Module 10 · Care Pathway Management · 10.4 · ORCHESTRATE
Patient Journey Overlay
One patient's thread across the pathway — every node instance, the variant transition, and how the segments compose into a single conformance score. Scoped to Full portfolio.
Index episode
Mohammed Al-Rashidi · EP-2027-018342 · patient mohammed-al-rashidi. Enrolled 15 Jan 2027 on V3 (HbA1c 9.4, PHQ-9 14); severity improved and the episode transitioned V3→V2 effective 15 Sep 2027. Cycle 20 Oct 2027.
SO-4 · severity ≠ risk. Current variant V2 (clinical, deterministic) beside RS-2 tier Rising (probabilistic) — rendered side by side; no payment surface consumes the tier as a variant.
74
V3 segment (38.5/52)
92.9
V2 segment (13/14)
78
composite (51.5/66)
81%
timeliness
Expected vs actual · episode timeline lane (V3 → V2)
N01Enrollment & assignment reviewexp on-timeOnTime◆
N02Baseline HbA1c + metabolic panelexp on-timeOnTime◆
N03Medication adherence reviewexp on-timeOnTime◆
N04Medication intensification decisionexp on-timemissed◆
N04Medication intensification decisionexp on-timeLate◆
N05Dietitian referral (closed loop)exp on-timeOnTime◆
N06Self-management education blockexp on-timeLate◆
N07Depression screen (PHQ-9)exp on-timeOnTime◆
N08BP captureexp on-timeOnTime◆
N08BP captureexp on-timeOnTime◆
N08BP captureexp on-timeOnTime◆
N09HbA1c retestexp on-timeOnTime◆
N09HbA1c retestexp on-timeOnTime◆
N10Follow-up encounterexp on-timeOnTime◆
N10Follow-up encounterexp on-timeLate◆
N11Retinal exam (closed loop)exp on-timeLate◆
N12Comprehensive foot examexp on-timeOnTime◆
N13Renal panel (uACR + eGFR)exp on-timemissed◆
N15Hypoglycemia safety checkexp on-timeOnTime◆
N15Hypoglycemia safety checkexp on-timemissed◆
N16Glucose self-monitoring reviewexp on-timeOnTime◆
N16Glucose self-monitoring reviewexp on-timeOnTime◆
N18Care plan update & goalsexp on-timeOnTime◆
↳ Variant transition 15 Sep 2027 · V3 → V2
N09HbA1c retestexp on-timeOnTime◆
N10Follow-up encounterexp on-timeOnTime◆
N18Care plan update & goalsexp on-timeOnTime◆
N15Hypoglycemia safety checkexp on-timeOnTime◆
N16Glucose self-monitoring reviewexp on-timeOnTime◆
N17Immunization reviewexp on-timemissed◆
N08BP captureexp on-timeOnTime◆
N08BP captureexp on-timeOnTime◆
Segment 1 — enrolment window · V3 · 15 Jan → 15 Sep 202738.5/52 = 74
N01Enrollment & assignment reviewOnTime
N02Baseline HbA1c + metabolic panelOnTime
N03Medication adherence reviewOnTime
N04Medication intensification decisionMissed
N04Medication intensification decisionLate
N05Dietitian referral (closed loop)OnTime
N06Self-management education blockLate
N07Depression screen (PHQ-9)OnTime
N08BP captureOnTime
N08BP captureOnTime
N08BP captureOnTime
N09HbA1c retestOnTime
N09HbA1c retestOnTime
N10Follow-up encounterOnTime
N10Follow-up encounterLate
N11Retinal exam (closed loop)Late
N12Comprehensive foot examOnTime
N13Renal panel (uACR + eGFR)Missed
N15Hypoglycemia safety checkOnTime
N15Hypoglycemia safety checkMissed
N16Glucose self-monitoring reviewOnTime
N16Glucose self-monitoring reviewOnTime
N18Care plan update & goalsOnTime
Variant transition · 15 Sep 2027. HbA1c control returned the episode from V3 (Uncontrolled) to V2(Controlled). Each segment scores against its own variant's nodes; the composite is weight-pooled, not averaged.
Segment 2 — maintenance window · V2 · 15 Sep 2027 → cycle13/14 = 92.9
N09HbA1c retestOnTime
N10Follow-up encounterOnTime
N18Care plan update & goalsOnTime
N15Hypoglycemia safety checkOnTime
N16Glucose self-monitoring reviewOnTime
N17Immunization reviewMissed
N08BP captureOnTime
N08BP captureOnTime
Variance ledger · 8 classified variances
| Node | Class | Detail | Δ days |
|---|---|---|---|
| N04 | Delay | N04 intensification — first window Missed, recovered Late after N19 re-trigger (credit 0.5) | +30 |
| N11 | System/Access | Retinal exam Completed Late +19d — ophthalmology scheduling backlog (attribution System/Access) | +19 |
| N06 | Delay | Self-management education block completed late | +12 |
| N10 | Delay | Second follow-up encounter completed late | +8 |
| N13 | Omission | Renal panel (uACR + eGFR) not evidenced in the annual window | — |
| N15 | Omission | Second hypoglycemia safety check omitted | — |
| N17 | Omission | V2 immunization review omitted | — |
| N04 | Delay | First N04 window closed unevidenced (paired with recovery instance) | +30 |