Information continuity refers to the capacity of a system to ensure that the information relevant to a patient’s care is made available to both the patient and provider at the right place and the right time, throughout a patient’s care experience. 3 Well-designed information systems empower and engage patients, improve communication among team members, and improve continuity and coordinated care. 41 42 Information systems should produce reliable, complete, and timely information that ensures interoperability from a wide range of data sources and continuity of patient information. 3 To ensure information continuity, robust information and communications technology should be in place with systems for documenting care information, patient context (including family and patient medical histories and geographic information), and patient preferences. 43 44 Health information systems (HIS) are an essential component of health system strengthening. 10 It is important that HIS align with national priorities and local needs and that their implementation is coupled with sufficient investment in infrastructure and training to promote their successful implementation. 19 More information on the utilization of information systems to support coordinated and continuous care can be found in Information Systems Use.
Patient medical records
Providers rely on the capacity of information systems to store reliable, authoritative, usable, understandable, and comparative data for making clinical decisions at the point of care and across time. 10 It is essential that these systems are well-capacitated to store and manage patient medical records in order to effectively identify, track, and respond to the needs of patients across the continuum of care. Individual-level data ( in the form of patient medical records) should capture information about the patient’s profile, health care needs, treatment and other information. 10
In many countries, portable medical records (such as booklets or cards) are utilized to document patient information. While portable records can help enable informational continuity (if no centralized record-keeping systems are in place), in the long-run these are fragile and unreliable mechanisms for maintaining patient records. To enable informational continuity, the care records of a patient should be easily accessible to all providers involved in their care through standardized clinical protocols and clearly defined referral networks. 43 45 46 To enable better monitoring, supervision, and decision making medical records systems should be interoperable and designed to collect information on a broad spectrum of patient information, taking into account the social determinants of health. From a technical perspective, like CRVS, medical record systems may be paper-based manual systems or electronic depending on the country-context. If paper-based, facilities should take steps to establish appropriate record keeping practices (responsive to changes in the volume of records) to limit errors such as duplication and incomplete data, coupled with staff training, monitoring, and supervision. Files should be able to be readily retrieved to mitigate barriers to timeliness and continuity of care. 18 47 48 Stakeholders can find more information on developing effective and efficient medical records systems in the World Health Organization’s Medical Records Manual: a Guide for Developing Countries.
Civil registration and vital statistics systems
Civil Registration and Vital Statistics systems record statistics on vital events, such as births, deaths, marriages, and divorces and give individuals a legal identity. CRVS systems should be comprehensive and aligned with international standards for the collection of reliable and continuous data on births, deaths, and causes of death. 49 While not essential for the keeping of medical records, CRVS systems help to enable informational continuity by giving patients a unique identifier that health information systems can use to identify, track, and respond to the needs of patients and population. In addition, countries can use data generated from CRVS to increase the health information system’s capacity for data collection, synthesis, analysis, and validation (such as CRVS data on child mortality) and accordingly strengthen system performance. 10 CRVS systems may be paper-based or technology driven. In many LMICs, especially those facing resource constraints, CRVS systems have remained largely paper-based and manual. However, the arrival of new technologies in resource-constrained environments, notably mobile phones, creates an enabling environment for countries to transition to more efficient and effective technology-based information systems.
Accordingly, to promote the development of CRVS systems that are accurate, comprehensive, accessible, and interoperable, countries should work to move from paper-based to automated systems, in which digitized information can be stored, sorted, manipulated and redistributed and checked for accuracy at high speeds and minimal cost. 50 Developing an efficient and effective CRVS system based on a well-functioning technology platform requires significant political commitment, public trust, financial support, and coordination across sectors. 51 In the interim of this transition, paper-based systems should ensure well-organized storage and management systems are in place to store, file, abstract, archive, and retrieve records. 52 More information on Scaling up CRVS and leveraging technology to transition from paper-based to automotive systems can be found in the Global Scaling Up Investment Plan prepared by the World Bank Group and the World Health Organization. Additional information on developing robust information systems, including CRVS systems, will be available in the Information Systems module.
Management continuity can be thought of as a consistent and coherent approach to the management of a health condition that is responsive to a patient's changing needs (known as flexible continuity, or as a property of care coordination). 3 In order to achieve continuity, services should be delivered in a complementary and timely manner and ensure a sense of predictability and security about the future of care for both patients and providers. Shared longitudinal care plans - a patient-centered holistic, dynamic, and integrated plan that documents disease prevention and treatment goals and plans and reflects a patient’s values and preferences - can help to facilitate management continuity and coordinated care 3 43 Goals should be met across a broad range of services (if necessary) and flexible in adapting care to changes in an individual’s needs and circumstances. For the management of patients with complex conditions, management continuity is enhanced through proactive, regular monitoring to ensure goals adapt to changes in an individual’s changes in needs and circumstances. 3 46 More information on shaping patient-centered longitudinal care plans across settings and levels of care can be found here.
As patients transition across care levels and sites, it is important to prioritize continuity of care across sectors through effective coordination and standardized mechanisms. Improving management continuity will require significant investment in resources and systems that promote continuity and coordination, including robust information systems and a diversified and proactive workforce. Informational continuity (use of standardized care plans and diagnostic protocols and availability of actionable information) and coordinated information systems use are critical components of interoperable health information technology structures. To facilitate continuity across providers and facilities and interoperability between systems, standardized care plans and diagnostic protocols should be in place. 46 Electronic health records (EHRs) provide a useful means to help improve communication and coordination in health systems to achieve health and wellness goals throughout a patient’s care experience. In systems with a significant number of non-facility based providers (community health workers, mobile health teams), it is important to integrate facility and community-based records into records systems (i.e MOTECH suite) to promote informational and management continuity. More information on achieving an interoperable health information technology structure to improve management continuity can be found here.
Interpersonal or Relational Continuity of Care
While informational and management continuity ensure the provision of longitudinal information about a patient and a consistent care experience, these types of continuity do not directly address the nature of the relationship between the patient and provider. Relational continuity bridges the past, current, and future needs of a patient through the expectation of ongoing relationships with providers and is essential for the concept of person-centered primary care. 3 11 Relational continuity can be improved through longitudinal care relationships, which refers to the ongoing pattern of care that occurs in an accessible and familiar environment from a consistent team of providers. 5 Fostering a predictable and coherent environment for both providers and patients promotes patient-provider trust and communication as well as patient satisfaction. 3 4 5 To promote relational continuity, facility managers should facilitate a collaborative space for patients and providers to create management plans and protocols that reflect a patient’s needs and preferences. 3 53 54 To promote active listening and accountability, managers should strive to build and retain a consistent core staff 3 that share a similar language and values to their target community. 55 More information on promoting patient-provider respect and trust can be found here.