Most primary care organizations use electronic health records (EHRs). In fact, the Office of the National Coordinator for Health Information Technology reported that by 2024, 95% of office-based physicians had adopted some type of EHR.*
But having and using an EHR does not always make it easy for care teams to identify and address a patient’s preventive care needs.
Relevant information may be spread across the practice’s EHR, hospital and specialist records, lab and pharmacy systems, and other sources. Because of this fragmentation of data, care teams may still spend valuable time piecing together a patient’s history, tracking down outside records or trying to determine what needs attention during the visit.
Make patient data actionable at the point of care
More data does not necessarily lead to better care. Physicians need data that’s accessible, relevant and actionable.
Three factors are especially important:
- Which relevant data sources are connected.
- How that information is prioritized.
- When it can be seen during the visit.
When the right information is available at the right time, physicians and care teams can more easily see what may need attention.
Has the patient seen a specialist since the last visit? Did they have to go to the emergency department? Are they due for a preventive screening or annual wellness visit?
Patients may not remember every clinician they have seen, the dates of recent visits or the names of new prescriptions. Bringing those details together can help care teams develop a more complete picture of the patient and identify opportunities for earlier follow-up.
For primary care organizations, including health systems, the goal is not simply to collect more information. It is to make relevant information easier to use—so care teams can spend less time searching for answers and more time helping patients receive the preventive care they need.
Make the most of time with your patients
Aledade is a physician-led value-based care partner. Primary care organizations that partner with and join one of Aledade’s accountable care organizations (ACOs) gain access to technology solutions designed to support their work in value-based care.
Our technology solutions allow physicians to see a holistic view of their patients with information from sources such as claims, EHRs, pharmacy feeds, lab results and health information exchanges, translated into evidence-based, patient-specific insights.
The Aledade App brings this data together for attributed patients and flags care events since the last visit. Within the App, the Care Gap Worklist prioritizes patients who need outreach for services like cancer screenings and blood pressure management.
These alerts also appear in Aledade Assist™, Aledade’s embedded EHR overlay. Patient summaries, care gap alerts and evidence-based next steps appear on the same screen, so physicians can act during the visit without searching multiple systems — keeping the focus on their patients.
For participating primary care organizations, the benefits include:
- No second login. Patient-specific insights appear in the clinical workflow, so there’s no other portal to open.
- No duplicate entry. Care teams can act and document through established processes instead of re-keying information later.
- No separate report to reconcile. Once claims, lab, pharmacy and hospital data connect to the chart, care gaps appear in the team’s existing workflow instead of a standalone report.
- No manual hunt. Claims, hospital, lab and pharmacy context can be assembled around the patient, so teams don’t have to piece the story together from separate sources.
Cut through the noise: See what patients need, when they need it
Prevention begins when the right information reaches the right physician at the right moment. Technology doesn’t replace the care team. It helps bring relevant information into focus so the human can identify risks earlier, before they become a crisis.
Primary care organizations that partner with Aledade and join one of Aledade’s ACOs gain access to technology solutions that bring patient-specific insights and care gap information into focus so physicians see opportunities for preventive care.
Ready to see what this could look like for your teams and your patients? Let’s connect.
* Office of the National Coordinator for Health Information Technology. Office-based physician electronic health record adoption. Health IT Quick-Stat #50. Updated June 2026. Accessed October 13, 2026.
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