Relevance of mandates, notifications and threads in the management of continuity of care.

Availability of electronic healthcare records (EHCR) and geographical networks allows nowadays to realise a set of functionalities to support continuity of care. Actual exchange of complete clinical information, common centralised records, common decisions within an agreed protocols are not mandatory. Sub-optimal alternatives, involving easier management, are possible. In fact, the crucial challenge for continuity of care is the mutual awareness of the multiple perspectives by the actors contributing to patient's care. The various actors should timely know changes in the status of: mandates, i.e. who is involved in the care provision and thus is responsible for a "local" record. knowledge about the patient, i.e. active and inactive problems, impressions, relevant findings. provision of healthcare activities, i.e. plans, orders and performed activities. The decisions on the actual implementation depend on the healthcare context, as implemented within the information system. For example, the mechanism for notifications involves decisions on the quality and quantity of information that must be exchanged, as well as on the modalities for the exchange, regulated by individual user's profiles. Each notification could be sent as a message to a central repository, and then each authorized user could select within the repository the pertaining messages. Or a notification could be sent directly to the list of professionals involved in the care of a patient, that asked for it in their profile. Mandates may be used to regulate the access of the users to the patient's information. This approach was embedded in a European standard under development in CEN/TC251 (CONTSYS--"System of concepts to support continuity of care").