-based CPT code suggestions to keep documentation aligned with what was actually done.
- Auto-starts when viewing patient records
- Activity-based CPT code suggestions
- One log powers documentation and billing together
Program Eligibility Matcher
Before enrollment, instantly see which CMS programs (RPM, RTM, CCM, BHI) a patient qualifies for — evaluated with the same rules engine that governs billing, and aware of provider-credential and same-month concurrency requirements.
Comprehensive Care Plan
The CMS comprehensive care plan captured as a real, versioned, clinician-attested artifact with a review cadence — not a checkbox. A missing or out-of-date plan blocks CCM billing automatically, and the month's logged minutes are never quietly billed against an outstanding prerequisite.
RTM for Musculoskeletal Care
Remote Therapeutic Monitoring built for MSK and chiropractic practice — patient-logged pain and home-exercise adherence, range-of-motion and Oswestry functional tracking, alerting on disengagement or functional decline, and device-supply day counting scoped to genuine MSK data.
Evidence, Quality & Compliance
Every result traces back to the evidence and encounter behind it, with the audit trail, consent record, and retention controls a healthcare organization needs to produce on review.
Clinical Evidence & Encounter Context
Every observation, condition, medication, and procedure resolves back to the encounter, provider, and date it came from — captured from any source (manual entry, device sync, or patient self-report) — so the same record that satisfies a review also drives care.
Quality Measurement
18 measures tracking performance aligned to selected HEDIS, MIPS, and CMS Star Rating methodologies — custom, curated rule logic, not certified eCQM or submission-ready reporting. MIPS composite scoring provides a payment-adjustment estimate; population calculations run nightly.
Claims-Based Adherence (PDC)
The fill-based Proportion of Days Covered calculation — PDC-DR and PDC-RASA, both triple-weighted CMS Star measures — computed from pharmacy claims rather than self-report, with patient-reported fills tracked separately and fenced out of the official measure. The claims feed is pluggable and validated end-to-end against the CMS Blue Button 2.0 sandbox; production payer credentials are a per-deployment activation step.
Consent, Access Logs & Retention
A patient-facing consent dashboard with revocable, purpose-specific consent; an access log showing who viewed a patient's record and when; and a retention and legal-hold framework that never purges below the six-year HIPAA floor and archives records before any deletion.
Evidence Packs for Review
A one-click, assembled compliance package — audit history, consent status, and outcome summaries — built for payer, auditor, or accreditation review instead of hand-collected from five different screens.
Funder & Grant Outcome Reporting
Model who underwrites a program — a grant or sponsor — as a first-class entity, separate from who pays the claim. Hand a funder a revocable, de-identified outcome snapshot scoped to exactly the cohort they funded, with small-cohort suppression built in.
Network & ACO Rollup
The architecture for a network organization to see consented, de-identified aggregate outcomes across member practices — combined quality measures, care-gap closure, and engagement — with tenant isolation preserved by construction and per-member results suppressed below a reporting floor. Member practices consent to participate and can withdraw at any time.
Interoperability & Platform
Open, standards-based connections to the EHRs, devices, and payers already in a clinic's stack — VitalEdge is designed to work alongside them, not replace them. Interfaces are available in multiple languages, with English and Spanish fully localized today.
FHIR R4
Read/write support for Patient, Observation, and MedicationStatement; read access to Condition, Practitioner, and Medication. Idempotent, sync-safe imports keep an EHR record current without creating duplicates.
EHR Connectivity
Epic and Cerner connect through the same generic FHIR R4 API — ready to configure per customer, not a pre-built, vendor-specific integration.
Device Integration Adapters
Built-in adapters for Omron blood pressure monitors and weight scales and the Tenovi RPM device suite — code-complete and sandbox-tested, ready to activate once vendor credentials and device provisioning are in place.
Eligibility & Prior Authorization
Real-time eligibility checks and prior-authorization submission (X12 270/271/278) built for the Availity and Change Healthcare clearinghouses — sandbox-tested and ready to activate with payer credentialing.
APIs, Webhooks & Exports
A documented REST API, real-time webhook events for alerts and assessments, and CSV export for billing summaries, patient lists, and audit logs — for teams that need to pull VitalEdge data into their own tools.
Security & Compliance
Security controls built around HIPAA's technical safeguards, hardened for multi-tenant healthcare data. Consent management and patient access logging are covered under Evidence, Quality & Compliance above.
HIPAA Technical Safeguards
Encryption in transit and at rest, audit logging, and role-based access control — implemented as HIPAA's Security Rule technical safeguards require.
Audit Trail
A timestamped record of who accessed or changed data, and when, across the platform.
Multi-Factor Authentication
TOTP-based MFA with backup codes, alongside social login options, for stronger authentication without added friction.
Role-Based Access Control
Granular permissions scoped to clinicians, nurses, billing staff, and administrators.
Tenant Isolation
Every query is scoped to an organization; cross-tenant data isolation is enforced at the data layer and tested on every release.
Seamless Integrations
Connect VitalEdge with EHRs, RPM devices, and clearinghouses through our FHIR R4 API and pre-built integration adapters.
✓ FHIR R4 API live — read/write for Patient, Observation, and MedicationStatement; read access to Condition, Practitioner, and Medication
Device and clearinghouse adapters (Omron, Tenovi, Availity, Change Healthcare) are code-complete and sandbox-tested, ready to activate with vendor and payer credentials. EHR integration is ready via FHIR R4 — customer configuration required for Epic/Cerner.
See the Platform in Action
Explore how VitalEdge connects clinical evidence, care delivery, quality, compliance, and operational workflows.