A patient is the only person who sees the whole pathway.

Care coordination · Research direction

The problem

Care crosses clinics, labs, pharmacies and homes. Each holds a piece. Handoffs lose context, and the person at the centre becomes the courier of their own record.

The question

What is the smallest shared, readable record that lets each party act safely, and how does a system keep it current without becoming another place to type?

A patient is the only person who sees the whole pathway

On handoffs, and why the record should belong to the person it describes.

Follow one person through a year of care and count the places they hold a piece of their own story. A general practice, a lab, a specialist, a pharmacy, a physiotherapist, a relative who helps with the tablets. Each one knows part of it. Each one asks the person to fill in the rest.

We tend to call this a data problem and reach for integration. Integration matters. But the first failure is simpler: nobody is named as responsible for the next step. A referral is made, and then nobody owns the fact that it has not happened yet.

So the smallest useful record is not a full chart. It is a short statement of what was done, what is pending, and who owns the next move. A receiving clinician should be able to act on that alone, and we can test whether they could.

The record should be visible to the person it describes, and correctable by them. The patient is the one person present at every handoff. If their account conflicts with a system's, that conflict is information. It should be shown to the people who need it, and never quietly resolved in favour of whichever source is newer.

A system that coordinates should therefore do three modest things. It should say plainly what is waiting. It should say who owns it. And it should make conflicts loud. It does not need to be clever to do that. It needs to be honest.

We claim no integration with any named system. Standards support is a design target. What we can publish now is the shape of the record and the test for it.

Test design

• Handoffs are structured: what was done, what is pending, who owns the next step.
• Patient-held context is first-class, with the patient able to see and correct it.
• Conflicts between sources are surfaced, never silently merged.

Protocol: Handoff record test