DRVS Add-On Modules

Optimize the use of DRVS at your organization by adding on modules that will help you better integrate with healthcare ecosystem and provide more extensive care to identified patient populations.

Risk Stratification

Referral Management

Controlled Substance




Transitions of Care


Risk Stratification

The risk stratification algorithm that is available in DRVS assists with the consistent identification of high risk patients within or across client health centers.  The risk stratification uses diagnostic and clinical data – age, chronic, behavioral health, infectious disease and substance use conditions, social determinants, clinical outcome indicators, medications, and utilization – to identify those patients at risk who might benefit from care management monitoring and intervention by center staff and programs. Patients are stratified into a high, moderate or low risk category which can be utilized across the DRVS platform in Dashboards, Reports, Registries, Patient Visit Planning, Care Management Passport and quality measures.

  • Identify patients that could benefit from care coordination.

  • Support NCQA PCMH requirements for population health management.

  • Efficient and consistent identification of the needy or costly patients.

  • Match the right resources to the patients need.

  • Better understand provider panels and comorbidities of specific patient populations.

  • Compare risk distribution across health centers (Network Risk Algorithm).

  • Engage in informed conversations with payers and funders with regards to patient risk.

  • Create programs and build resources specific to population needs.

  • Monitor program performance and success of the high-risk populations.


Referral Management

The Referral Management module helps DRVS customers improve referral completions and patient safety by providing a tool to manage the often complicated and inconsistent referral process between providers. The Referral Management module also enables centers to gain insights on referral patterns and specialist behavior and helps achieve the requirements of Patient-Centered Medical Home (PCMH) recognition and the new HRSA UDS measure for closing the referrals loop. DRVS users can view performance and patient populations using Dashboards, gain insights on patient health, priority, and composition, and track and monitor patients through Registry Reports. Referral coordinators can prioritize their work by referrals that need the most attention, follow up on referrals for consults or results, understand their daily workload, and manage referrals as a patient population.

  • Identify open referrals and referrals by specialist.

  • Monitor the impact of referrals on the clinical workflow.

  • Understand health center workload distribution.

  • Ensure sign-off on all referrals to limit liability.

  • Recognize provider referral patterns.

  • See the risk associated with outstanding referrals – by priority and specialty type.

  • Know stat and urgent referral closure rate.

  • Track performance based on type, priority or referred to location.


Controlled Substance

The Controlled Substance Module provides you with tools to more efficiently manage populations at risk - those in treatment for substance use disorder, those at risk for developing a disorder and those with chronic pain. A combination of four registries and measures (16+) will allow you to access relevant clinical information to support team meetings, conduct and evaluate outreach efforts, improve preventive screening efforts and ease the burden of reporting. You can also use dashboards to quickly understand the status of various aspects of your programs.

  • Early identification of patients at risk for alcohol and substance misuse.

  • Identify at risk patients based on being ordered an opioid medication.

  • Monitor patients who have chronic pain.

  • Track and manage patients with known alcohol and opioid use disorders.

  • Monitor all patients enrolled in an office-based opioid treatment (OBOT) program.

  • Monitor patients with active opioid treatment medications such as methadone and/or the use of Benzodiazepine and opioids.

  • Monitor patients with active opioid treatment medications such as methadone and/or the use of Benzodiazepine and opioids.

  • Assess the impact of outreach, education and changes to workflow.



The HEP C and HIV DRVS Modules helps health centers identify and provide better care for at-risk and diagnosed HEP C and HIV patient populations through the use of additional measures and tracking of treatment and prevention programs.

  • Identify patient populations for screenings, diagnosis, and other risk factors.

  • Incorporate screenings and treatments into the DRVS Pre-Visit Planning report (PVP).

  • Support patients through behavioral health and social determinants of health (SDOH) assessments.

  • Use Dashboards to view at-risk and diagnosed populations as well as prevention and treatment program status.

  • Manage overlapping patient populations with other substance abuse and/or chronic pain conditions.

  • Create cohorts by diseases and conditions.

  • Support Pre-exposure prophylaxis, (PrEP) preventive treatment and medication program with the HIV core and extended modules.

  • HEP C includes over 15 measures that follow the Hep C cascade from screening to treatment to cure and includes barriers to treatment.

  • Extended HIV Module includes additional measures such as Ryan White quality measures and the NY State eHIVQual measures for centers who have a significant HIV population. This module includes a both an HIV Lab and an HIV Behavioral Health registry.

  • RSR Reporting Module includes the extended HIV Module, and adds the ability to generate a .csv extract that can be used with the HRSA Chex tool to prepare annual Ryan White submissions.



The DRVS EHR Plug-in allows health centers to access DRVS data from within an EHR at the point of care, including outstanding care gaps, pre-visit planning alerts, and open referrals. Users can save valuable time by accessing DRVS information from within their EHR through a single sign-on and authentication. This integration also displays an HCC/RAF (Risk Adjustment Factor) coding guide that allowing providers to assure that their patients conditions and severity are properly reflected within their visit coding. Azara helps configure the display of DRVS information within the EHR to make sure it is properly aligned to your center’s specific point of care workflows.

Please contact your Azara DRVS representative or Primary Care Association to see if the DRVS EHR Plug-in is currently available or planned for your EHR system.



The DRVS Obstetrics (OB) module enables community health centers to identify and report on pregnant patients to help keep mothers-to-be healthy and on-track before, during, and after pregnancy. With the OB module, centers can look at all pregnant patients during any period of time and determine who is currently pregnant, review various screenings and labs that occur during a pregnancy episode, and capture trimester of entry and birthweight for UDS reporting. There are nearly 100 data points available within the OB module in categories ranging from demographics, to birth details, grouped by pregnancy episode with detailed tests dates and results and accompanying appointment information.

Summary Registry

  • List of currently pregnant patients including those at risk.

  • Sort and filter by gestational age.

  • Review key metrics, tests, and screenings.

  • Differentiate between patients in and out of the formal prenatal program.

  • Access a basic set of episode data (no labs or screenings).

Detailed Registry

  • Includes registry information plus a full suite of pre-natal related labs and screenings.

UDS Reporting

  • Episode-based reports are available for UDS Tables 6b and 7.

  • Reports utilize all OB mappings to determine OB episodes.

  • Contains an "In CHC OB Care” filter to view only patients receiving prenatal care at your center.


Transitions of Care

The DRVS Transitions of Care (TOC) Module solves the most pressing challenges of keeping track of and providing the best care possible to health center patients who have been admitted to and discharged from emergency departments or inpatient hospital stays. For most health centers today, this information is not available in the EHR systems and the DRVS Transitions of Care Module can provide centers with critical details such as admittance time, date, and location, diagnosis, and discharge disposition. Health centers are better informed and can call patients to remind them of or schedule follow-up activities, recognize issues with medications or treatment plans and easily share episode details with team members to better prepare for a patient's upcoming appointment.

  • Provides an interface with your Health Information Exchange (HIE) or regional hospital to receive daily information on your health center's patients and makes the data available in DRVS.

  • Run daily Transitions of Care Registry Reports to gather admissions and discharges for IP or ED within specific timeframes.

  • Enable IP and ED stay alerts into your center's pre-visit planning report (PVP).

  • Improve patient follow up by contacting the IP/ED facility to receive discharge summaries and medication reconciliation documentation.

  • Manage and monitor transition of care processes with relevant TOC quality measures through DRVS Dashboards.

  • Use the DRVS Care Management Passport for a more in-depth review of the patient's IP/ED history and outcomes to lower readmissions.

  • Track readmission rates for cost management.

  • Identify “frequent utilizers” for care management and other patient population interventions to reduce risk.

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