Documentation Index
Fetch the complete documentation index at: https://docs.metriport.com/llms.txt
Use this file to discover all available pages before exploring further.
Analytics must be enabled for your account to receive this
data. Contact us to get
started. Overview
Suspecting automatically identifies patients who may have undiagnosed or under-coded conditions
based on clinical evidence in their medical records. The system analyzes prior medical history
to find patterns that suggest a condition may be present but has not yet been formally coded.
Suspected conditions are represented as FHIR Condition resources with a verificationStatus
of unconfirmed. Each suspected condition includes the ICD-10 code, supporting evidence, and
the clinical rules (definitions) that triggered the suspicion.
When clinical data becomes available in our system for a patient, suspecting runs on the next
analytics cycle (typically within about 30 minutes). Data may arrive through a
Network Query or
real-time patient notifications such as ADTs. Later cycles keep re-evaluating your
patient population to surface coding opportunities and improve risk adjustment accuracy.
How It Works
The system uses two detection modes:
- Suspect — The patient has clinical evidence suggesting a condition but no existing diagnosis
code on file. For example, two fasting glucose readings above 126 mg/dL without a diabetes
diagnosis.
- Recapture — The patient had a diagnosis code in a prior year but it has not been captured in
the current year, and there is supporting clinical evidence.
Each detection rule is called a definition. A definition belongs to a group (e.g.,
“diabetes”) and specifies the exact clinical logic used to identify the suspect. Multiple
definitions within the same group may target the same ICD-10 code through different evidence
pathways.
Available Condition Groups
The following condition groups are currently supported.
Mental Health
| Condition |
|---|
| Bipolar Disorder |
| Major Depression |
| Dementia |
| Seizure Disorder |
| Anorexia / Bulimia |
| Alcohol Use Disorder |
Cardiovascular
| Condition |
|---|
| Heart Failure |
| Hypertension |
| Coronary Artery Disease |
| Peripheral Arterial Disease |
| Carotid Artery Stenosis |
| Angina |
| Arrhythmia |
| Aortic Aneurysm |
| History of Cerebrovascular Accident |
| Condition |
|---|
| Morbid Obesity |
| Diabetes |
| Prediabetes |
| Hyperlipidemia |
| Hyperparathyroidism |
| Hypothyroidism |
Respiratory
| Condition |
|---|
| COPD |
| Obstructive Sleep Apnea |
Renal / Hepatic
| Condition |
|---|
| Chronic Kidney Disease |
| Cirrhosis |
| Chronic Hepatitis C |
Other
| Condition |
|---|
| Diabetic Retinopathy |
| Retinal Vein Occlusion |
| Age-Related Macular Degeneration |
| Lung Nodule |
| Thyroid Nodule |
| Barrett’s Esophagus |
| Benign Carcinoid |
| Bone Density |
| Amputation |
| Ostomy |
| History of Active Cancer |
Getting Started
Once suspecting is enabled for your account, suspected conditions are available through the
API and Dashboard as each analytics cycle completes.
Accessing via API
Suspect results are available through the API:
Each result is a FHIR Bundle that includes a Patient resource, the suspected Condition, and
supporting evidence resources (Observations, Procedures, MedicationRequests).
Additional Information
For more information about working with patient data, see the data analytics
documentation.
