The Coordination Record
The fast-moving record healthcare does not keep: what is currently open for a person, who owns it, what turn it is on, and what is overdue — across every service line and channel they touch. Its absence is what turns coordination into unpaid work for patients and families.
Every complex industry runs some version of this. A list of open items, each with an owner, a state, and a due date, visible to everyone who touches the work. Healthcare has it inside individual departments and almost nowhere across them.
So the referral is pending in one system, the prior authorization is queued in another, the prescription was never picked up in a third, and the discharge instruction that mattered most is in a PDF nobody opened. Each silo can see its own item. Nobody holds the list.
The person who ends up holding it is the patient, or more often a family member. That is not a failure of any individual team. It is the predictable result of an object that does not exist.
It has an outcome measure attached, and the word for it is completion. Care fails to complete on the way in — the referral never booked, the coverage question that stalls — and it fails again on the way out, when the plan agreed in a room has to survive an ordinary week without supervision. The coordination record exists to make both visible.
Two things make this worth naming separately from the trajectory record. First, they get conflated, and conflating them leads people to build the hard thing before the useful one. Second, this one is considerably more tractable: no ontology, no forward projection, no goals modeling. It is work-tracking that crosses organizational boundaries.