Provenance-Aware Memory Architecture for Chronic Healthcare Continuity: Continuity Burden, Provider Fragmentation, and the Narrative Gap in Longitudinal Care

Domain application preprint extending the continuity burden framework to chronic healthcare. Introduces healthcare continuity burden as the cumulative cognitive, emotional, and temporal cost imposed on patients who must repeatedly re-establish medical history, symptom context, treatment responses, and personal circumstances across fragmented provider interactions. Identifies five healthcare-specific failure modes of stateless AI: provider transition knowledge loss, symptom trajectory fragmentation, treatment response amnesia, contextual self-management erosion, and emotional withdrawal from support systems. Proposes a patient-centered persistent memory system based on CAMA with patient-sovereign data governance (three-tier model: patient-only, provider-shared, research-shared). Addresses the narrative gap in healthcare data — the absence of contextual details about symptom evolution and treatment reasoning that limits personalized care. Includes worked scenario demonstrating longitudinal lupus management across provider transitions. Paper 3 of 4 in the Applied Persistent Memory Series.