BACKGROUND:
Continuity of care is a core component of high-performing health systems and is an essential determinant of quality, safety, and outcomes for patients and populations. However, even as investment in digital health technologies increases, care delivery in many health systems (especially in low- and middle-income settings) remains fragmented across community, facility and post-care environments. When digital health interventions are deployed, they are commonly done so as vertical interventions with insufficient capacity to enable integrated, coordinated and longitudinal care for patients and populations as they progress along the care continuum.

METHODS:
A conceptual systems-level analysis was performed to explore continuity of care in digital health-enabled health systems. Leveraging existing domains of continuity of care and systems thinking concepts, patient pathways through interconnected community-based services, facilities, and post-care follow-up were subjected to an analytical model to explore structural and informational discontinuities. Relevant digital health implementation strategies were explored within the context of their alignment with longitudinal continuity of care through transitions in care.

RESULTS:
The systems-level analysis revealed that continuity of care is a prominent gap in the current approach to digital health implementation. Major barriers were identified in terms of fragmented information flow, poor continuity across care levels, inadequate follow-up procedures after clinical contacts, and weak enforcement of continuity of care strategies that would ensure ongoing patient involvement beyond clinical visits. The results emphasise the necessity for digital health solutions that aim to promote continuity of care in terms of information, interactions and capacity management throughout the entire care continuum.

CONCLUSIONS:
The issue of continuity of care still remains inadequately attended to in digital health-enabled health systems. As a potential improvement, understanding digital health implementation using the continuity-of-care framework provides insights into better integrated and patient-centred system architecture as well as enhances continuity of care within resource-constrained health system environments.