Method and system for automated healthcare care coordination and care transitions

摘要

A system and method configured for coordinating healthcare services is disclosed. The method can comprise selecting a patient for care coordination based in part on a patient diagnosis and data analytics, assigning a predetermined patient care flow plan to a patient based in part on the patient diagnosis, modifying the predetermined patient care flow plan in response to input from at least one of a healthcare provider and the patient, and generating a customized patient care flow plan for the patient, executing the customized care flow, and engaging the patient by providing to the patient at least one of patient scheduling, notifications, a personal health record, patient home monitoring, and patient education and medication information materials. The present disclosure further includes computer program product of a computer-readable medium usable with a programmable computer and having computer-readable code embodied therein for coordinating healthcare services.