Improving Continuity of Care in High-Income Countries by Obtaining External Clinical Notes Before Scheduled Primary Care Visits: A Scoping Review of Workflow, Value, and Evidence Gaps

This scoping review examined how external clinical notes are obtained and used before scheduled primary care visits in high-income countries, with attention to continuity of care, workflow integration, value, healthcare delivery, policy, and risk. Within the health data ecosystem, the value of external clinical data depends not only on exchange capability but also on whether information is timely, easy to find, and usable in practice. Guided by Arksey and O’Malley, Joanna Briggs Institute guidance, and PRISMA-ScR, the review searched PubMed, CINAHL, and Google Scholar for English-language, peer-reviewed studies published from 2021 to 2026. Of 330 records identified, 15 studies were included and assigned Johns Hopkins evidence levels and quality ratings. The evidence base was dominated by Level III studies, indicating stronger support for conclusions about workflow barriers, usability, and care coordination than for causal or economic effects. Three patterns emerged: technical exchange alone did not ensure continuity of care, workflow integration shaped whether external information was useful, and the literature described clinical and operational value more clearly than direct financial return. Using the Sittig and Singh sociotechnical model, the review shows that value is produced or lost across infrastructure, clinical content, interface design, people, workflow, organizational conditions, external rules, and monitoring. Overall, external clinical notes function as high-value data only when they are available before the visit, routed appropriately, and usable within the routine primary care workflow. Future research should use stronger workflow-specific measures and assess cost implications and return on investment more consistently.