EHR-PHR Linkage Platform for Managing Personalized Healthcare Processes Within Clinical Pathways

Japan's aging society and declining birthrate, underscore the need to leverage health and medical information to address challenges, such as extending healthy life expectancy, declining birthrates, and optimizing social security costs. To this end, the Japanese government is promoting the integration of EHR and PHR as a national policy. In previous studies, we developed a three-layered structure consisting of outcomes, assessments, and tasks, i.e., OAT units, as a fundamental unit of clinical practice to structure and standardize of clinical processes. Using the OAT units, we implemented inpatient process management and a learning health system (LHS) within clinical pathways. This study extends these efforts, based on the OAT units, to outpatient clinical pathways for outpatient process management, integrating electronic-personal health record platforms with personalized LHS. When used in diabetes care and chemotherapy, this system enables patient-specific management goals, which are determined in the outpatient clinical pathways and shared with the patient, evidence-based lifestyle guidance, and early detection of side effects. Moreover, the platform facilitates bidirectional communication, focusing on meaningful data exchanges between healthcare provider-related policies and information on patients' daily life, rather than exhaustive data exchange. Additionally, we have organized fundamental concepts related to healthcare processes and submitted a proposal to ISO/TC215 WG1 for developing standardized healthcare processes. These approaches are expected to advance patient-centered care and promote to develop personalized LHS.