Stroke manager service for improved post-acute continuity of care

Stroke is one of the leading causes of adult disability being responsible for enormous societal healthcare costs. The inter-institutional post-acute stroke processes suffer from information discontinuity and information asymmetries between stakeholders in the healthcare service network (HSN). A central coordination of the HSN's information flow is a promising approach. Because of disease-specific characteristics or differing legal regulations existing concepts cannot easily be adapted. Therefore, we investigated the current post-acute stroke workflow, the involved technologies and legal regulations. Using a combined service engineering and software engineering approach, we developed a novel stroke manager service that supports the patient along the post-acute care pathway. We identified requirements for such a stroke manager service, its supporting IT-infrastructure and legal issues. This paper presents the requirements for an effective post-stroke management, the complex inter-institutional workflow of the novel stroke manager service and the corresponding stroke manager IT-infrastructure. Domain experts evaluated the requirements confirming the demand for more coordination along the patient's complete medical pathway. The feasibility of the stroke manager service concept has been shown in workshops. Even though the incorporation of existing hospital information systems continues to be challenging, first results show that patients, care-givers and healthcare service providers benefit from the stroke manager service. (C) 2012 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.