Care Transition & Complex Care

The young person moves between services.
Their story should move with them.

Transition from paediatric to adult care is more than a handover. Years of clinical history, functional information and family-held knowledge need to move across teams, services and organisational boundaries.

EnrichMyCare helps bring that accumulated understanding together into a structured longitudinal picture that can support the next stage of care.

Clinical history Functional needs Family knowledge MDT understanding Current care Goals & priorities Transition Paediatric care Adult care

Continuity of understanding — carried across the boundary, not left behind at it.

Paediatric careClinical history · functional needs · family knowledge · MDT understanding · current care · goals & priorities
TransitionWhere continuity can become vulnerable
Adult careContinuity of understanding

Years of knowledge can become fragmented at one point of transition.

For young people with complex health needs, paediatric teams and families can build a detailed understanding over many years — clinical history, functional needs, treatments, communication, daily life and what matters to the young person. At transition, care moves across teams, services and sometimes organisations. The receiving team may not have the same visibility of that accumulated picture, while young people and families can find themselves carrying information between services.

Clinical Functional Family MDT History Transition Reconstructed, not carried forward Years of paediatric care Adult service
Years of paediatric careClinical · functional · family · MDT · history — accumulating richly over time
TransitionInformation handover — narrows and can fragment here
Adult serviceReceiving team needs the whole picture, often reconstructed rather than carried forward

Transition is not simply the transfer of a record.

It is the transfer of understanding.

A safe and effective transition depends not only on diagnoses, medications and previous interventions, but on understanding the young person’s functional needs, lived experience, priorities and the knowledge accumulated by families and professionals over time.

Clinical history. Functional needs.
Family knowledge. Young person’s priorities.
One transition picture.

From fragmented handover to continuity across services.

EnrichMyCare helps bring together the clinical, functional and family-held information accumulated through paediatric care into a structured longitudinal picture that can support the transition into adult services. The aim is not simply to transfer more information — it is to preserve understanding across the transition boundary.

Before

Paediatric Team Reports Documents Family knowledge Clinical history Different systems Transition Adult Receiving Team

Transformed

Paediatric Team + Young Person & Family Structured Longitudinal Transition Picture Adult Receiving Team Continuity from the first adult-care interaction

Before

Paediatric TeamReports, documents, family knowledge, clinical history, spread across different systems
TransitionMultiple separate sources converge imperfectly
Adult Receiving TeamReconstructing the picture from fragments

Transformed

Paediatric Team + Young Person & Family
Structured Longitudinal Transition Picture
Adult Receiving Team
Continuity from the first adult-care interaction

A better prepared transition for everyone involved.

For the Young Person & Family

Less dependence on carrying and reconstructing years of information between services, with greater visibility of their own transition information.

For Paediatric Teams

A more structured way to prepare and communicate the clinical and functional picture ahead of handover.

For Adult Receiving Teams

A clearer picture of the young person’s history and needs before or at the point of transition, supporting a more informed first interaction.

One shared picture across the transition boundary.

EnrichMyCare brings together information that can otherwise sit across different people, documents and stages of care. Structured information, transition workflows and longitudinal visibility create a shared picture that can support paediatric teams, young people and families, and receiving adult services.

Longitudinal health info Clinical & functional history Transition information Young person & family input MDT information One Shared Transition Picture Paediatric Team Young Person & Family Adult Receiving Team
Streams inLongitudinal health info · clinical & functional history · transition information · young person & family input · MDT information
One Shared Transition Picture
Available toPaediatric Team · Young Person & Family · Adult Receiving Team

The technology supports the pathway around the young person — not the other way around.

Developed with NHS teams. Being applied in real care.

Oxford University Hospitals NHS Foundation Trust

EnrichMyCare is working with Oxford University Hospitals’ Paediatric Critical Care team to strengthen continuity for children and young people moving through complex care and into adult services.

The work brings together clinical, functional and family-held information to create a clearer longitudinal picture of the young person — supporting more structured transition, better continuity between teams and a stronger shared understanding at the point of handover.

Working alongside clinical and operational teams, we are exploring how this approach can improve pathway experience, reduce avoidable friction around transition and referral, and help multidisciplinary teams work with better-connected information across organisational boundaries.

The ambition is not simply a better handover. It is a more connected transition pathway around the young person.

A transition should move care forward — without leaving understanding behind.

When the clinical, functional and personal picture moves with the young person, the receiving team can begin from what is already known rather than rebuilding that understanding at the point of transition.

Transforming your transition pathway?

Start with where information, responsibility and continuity are being lost between services.

Talk to us about your transition pathway Explore our approach →

Backed by Oxford University Hospitals

Institutional shareholder in Enrich Digital Technologies Ltd.

Working Across the NHS, Academic & Innovation Ecosystem

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