Digital Health Technology-Based Patient-Centered Seamless Care Model for Chronic Disease Management after Cancer Treatment

Abstract

Over the past several decades in South Korea, the number of cancer survivors has increased to more than 1.1 million [1]. This has been accompanied by an increase in non-cancer mortality from chronic diseases in cancer patients [2], and therefore, the importance of chronic disease management after cancer treatment has garnered attention. Survivorship care models for cancer patients’ healthcare have been proposed in countries throughout the world [3-5]. In South Korea, projects linking local clinics and community-based healthcare resources are being conducted at the national level. For example, the health information exchange (HIE) pilot project is establishing an electronic transmission/reception system for patient medical records [6,7], the primary care chronic disease management (PCDM) pilot project is laying the foundations for a comprehensive chronic disease management system based on local clinics [6], and the personal health records (PHR) project is building a health management platform by standardizing, integrating, and relating personal medical information [8]. Although a system for managing chronic diseases through linkage between local primary care clinics and cancer treatment hospitals has been developed, limited information is currently being exchanged through this system. Cancer survivors tend to return to the hospitals where they received cancer treatment for chronic disease management [9]. However, effective cancer patient health management necessitates the establishment of a patient-centered, community-based health management system that is connected with the previously developed health management system.