IEEE White Paper

- Active. This paper examines clinical barriers to continuity of care (CoC), including fragmented transitions between providers, unequal access to healthcare services, delayed interventions, and variations in outcomes across geographic and socioeconomic populations. The analysis suggests that future CoC models will evolve from episodic treatment toward continuous, personalized, and proactive health management. Emerging technologies, including digital twins, the Internet of Things (IoT), and synthetic data, are clinical enablers that can support earlier detection of deterioration, individualized treatment planning, reduced medical errors, and improved management of complex chronic conditions. The paper also highlights the essential role of standards in enabling interoperable, secure, and context-aware data exchange across care settings, thereby supporting trustworthy AI and longitudinal patient care. Finally, a clinically focused research agenda is proposed, designed to improve outcomes, strengthen care coordination, and advance patient-centered healthcare delivery.