Today, the Linkcare platform can be used to manage patients belonging to different geographic areas, for both the adoption by public health systems or by private hospital chains and independent practitioners, allowing the integration of primary care with specialty care suppliers (hospitals).

Linkcare enables to provide a patient-centered care and serves both chronic diseases and acute care. The integration of primary care with tertiary reference centers facilitates the implementation of "bundle payment" schemes and health care outcomes measuring in relation with the amount of resources used.

Helping Health Care professionals to work together

The value of Linkcare stands on allowing access to preexisting treatment protocols to be shared among health care professionals (primary care practitioners, specialists, nurses, case managers, caregivers, patients and relatives).

Linkcare may store collected clinical data in pre-existing medical record systems (EMR) or hospital information systems (HIS).

Features

Today, the Linkcare platform is completely developed and has been tested in a number of clinical trials and integrated care services. It includes a set of modules that allow to:

Create teams and set team profiles: Hospital Units, Research Units, Health Care Centers, Geographic Communities, Clinical and technical advisor teams, Sponsors, Universities, Health Care suppliers, Government Offices, Pharmaceutical Companies, Technical Support Teams…

Create users (professionals) and cases (patients & beneficiaries). A very important point is that personal contact data of professionals and cases are maintained in a separate database repository, independent of all the related clinical information. A secret, encrypted identifier is associated to each professional and case and is delivered only to those who has been given granted access to his personal data by the affected person.

Create membership relations between the users and teams and other teams. Each membership relation includes a number of role choices that: allow enrolling, transferring and discharging cases in a particular program (Case Manager); perform the programmed activities (Staff); provide the clinical assessment support (Consultants); create ACM pathways (Program Editor); manage the clinical pathways library and subscribe to other public or shared libraries (Library Manager, Program Manager); perform administrative tasks (Clerk); browse and extract activity information (Supervisor); give contact service support (Call Centre) and provide external services such as device integrations, hospital information system interoperability, clinical decision support services (CDSS), translation services; workflow services..(Service).
Such membership relations can be established either by an invitation or request approach or by traditional centralized organization management.

Design and publish adaptive case management pathways. Linkcare’s library tool kit allows creating adaptive case management programs as a combination of tasks to be performed according to a predefined plan. A set of ready to use form and report templates, device interfaces and event templates allow authors to design programs from scratch or as a derivative of a previously existing program.

Enroll, pause transfer and discharge patients into a program (pathway) subscription. Once a patient is enrolled in a program, all the planned activities are scheduled according to the program plan. This includes: Enrolment tasks, such as Personal Profile Review, Medical Record Review, Health Profile Assessment, Eligibility checking (i.e. inclusion / exclusion criteria), Program stratification and (only for controlled clinical trials) randomization; and programed tasks; protocolled tasks and optional tasks.

Schedule, assign and execute protocolled and optional tasks (reviews, site visits, home visits…) patient self-administered activities (patient reported outcomes, mobile devices…), remote support (messaging, phone calls, videoconference…) and group activities can be completed in the web or mobile app clients.

Telemonitoring. The Linkcare’s mobile app allows deploying telemedicine and telemonitoring services. Linkcare considers mHealth devices as a valuable supplementary tool for being able to manage patients. Linkcare uses all sorts of devices, as doctors don’t get locked-in when they use Linkcare. Any device can be potentially integrated, allowing for specific tailoring (both in needs and available budgets) of every solution required.

Event management and call center integration. Linkcare allows managing support and advice requests and perform alert management by messaging, SMS, telephone or video conferencing.

Perform activity and clinical data extractions for service management, clinical research, epidemiological studies and outcome measurement.

Adaptive case management libraries

Linkcare maintains a library of adaptive case management pathways, allowing the adoption of uniform care plans for patients with similar profiles (meaning similar combinations of pathologies and disease severity). This library of protocols is not a set of "mandatory guidelines", but constitutes the practical know-how generated by healthcare professionals in following their own judgment, often based on interpretation of clinical guides, supplemented by their personal experience and adapted to the circumstances of the individual patient’s profile.

There are three types of libraries in Linkcare:

• Private libraries: These are sets of protocols designed by each healthcare professional to facilitate the monitoring of their patients. Private libraries allow professionals to reuse their own experience in other cases with similar profiles and make easier the programming and monitoring of each task.
• Public libraries: Created by Linkcare’s scientific committees. These committees are recruited and trained by renowned professionals in their field. Public libraries are funded by contributions from sponsors that in exchange of economic cooperation will obtain clinical information. This information will permit to assess the effectiveness of each treatment in the context of standard clinical practice.
• Shared libraries: Consists of a set of protocols that health professionals decide to share with each other to improve their clinical practice by adopting best practices from other colleagues. 

Figure 1: Linkcare's adaptive case management library

Interoperability

Linkcare doesn’t replace existing HIS (Hospital Information System): Linkcare doesn’t replicate already existing systems’ data, but interoperates with them, independently of their specific configurations and characteristics. Linkcare provides a high interoperability and scalability of the platform, as it has been programmed using web services an open three-layer architecture. As a key element for the success of the platform is to make communication among several healthcare entities plausible, this part has been carefully designed and developed.

Figure 2: Linkcare is “the glue” among all existing health systems to allow for knowledge sharing.

An anonymous clinical information exchange system allows different care providers from different centers to collaborate on the same patient using Linkcare as an extension of their own information systems. Once healthcare providers’ systems are integrated with Linkcare the access to existing data is controlled by the owners of those systems (rather than by Linkcare). As soon as a professional has logged in the platform, the system retrieves all information available from a given patient independently of the number of centers where this information may be stored. For this, Linkcare acts as a gateway requesting access to the repository systems, showing the same health professional access information they would have use to access those systems directly. It also provides connectors for mobility systems and telemedicine devices.

Architecture

The overall three layers architecture of the system is show in Figure 3

Figure 3: Linkcare general three layer architecture

One of the important principles of Linkcare is the complete separation between personal and clinical data.

Figure 4: Repositories architecture

This ensures patients and users privacy. This is accomplished by creating a complete separation between personal and clinical data, and extensive use of encoding standards and a set of connectivity options to dialogue with existing Health Information Systems (medical records, electronic prescriptions, user directories…)

A more detailed view allows seeing that all elements in the platform can be combined as a toolkit, and being located in different physical computing resources:

Figure 5: Linkcare platform elements are highly distributed around clients, SaaS and on site services, Linkcare core services and third party services

This design provides a very high scalability in terms of geographical distribution and workload of patients and users involved, requiring a very low maintenance cost. Data repositories can spread along servers in different physical locations. The difference instances communicate with each other following the designed network schema.

Linkcare can be used as Software as a Service (SaaS), avoiding costly disbursements in acquiring licenses, or on site deployment at the service supplier site. Under SaaS, software and associated data are centrally hosted on the cloud and these systems are very easily scalable. Typically, SaaS allows user to access the service over a web. Beyond the obvious cost reductions, the online platform represents a network that links all stakeholders and builds a knowledge base. Linkcare is already available in 6 different languages.

Additionally, Linkcare is an open platform, meaning that other developers can implement new functionalities and share them (or not) with the rest of the community of users. This aims at making Linkcare very flexible to promote its acceptance and widespread as fast and simple as possible.

If at any given time an institution decides to stop paying for the use of Linkcare, that institution will still have the right to use the program, but they will lose the right to get updates and access the protocol libraries (public and shared ones).