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 Open · 2018
"Continuity of care with doctors is consistently associated with lower mortality rates. Eighteen of 22 studies reviewed found a significant association — across multiple countries and healthcare systems."
A systematic review of 22 studies from 18 countries examined the relationship between continuity of care and mortality. The evidence is consistent and robust: patients who see the same doctor over time die at lower rates — independent of age, morbidity, and socioeconomic status. The finding holds across the NHS, US Medicare, Nordic national registries, and primary care systems worldwide.
02 / BJGP · 2022
"A GP relationship lasting more than 15 years is associated with a 25–30% reduction in acute hospital admissions and mortality — a dose-response relationship that indicates causality."
A national registry study of 4,552,978 Norwegians linked the duration of each patient's GP relationship to acute hospital admission and death. Longer relationships produced fewer admissions and lower mortality in a consistent, dose-dependent gradient — after adjusting for age, morbidity, education, centrality, and physician factors. The pattern suggests the relationship itself protects.
Sandvik H, Hetlevik Ø, Blinkenberg J, Hunskaar S · British Journal of General Practice · 2022 ·
DOI: 10.3399/BJGP.2021.0340 · PMID: 34607797
03 / BMJ · 1975
"In 66 of 80 new outpatients, the correct diagnosis was reached from history alone. Physical examination and laboratory investigations each contributed the final diagnosis in fewer than 10% of cases."
The foundational study establishing that the medical history is the single most powerful clinical tool. Among 80 consecutive outpatients, the history alone led to the correct diagnosis in 82.5% of cases — more than physical examination and laboratory investigation combined. A fragmented record is not merely inconvenient: it removes the most diagnostically decisive input a clinician has.
04 / Health Expectations · 2007
"Patient-held records provide continuity and patient involvement — critical in complex multi-provider journeys where gaps are most costly."
A systematic review of patient-held records in cancer care found that patients who carried and managed their own records had better clinical continuity, higher engagement, and richer information at point of care. The gains were largest for patients navigating multiple specialists over extended periods — precisely the population most harmed by fragmentation.
05 / BMJ · 2017
"Patients with the lowest continuity of care scores are significantly more likely to be hospitalised for conditions that could have been managed in primary care."
A cross-sectional study using person-level NHS England data found that poor relational continuity — being seen by a different clinician at each encounter — was independently associated with higher rates of preventable hospital admissions. The conditions involved are the ones that accumulate silently: chronic conditions that go unmanaged when no one holds the full picture.
06 / BMC Primary Care · 2024
"Patient-reported continuity — the experience of being known by the system — is a marker of healthcare quality in its own right."
This systematic review found that patients who felt remembered and understood across encounters showed higher satisfaction, engagement, and trust — separate from how complete their records actually were. The subjective experience of continuity has its own clinical value, and it is measurable. A patient who feels known behaves differently: discloses more, engages earlier, trusts the process.
07 / PLoS One · 2014
"Both longitudinal and interpersonal continuity of care are independently associated with reduced emergency department use, fewer hospitalisations, and lower mortality in older patients."
Analysis of Medicare beneficiaries in the United States examined two dimensions of continuity — seeing the same provider over time, and the quality of that relationship. Both independently predicted fewer emergency visits, fewer hospital admissions, and lower mortality. The effects held after controlling for health status and demographics, suggesting continuity itself — not just patient health — drives the result.
Why the system fails today
The average person sees 19 different healthcare providers across their lifetime. Each encounter begins, by default, from a partial picture. 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 thorough medical secretary would do: pull the prior history into a structured brief any clinician can read in 90 seconds. The doctor still makes the call. They just have the full picture to make it well.
The research above is not ambiguous. Fragmented records cause preventable harm. SinceWhen gives the record back to the person it belongs to.