Medical Informatics

Research Article

An evolutionary approach to ensuring continuity of care in an adaptive and multi-agent digital ecosystem

Dmitriy Vladimirovich Belyshev¹, Aleksandr Eugen'yevich Mikheyev²

1,2	Ailamazyan Program Systems Institute of RAS, Ves'kovo, Russia
1	belyshev@interin.ru

Abstract. This article addresses the challenges of modern healthcare related to the "information logistics deficit" caused by fragmented care and the ineffectiveness of centralized data exchange models. An approach is formulated for considering the continuity of medical care as the horizontal and vertical integration of various medical technological processes in a complex, adaptive, decentralized, and multi-agent ecosystem based on the shared use of patient data.

Materials and Methods: Based on an analysis of international and domestic experience, as well as our own practice, this paper is based on an evolutionary approach that proposes the construction of a decentralized digital medical ecosystem. A common communication platform, ensuring basic data exchange (including unstructured documents), is considered the strategic framework for the ecosystem. A system of interacting autonomous and semi-autonomous AI agents implementing the principles of information logistics is used to intellectualize processes. The effectiveness of this approach is assessed by analyzing a hypothetical clinical scenario for interaction between medical organizations.

Results: A target concept for a medical ecosystem focused on data and generating new knowledge about health preservation is presented, including fundamental principles embodying the idea of creating and managing the ecosystem, as well as its elements—individual participating MOs—as a more open and loosely coupled system. Unlike vertically integrated corporations, this system allows participants to use acquired knowledge and data in their own ways, for example, within individual ecosystems of participating MOs or their associations. In this digital medical ecosystem architecture, a strategic role is assigned not to a repository, but to a common communication platform. A hybrid ecosystem architecture is proposed, in which centralized systems (e.g., the Unified State Health Information System) redefine their role, becoming an infrastructural catalyst for the healthcare ecosystem. They provide registry services, trusted authentication, auditing, and hosting, while relevant data and expertise remain at the source (medical organizations) and are accessible through decentralized requests. The proposed model has been proven to be technically feasible and cost-effective, enabling rapid practical results without the need for prior, complete semantic unification of all systems.

Conclusion: The proposed evolutionary approach paves the way to seamless healthcare through consistent iterations rather than a radical overhaul of processes. The symbiosis of a communication platform and a multi-agent system creates a sustainable, patient-centered environment where continuity of care is ensured through active, intelligent interaction between physicians and systems, rather than passive data exchange. (In Russian).

Keywords: continuity of medical care, seamless healthcare, digital medical ecosystem, interoperability, communications platform, AI agents, information logistics, Unified State Health Information System (EGISZ), decentralization

MSC-2020 94A05; 92C50, 93Bxx

For citation: Dmitriy V. Belyshev, Aleksandr E. Mikheyev. An evolutionary approach to ensuring continuity of care in an adaptive and multi-agent digital ecosystem. Program Systems: Theory and Applications, 2025, 16:6, pp. 155–196. (In Russ.). https://psta.psiras.ru/2025/6_155-196.

Full text of article (PDF): https://psta.psiras.ru/read/psta2025_6_155-196.pdf.

The article was submitted 03.11.2025; approved after reviewing 09.11.2025; accepted for publication 17.11.2025; published online 15.12.2025.