Particular embodiments provide a quality adherence guide. In one embodiment, a plurality of medical records from a plurality of medical providers are received. A quality adherence guideline is used to determine if a standard of care is being adhered to by various medical providers. A quality adherence guideline is then generated using the selected standard of care. The quality adherence guideline includes a set of treatment steps that are defined by the selected standard of care. Information from the medical records associated with the patient is also used to populate the guide. During treatment of the patient, input may be received from a plurality of users from health care providers regarding the treatment steps. The patient-direct system automatically analyzes the information inserted in the guideline to determine the level of adherence that various users have achieved when compared with the industry standard for quality care.