Introduction: Analysing variance from care pathways in situations when adverse health outcomes have occurred may identify missed opportunities for healthcare improvement.

Methods: We developed a computational model for contrasting observed with expected care in pathway searches of coded electronic health records (EHRs). The model was applied in Salford, UK, looking at blood pressure (BP) control and cardiovascular disease (CVD) events. BP was summarised as the integral of serial measurements.

Results: A missed opportunities mapping (MOM) model consisting of a collection of disease Events and pathophysiologic States was used to articulate all CVD scenarios conceived. In 3718 patients suffering CVD events in Salford (2007–2012), 1186 (32%) had suboptimal BP control. This missed opportunity detection rose to 36% using the integral instead of the most recent BP record.

Conclusions: MOM provides a useful, computable model for encoding care pathways and searching EHRs to detect variations from expected care. Further research is needed in other disease areas. The indications however, are that this model could be used to embed healthcare quality improvement at both patient and population levels.