Learning Health Systems

"A learning health care system is one in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the care process, patients and families active participants in all elements, and new knowledge captured as an integral by-product of the care experience." [1]

The concept of a learning health system has been around for almost two decades [2]. It is envisioned as a cyclical process involving stages for transformation of Data to Knowledge (D2K), implementation of Knowledge into Practice or Performance (K2P), and assessment of Practice or Performance through Data (P2D) [3]. These cycles bring together "Discovery" and "Implementation" to address a Health Problem of Interest, guided by a multi-stakeholder learning community [4].

Electronic health record (EHR) systems capture a wealth of Health Data that can be used for clinical, quality, and research purposes. These data can be analyzed to validate existing knowledge or generate new knowledge about disease diagnosis, treatment, and prevention (D2K). This knowledge can inform inform creation of new protocols, guidelines, and educational materials, which may be put into practice as decision support tools in EHR systems (K2P). The performance of these tools for improving diagnosis, treatment, and prevention can then be assessed through new EHR and other data (P2K).

References

1. Committee on the Learning Health Care System in America; Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Washington (DC): National Academies Press (US); 2013 May 10. PMID: 24901184.

2. Institute of Medicine (US). Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary. Grossmann C, Powers B, McGinnis JM, editors. Washington (DC): National Academies Press (US); 2011. PMID: 22379651.

3. Flynn AJ, Friedman CP, Boisvert P, Landis-Lewis Z, Lagoze C. The Knowledge Object Reference Ontology (KORO): A formalism to support management and sharing of computable biomedical knowledge for learning health systems. Learn Health Syst. 2018 Apr 16;2(2):e10054. doi: 10.1002/lrh2.10054. PMID: 31245583; PMCID: PMC6508779.

4. Friedman CP. What is unique about learning health systems? Learn Health Syst. 2022 Jul 15;6(3):e10328. doi: 10.1002/lrh2.10328. PMID: 35860320; PMCID: PMC9284922.

Resources

Books

• National Academy of Medicine: The Learning Health System Series

Articles

• Institute of Medicine (US) Roundtable on Evidence-Based Medicine. The Learning Healthcare System: Workshop Summary. Olsen L, Aisner D, McGinnis JM, editors. Washington (DC): National Academies Press (US); 2007. PMID: 21452449.

• Rosenthal GE, McClain DA, High KP, Easterling D, Sharkey A, Wagenknecht LE, O'Byrne C, Woodside R, Houston TK. The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers. Acad Med. 2023 Sep 1;98(9):1002-1007. doi: 10.1097/ACM.0000000000005259. Epub 2023 Apr 25. PMID: 37099650; PMCID: PMC10453356.

• Collard HR, Grumbach K. A Call to Improve Health by Achieving the Learning Health Care System. Acad Med. 2023 Jan 1;98(1):29-35. doi: 10.1097/ACM.0000000000004949. Epub 2022 Aug 23. PMID: 36006840.

• Forrest CB, Chesley FD Jr, Tregear ML, Mistry KB. Development of the Learning Health System Researcher Core Competencies. Health Serv Res. 2018 Aug;53(4):2615-2632. doi: 10.1111/1475-6773.12751. Epub 2017 Aug 4. PMID: 28777456; PMCID: PMC6051975.

Links

• Journal: Learning Health Systems (LHS)