Connectivity, networking, tracking are just three examples of words that have invaded the common discourse and not by coincidence - they mediate the way we live, how we relate, how we interact. Any doubts about the level and potential of what I have just described were cleared up when NASA launched the Where Is Webb page, a tool throughout which anyone could follow, in real time, the path of a telescope. 

Where is it? What happened? Where is it going? When is it supposed to arrive? For all these questions, the most curious minds - scientists or not - found answers. Quickly, updated, just a few clicks away. The same questions can be asked by doctors, nurses, or health managers regarding the thousands of people who, every day, use the health system. And - let's face it - the answer is never easy to find. 

It is curious that we know so much about the universe and very little about where the patients are - often lost between appointments, exams, and waiting hours that are repeated until exhaustion. 

The problem is not new, but despite some promising experiences regarding integrated care models, global health systems remain fragmented, focused on acute and episodic care, unable to meet the needs of today's society. In Portugal, the reality is not different and the discussion has recently gained new impetus with the announcement of new Local Health Units (Unidades Locais de Saúde) - a clear bet on a model in which primary health care and hospital care work (or should work) in a network. 

On the other hand, new questions also pop up: is this formalization sufficient to ensure the optimization of NHS resources and citizens’ quality of life? 

No. You need to connect all the scattered dots - both for healthcare professionals and citizens – striving for four essential requirements: 

We know that fragmented care is particularly harmful to chronic illness, whose patients complexity requires multidisciplinary care and the articulation of different professionals and levels of care, in the course of a long and continuous relationship with the healthcare system.

In this context, it is primary to ensure that there is a defined, multidisciplinary and comprehensive care journey that indicates the path that the patient will follow from the moment he or she is diagnosed. A map that connects several points in the system and guides care provision. This is the guarantee that each patient receives the appropriate care at each point in time, regardless of where they are, precisely because the care journey defines all the stages the patients must go through and what happens at each stage. 

Care integration is the engine of a health system with increased responsiveness and higher quality, by allocating each patient to the right professional, maximizing the opportunity cost of each one. To achieve this, it is essential to define clear referral criteria throughout the entire care journey, ensuring that the patient is seen at the correct level of care.  

Taking the care journey as the map that defines the stages a person must pass through and what happens at each stage, the referral criteria act as the traffic rules that dictate when the patient must (or must not) move forward or backward to the next stage or level of care. This point is particularly relevant to optimize the allocative efficiency of the health system and avoid, for example, unnecessary overuse of hospital resources. 

Given the increasing volume and complexity of patients - associated with several factors, including the increase in average life expectancy -, the scarcity of resources, and the connectivity era in which we live today, it makes no sense to have patient's progress dependent of face-to-face appointments: we can - and should - use the tools that already exist to remotely monitor patients.  

So, just as a navigation system identifies an accident or traffic intensity and adjusts the route, so in healthcare there must be total visibility over the patient's progress, identifying any red flags and adjusting the journey automatically. 

Ultimately, the success of care integration depends on the ability to overcome the information silos that still persist and find an agile way to obtain structured, compiled and updated health information in real time.  

Like a satellite network that follows the entire journey and ensures that the multiplicity of information systems used in hospitals, primary care centers and other units, communicate with each other, speak the same language, assign a unique and unambiguous meaning to each piece of information they receive or transmit, and guarantee that patients data follow them throughout the health system. 

Even in vertically integrated models designed to work in networks, several challenges remain to make the proclaimed benefits of care integration a reality.   

Let’s connect the dots?