Health and social care continuity

Different facilities. One shared medical and social memory.

Find the clinical and social context you need at every care transition.

Hospital stays, return home, admission to a long-term care facility: CLARYS Medical Memory brings the available information together, across facilities and software.

Explore a care pathway
Helen Marshall(70 years)
Hospital discharge
Halverton General Hospital · GeriatricsAshgrove Senior Living
  • Hospital stay summary
  • Current treatments
  • Social context and functional independence

Information available based on access rights

The problem

Care settings change. The person’s story remains.

At every transition, medical, social and functional information gets scattered across systems and documents.

Yet medical history, treatments, independence and living conditions are essential to prepare care.

Multiple conditions, loss of independence, many professionals, carers: every transition becomes more delicate.

Memory sources

Legacy EHR

Archived · read-only
18,420 documents

New EHR

Live
2,316 documents

Regional HIE (FHIR)

Connected
4,907 resources
History preserved
Health & social care

Two fields. One readable view.

In hospitals and social care settings alike, CLARYS Medical Memory makes information chronological, contextual and traceable.

Healthcare

Clinical history, diagnoses, treatments, care events.

Social care

Personalized plan, independence, needs, support events.

For support

A medical and social memory. Pathways readable over time.

CLARYS Medical Memory links events, documents and context, without altering the sources. Social care data is added when available and accessible.

  • The person’s pathway, better understood

  • Care and support, without a break

  • The right context to coordinate

Social determinants of health
Illustrative example
Living conditionsLives alone, 3 floors up, no elevator
Social supportPrimary caregiver: her daughter
OccupationRetired, former textile worker
Three concrete situations

From care to support. One shared medical and social memory.

Prepare an admission

Medical history, treatments and events, found before care begins.

Support hospital discharge

The key facts of the stay and follow-up, available to the professionals taking over.

Coordinate a complex care pathway

Clinical, social and functional data side by side, when available.

Example

Returning to where the person lives after a hospital stay.

Reports, treatments, independence assessments, personalized plan: the team welcoming the person back finds what matters to ensure continuity.

One shared view for healthcare and social care teams.

Subject to information availability, interoperability and access rights.

Helen Marshall(70 years)
Hospital discharge
Halverton General Hospital · GeriatricsAshgrove Senior Living
  • Hospital stay summary
  • Current treatments
  • Social context and functional independence

Information available based on access rights

The difference

Connect the information. Understand the whole care pathway.

CLARYS Medical Memory organizes documents and events over time, whatever their source systems.

CLARYS Intelligence understands their clinical meaning, in context, with a link to every source document.

Together: a more complete medical history, for continuous care pathways.

Helen Marshall(70 years)

Patient summary

Mar 22, 2025 · International Patient Summary (FHIR-IPS)

IPS

70-year-old female patient with a documented history of malignant neoplasm of breast and fracture.

Patient problem history

  • malignant neoplasm of breast, first mentioned in 2001 (age 46)
  • fracture, first mentioned in 2025 (age 70)
SourceEmergency department note · Halverton General Hospital
Documents
Share IPS
The IPS sums up the essentials. The memory keeps the whole story.

  1. Hospital

    • Emergency
    • Medicine
    • Surgery
    • Specialties

  2. Hospital stay

    • Diagnoses
    • Treatments
    • Tests
    • Reports

  3. Discharge

    • Discharge summary
    • Care plan
    • Follow-up
    • Referral

  4. Return home

    • Primary care physician
    • Home health nurses
    • Pharmacy
    • Home care aide

  5. Long-term care facility

    • Senior care
    • Rehabilitation
    • Disability care
    • Day care

  6. Coordinated pathway

    • Reassessments
    • Person-centered plan
    • Caregivers
    • Care coordination
CLARYS Medical MemoryGathers and organizes the informationTimeline · Context · Traceability
Medical and social memory
CLARYS IntelligenceUnderstands and structures meaningClinical and social concepts · SNOMED CT · LOINC · ICD

Data sources (FHIR)

  • Admissions (ADT)
  • Procedures
  • Diagnoses
  • Tests (LOINC)
  • Medications
  • Documents
  • Social and long-term care data
  • Care plans and life plans
  • A complete view of the pathway
  • Better-informed professionals
  • Easier coordination
  • Safer, more continuous pathways
Context in applications

A shared clinical context. Better-informed applications.

The goal: relevant clinical information right inside professionals’ applications, according to their access rights.

Clinical Context as a Service: new services, developed step by step with our partners.

CLARYS Medical MemoryMedical and social memory
Relevant contextMedical historyTreatmentsIndependenceSupport network
Your applicationAccording to access rights

Key takeaways

At every transition, the medical and social history follows the person.

  1. Better-informed handovers

    Medical history, treatments and independence found before care begins.

  2. Medical and social together

    Living conditions, support network and independence, alongside clinical information.

  3. Beyond each facility

    Hospital, home, long-term care: one memory, whatever the software.

Let’s build your project

A first care pathway. Continuity to build together.

Hospital discharge, primary and hospital care coordination, older people, health and social care continuity: let’s start from a real situation to define a first scope.

Let’s talk about your project