So, you think you have achieved Continuity of Care?

No one doubts the importance of Continuity of Care in Medicine.

ONC’s 45 CFR Part 160 Subpart C Final Rule includes a number of criteria (22 out of 44) that have a specific focus on Continuity of Care.

302a Drug-drug Interaction checks, 302c Problem list, 302d Active Medication List, 302e Active Medication Allergy List, 302h Incorporate Lab Test Results, 302j Medication Reconciliation; 302p Emergency Access ; 304c, d, e, f, g, h, i; 306a, b, c, d,e, f, g, h.

What is missing at these ONC guidelines, if you look under the hood?

Missing is the ability to reach out to a superior, colleague or domain expert as and when there is a need for a “second opinion” (e.g. advice and assistance) that improves patient quality of care.

Consider a busy 24 x 7 healthcare facility where one provider has a question at 1545 hours that impacts patient care and where the provider will be going off shift at 1600 hours.

Suppose he/she poses a question using ordinary e-mail services/systems – the result will be either a quick response and a timely intervention or a 16-hour delay (worst case) and an untimely intervention.

Another variation to this scenario is, the provider, not having received a response by 15:50, will perform an intervention in the absence of possibly important information, resulting in a medical error.

What is missing is “dynamic Continuity of Care” where a record of the provider’s outgoing request for information posts to the patient EMR and the response to the request for information comes back, not to the provider, but to the point of service, where it will be seen by anyone attending to the patient on night shift.

So, we have here yet another reason why ordinary e-mail is not effective for medical collaborative initiatives.

Why not just leave a note for the person who takes over on night shift?  The answer for busy clinics is that provider in our scenario will not necessarily know who his/her replacement will be and even if he/she were to know, there could be a last minute change in provider.

Bottom line, don’t engage in collaborative consultations using anything other than in-line messaging/notification services where requests go out from points of service and responses come back to those same points of service.


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, major crimes case management, healthcare services delivery, and b2b/b2c/b2d transactions. (C) 2010-2019 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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3 Responses to So, you think you have achieved Continuity of Care?

  1. Salim says:

    شكرا جزيلا
    thank you very much


  2. Salim says:

    unfortunately not yet,,
    but still trying to do so,,
    but there must be a system assisting this approach


    • The approach is at the foundation of Adaptive Case Management (ACM) and there are a number of systems on the market that support ACM. However, medicine is a complex area so customers need to be able to acquire a “healthcare case management” environment that can accommodate both ad hoc interventions as well as the more streamlined intake, assessment, diagnosis, tx plan/medications, scheduling, monitoring, billing/claims, and discharge processing. Civerex has been marketing this type of environment since 1995, years before we learned that what we were doing was ACM. This is why today we promote ACM/BPM – it gives our customers, in our view, the best of both methodologies.

      Thank you for expressing an interest in our research.


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