Continuity of care — the experience of being known across encounters, remembered by the system — is one of the most consistently validated predictors of good health outcomes. Here is the evidence that drove our design decisions.
01 / BMJ
"Increased continuity of care is associated with lower mortality rates, decreased hospital admissions, and reduced healthcare costs."
A large-scale longitudinal cohort study tracking patient outcomes across multiple years found that patients with a consistent primary care relationship experienced significantly better survival rates and fewer preventable hospitalisations — independent of age, comorbidity, and socioeconomic status.
British Medical Journal · Continuity of Care & Patient Outcomes · Longitudinal cohort study
02 / JAMIA 2024
"Patients with comprehensive longitudinal records encounter 24% fewer hospital readmissions compared to those without such access."
The presence of a complete longitudinal record reduces the compounding errors of fragmented care — missed follow-ups, undocumented prior treatments, and unrecognised contraindications — that drive preventable readmissions. This finding from JAMIA 2024 quantifies what clinicians have long observed.
Journal of the American Medical Informatics Association · JAMIA · 2024
03 / Journal of Medical Systems
"Complete medical histories improve diagnostic accuracy by 37% — the highest-impact variable in first-consultation outcomes."
Of all variables studied — including clinical test results, imaging, and physician experience — the completeness of the prior medical history had the greatest single impact on diagnostic accuracy at first visit. A complete record is more valuable than almost anything else a doctor can have at the moment of decision.
Journal of Medical Systems · EHR Completeness & Clinical Decision Quality
04 / King's College London
"Patient-held records provide continuity and patient involvement — critical in complex multi-provider journeys where gaps are most costly."
A systematic review across 46 studies found that when patients actively held and managed their own records, continuity improved, patient engagement increased, and clinical teams received richer information at the point of care. The effect was strongest for patients managing chronic conditions across multiple specialties.
King's College London · Systematic Review, Health Expectations, 2007
05 / Journal of General Internal Medicine
"Continuity is linked to better chronic condition management, improved medication adherence, and increased trust in providers."
Patients with chronic conditions who experienced high continuity — defined as consistent access to their full history and recurring contact with the same provider team — showed measurably better medication adherence, more consistent monitoring, and greater willingness to disclose lifestyle factors relevant to their care.
Journal of General Internal Medicine · Chronic Disease Management & Continuity
06 / University of Manchester
"Patient-reported continuity — the experience of being known by the system — is a marker of healthcare quality in its own right."
This 2024 study from BMC Primary Care found that subjective continuity — the patient's own sense of being remembered and understood across encounters — independently predicted satisfaction, engagement, and trust, even when objective record completeness was controlled for. Being known matters, not just having the data.
University of Manchester · BMC Primary Care · Burch et al., 2024
Why the system fails today
The average person sees 19 different healthcare providers across their lifetime. Each encounter begins, by default, from near zero. The electronic health records that exist are institution-owned — they follow the hospital, not the person.
The result is a system that is episodic by design. A GP visit generates a GP record. A hospital admission generates a hospital record. A psychiatric referral generates a mental health record. None of these speak to each other automatically. The patient is the only person who attends every encounter — but they have no structured record of any of them.
What SinceWhen does differently
SinceWhen gives the record to the person. It follows the patient, not the institution. It accepts any format — documents, voice notes, photos of prescriptions, discharge summaries — and structures them into a single, searchable, shareable thread that begins at birth and continues for life.
The AI layer does not replace clinical judgment. It does what a good medical secretary would do: synthesise the prior history into a structured brief that any clinician can absorb in 90 seconds. The doctor still makes the decision. They just have all the information to make it well.
The research above makes the stakes clear. Fragmented records are not an administrative inconvenience. They are a source of preventable harm. SinceWhen was built to fix that — one thread at a time.