Digital Care Journeys

A digital care journey is a personalized, longitudinal care plan that guides a patient step-by-step through an episode of care on their own device. It combines four things: automated reminders, interactive education delivered at the right moment, symptom and progress check-ins completed from home, and alerting that routes concerning responses back to the care team. Unlike a static PDF, a pamphlet or a one-off portal message, a digital care journey adapts to where the patient is in their journey and gives the care team continuous visibility between visits. Episodes of care include pre/post-surgery, cancer treatment, chronic care management, maternity care, behavioral health and more.

Device-based remote patient monitoring typically focuses on capturing physiologic data — often from connected devices — for a defined chronic condition. A digital care journey is broader: it covers the entire episode of care, combining patient education, task reminders, protocol compliance, patient-reported outcomes and symptom monitoring in a single plan. SeamlessMD includes remote monitoring inside a wider engagement platform, which is why health systems deploy it across surgery, oncology, maternity and chronic care rather than for a single monitoring use case.

Patients are most often enrolled automatically through an automated EHR integration, however patients can also be enrolled by staff through a standalone web portal, or patients can even self-sign up — the right access method is customized to the organization’s clinical workflows. The patient then receives an email or text with activation instructions. Once activated, patients access their care plan through any web browser, or by downloading the app from the Apple App Store or Google Play Store. Where the health system uses Epic or a similar EHR, patients can also reach SeamlessMD through MyChart or another patient portal. Patients can also access it through a health system’s custom digital front door. No new hardware is required.

No. SeamlessMD works on any smartphone, tablet or desktop computer through a web browser, with native iOS and Android apps available for patients who prefer them. For patients without a smartphone, SeamlessMD supports SMS-based delivery of reminders and education, including to basic feature phones, and SMS-only programs that require no account at all — used for population health outreach such as colorectal cancer screening and hypertension. Caregivers can also be enrolled to support patients who cannot use the technology themselves.

SeamlessMD provides out-of-the-box digital care plans that include the education content, workflows and clinical algorithms, and SeamlessMD’s patient education team then helps the health system customize it to its own protocols. The library includes 75+ pre-built, evidence-based pathways covering 150+ conditions, procedures and treatments. Usually health systems will say they love 80% of the template and need 20% customized to match their existing protocols.

SeamlessMD employs a dedicated Patient Education team of clinicians and health communication specialists — nurses, pharmacists, health communication specialists and so forth — who review evidence-based guidelines and translate them into patient-facing content written at a Grade 6 reading level and built to best practices for accessibility, health literacy, adult learning and behaviour change. Health systems do not start from a blank page.

Yes. Health systems customize the content, workflows, algorithms, alert thresholds, to-do lists and surveys in every care plan, and clinical teams are directly involved in that build. The app can also be branded with the health system’s logo, colours and clinician photos so patients experience it as an extension of their care team.

Yes — after a care plan is live, clinical teams can make change requests for care plans and content updates, which will be handled by our Patient Education teams. Change requests required for patient safety are prioritized. Clinical teams typically have scheduled content reviews and updates at 1 month post-launch, 6 months post-launch, and then once a year after that. Other edits can be made in between upon request. Safety-related changes are made as soon as possible.

Health systems that prefer direct control can request access to the content management system and make changes themselves, however we find that the vast majority of health systems prefer to use SeamlessMD’s fully managed services here.

The health system decides, based on the episode of care. Care plans can range from a few weeks to a year or longer. Tracking windows are configurable — for example, collecting data for pre-op baseline plus 7, 14, 30, 90 and 365 days post-surgery. There is no platform-imposed limit.

No. There is no limit to how many patients can access SeamlessMD. We have health systems that have tens of thousands of patients using our digital care journeys, and across provincial or large regional deployments.

Four things differentiate SeamlessMD from other solutions in this category.

Breadth of the care plan library. SeamlessMD covers 150+ conditions, procedures and treatments through 75+ pre-built, evidence-based pathways spanning surgery, oncology, maternity care, chronic disease and mental health. Health systems can standardize on one platform enterprise-wide instead of running a separate vendor per service line, which reduces staff training, security review cycles, integration overhead and vendor management.

Depth of clinical evidence. 50+ clinical studies and evaluations, across more clinical specialties than any peer vendor. This gives every clinical team confidence that SeamlessMD can scale and support their patients too.

Depth of EHR integration. SeamlessMD was the first company in this category with turn-key integration partnerships across Epic, Oracle Health (Cerner) and MEDITECH, and has been a validated Epic Vendor Services partner since 2018 — in fact, Epic has written an official SeamlessMD integration guide for its customers. SeamlessMD is also the only third-party vendor Epic has validated as a Toolbox partner for MyChart Care Companion content, which means health systems on either an Epic-first or a platform-first strategy can be supported. We have also been on the Oracle Health (Cerner) marketplace as an integration partner since 2018, and integrated with MEDITECH since 2022.

Full-service delivery. SeamlessMD’s clinical team builds, customizes and maintains care plan content on the health system’s behalf rather than handing over a configuration tool and a login. Most partners choose this model over managing configuration internally, because it keeps clinical and IT staff focused on care rather than platform administration. We also provide a dedicated customer success manager to provide on-going advisory services, troubleshooting help, training and support.