ConditionXpert™ will ensure that your patients are getting the highest-quality CCM and post discharge care.


  • Physician-written workflows for two dozen of the top discharge diagnoses, such as diabetes, heart failure, asthma, COPD, stroke, heart attack, pneumonia, back surgery, heart surgery, hip replacement, and knee replacement.

  • Physician-written workflows for 34 of the top chronic conditions, such as diabetes, heart failure, obesity, asthma, and COPD. Contact DSHI or an updated listing of chronic disease workflows.

  • Comprehensive workflows empower a medical assistant to perform a physician-level medical history, capturing relevant symptoms, biometrics, co-morbidities, self-monitoring, lifestyle factors, and psychosocial and behavioral data, as well as medication reconciliation, and a functional needs assessment.

  • Workflows are designed to identify patients whose status may be worsening due to chronic disease or a medical complication.

  • A physician-written evidence-based algorithm synthesizes the collected history into a physician-friendly post discharge followup note that includes medical history, objective measures, and a comprehensive care plan.

  • Assigns a Priority Score (1-7) an objective measure assigned to each CCM note. Indicates how quickly the note should be reviewed by the provider. Identifies acute opportunities where clinical intervention could avoid an ED visit or hospitalization.

  • Calculates Disease Control Score, an objective measure (1-100%) that is calculated using a wide variety of data such as biometrics, symptoms, symptom severity, co-morbidities, and behaviors. Allows you to quickly identify which patients are doing better and which ones need attention.

  • Calculates Patient Effort Score, an objective measure (1-100%) that reflects the patient's adherence with the treatment plan. Quickly identify educational opportunities to get the patient back on track.

  • Extensive medical library supports verbal and web-based education. Links in the care plan provide the medical assistant with instant access to targeted educational content from a 28,000 topic medical library.

  • Creates a personalized, web-based, interactive care plan. Our Virtual Health Coach allows patients to educate themselves when they want, and perform self-assessments to check for improvement in their Patient Effort Score.

  • Time audit logs encounter start times and duration in the PDF note.

  • Free web-based training every month.

  • Available as an API or easy-to-deploy widget.


  • Establishes consistency and accuracy to evaluation process.

  • Reduces time to provider for sickest patients.

  • Empowers staff to work at the top of their license.

  • Automated documentation saves staff time.

  • Safely identifies virtual care candidates.

  • Assists provider in medical history gathering.

  • Comprehensive note augments provider decision making.

  • Free web-based training for your staff

  • Easy-to-use solution allows staff to quickly become competent.

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