Longitudinal Patient Record Systems – A Necessity for Accountable and Collaborative Care

By Alan Gilbert

In response to Dr. Jayne’s inaugural Curbside Consult regarding the lack of longitudinal care systems and the focus on episodic care, our experience has shown that a longitudinal patient record system is critical to realizing a goal of a more effective and efficient healthcare system that results in improved outcomes for patients. We believe that healthcare needs to be delivered at the point of need and not at the point of care.

One example of a longitudinal patient record is the National Clinical Network for Cleft Lip and Palate Services in Scotland. This project was established in 2000 to deliver interdisciplinary care between health professionals providing care for cleft lip and palate patients between birth and 20 years old. The objective was to provide a single record for a patient, creating a virtual multi-disciplinary care team for that patient including dentists, orthodontists, oral surgeons, speech pathologists, ENTs, audiologists, as well as the patients themselves, who were active participants in their own care. The platform accommodated clinical imaging, generated email,and letter alerts to remind clinicians and patient alike of their particular responsibility at specific times, and supported and facilitated audit and outcome assessments.

Benefits realized included:

• Improved communication – sharing of information across care providers
• Improved standards of care — a single source of patient information to monitor and analyze outcomes
• Improved coordinated care — interdisciplinary treatment planning and care has improved due to use of the platform
• Improved efficiencies — more effective use of clinicians’ time as well as the patients, their parents, and caregivers
• Improved data access — minimized risk of data fragmentation over multiple sites, reduced cost, time and effort incurred by offline data entry and replication
• Better patient satisfaction — through improvement in the organization of clinics and coordination among specialties
• Improved reporting — reports and analysis on a national basis

Another example of a longitudinal patient record is the National Sexual Health System in Scotland (NaSH) that was started in 2005. This strategy set out a framework for improving sexual health by enhancing access to information and services while enabling flexibility for local services to respond to local requirements. It also highlighted the need to be able to review existing data and develop a data collection framework to provide a more accurate picture of sexual health and wellbeing, in terms of both sexual conditions (chlamydia, AIDS, etc) and behaviors and attitudes.

Benefits realized included:

• Ability to produce and aggregate national sexual population and public health data
• Improved clinical care and access to patient clinical information by introducing more patient focused processes and the ability to communicate directly with patients through patient portals, secure email and text
• Streamlining of services enabling improved throughput and availability
• Increased ability to share clinical data across services nationally
• Removal of multiple manual record keeping systems
• Ability to address some clinical governance issues more effectively
• Reduced requirement for duplicate entry of patient data and better quality of data
• More efficient and increased integration of systems

These examples, as well as others in diabetes, cancer care, COPD, and infection control, all focus on the need for a technology platform that can create a consolidated clinical view of the patient, no matter their care setting.

Alan Gilbert is VP of business development for AxSys Health of New York, NY.