2014;75(3):20410. eGEMs. Mastellos N, Bliniuk G, Czopnik D, McGilchrist M, Misiaszek A, Brdka P, et al. PLoS One. Available from: https://www.kpwashingtonresearch.org/about-us/capabilities/learning-health-system-program. What You Need to Know About Network Theory | USC Online MCM Cookies policy. Clinical use of an enterprise data warehouse. PubMed We searched OVID Medline, Embase and IEEE Xplore from January 2007 to January 2020. Available from: https://www.optumlabs.com/. Denver health: how a safety net system maximizes its value [Internet]. We identified 21 LHSs including primary care that met our definition, from 40 peer-reviewed research articles and 22 websites (Table 1). 2018;53(6):4789807. Kaiser Foundation Health Plan Inc. Kaiser Permanente [Internet]. 2012;157:20710. We only searched up to page 8 in Google for our internet search, since the results were not relevant after this. 2003;327(7405):335 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12842955. 2019;57(10):S20612. Kaiser Permanente Southern California. A formative evaluation of a diabetes prevention program using the RE-AIM framework in a learning health care system, Utah, 20132015. The delivery science rapid analysis program: a research and operational partnership at Kaiser Permanente Northern California. 2019;57(10):S23945. 2014;83(11):77996 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25085286. Greene SM, Reid RJ, Larson EB. Know Your Rights: Student Disability Rights | ACLU of Northern CA They provide a service for data integration and analysis, and a platform for collaboration and research. Boes S, Mantwill S, Kaufmann C, Brach M, Bickenbach J, Rubinelli S, et al. The TRANSFoRm project: experience and lessons learned regarding functional and interoperability requirements to support primary care. AMIA Jt Summits Transl Sci proceedings AMIA Jt Summits Transl Sci. Optum labs: building a novel node in the learning health care system. Cancer Research UK. Fam Pract. Frakt AB, Prentice JC, Pizer SD, Elwy AR, Garrido MM, Kilbourne AM, et al. Henry SL, Mohan Y, Whittaker JL, Koster MA, Schottinger JE, Kanter MH. About Learning Health Systems - Agency for Healthcare Research and The LHSs included in this review identified challenges that they experienced or anticipated and potential solutions to these challenges in regards to data standardization or quality, ease of data access and use, financial sustainability, promoting a culture of learning, involvement of patients and the community, consistency across different sites within the same organization, prioritization of learning initiatives, the use of EHRs for quality improvement, and the move toward embedding evaluation and implementation of improved practices into usual care rather than traditional research projects (Table 2). Care and coverage together makes Southern California healthier [Internet]. Available from: https://www.ahrq.gov/learning-health-systems/about.html. Four priority research projects were: 1) home- and community-based care for Veterans at risk of nursing home placement, 2) risk mitigation for patients receiving opioid prescriptions, 3) targeting care for patients at high risk for suicide, and 4) a telehealth tool to improve access to dermatology services. HCSRN. Care and coverage together help Colorado thrive [Internet]. Ethier JF, McGilchrist M, Barton A, Cloutier AM, Curcin V, Delaney BC, et al. CAS Evans RS, Lloyd JF, Pierce LA. High value healthcare collaborative [Internet]. 2019;40(1):149. Privacy Quality enhancement research initiative implementation roadmap: toward sustainability of evidence-based practices in a learning health system. eGEMs. Knowledge is usually captured in some form or other, and most systems at least claim to seek improvement. PubMed Central The PCORnet projects demonstrate the United States motivation to move towards a national-level LHS, yet many of these networks need to apply more rapid quality improvement initiatives to keep moving in this direction rather than relying on traditional research [76, 81]. volume22, Articlenumber:126 (2021) Swiss Learning Health System. *Ineligible sources refer to data networks and organizations that did not meet our definition of a learning health system but were included as an additional file of those with potential to become one. The authors have no competing or conflicting interests to declare. On the face of it, the definitions above are comprehensive, but not very specific. 2019 [cited 2020 Mar 19]. The idea was introduced to healthcare in 2007 by the United States Institute of Medicine (IoM, now the National Academy of Medicine) [4], which later defined it as a system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process, [with] patients and families active participants in all elements, and new knowledge captured as an integral by-product of the delivery experience [5]. The "learning health system" (LHS) concept has been defined in broad terms, which makes it challenging for health system leaders to determine exactly what is required to transform their organization into an LHS. The purpose of this scoping review was to understand the extent of LHSs spread in primary care and their characteristics. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. AHRQ asked healthcare systems how they became Learning Health Systems. 2019 [cited 2019 Nov 14]. Learning Health Systems - Agency for Healthcare Research and Quality (AHRQ) In 2007, the Institute of Medicine (IOM) first described the concept of a learning health system (LHS) [ 6 ], which is an organization or a network with a culture of health system improvement where internal data is integrated with existing evidence and rapidly analyzed, this knowledge is put into practice, and its effectiveness at closing practi. 2017 Guidance for the conduct of JBI scoping reviews: chapter 11 scoping reviews. The potential of LHSs in primary care has started to be realized and will hopefully be expanded on in the future as more data networks and organizations move toward an LHS and focus on quality improvement that goes beyond traditional research. To optimise the use of knowledge and evidence for decision making: A Learning Health System can improve the use of research evidence, staff knowhow, learning from experience and organisational memory. The number of data sources included and excluded in review, and reasons for exclusions. Intermountain Healthcare was an early adopter of a data warehouse in 1998 to measure best practices and costs, and to inform quality improvement initiatives [15]. The final main section explains the key Strategic Considerations in an LHS (the ring second from the outside). 2001-2023 Oregon Health & Science University. 2019 [cited 2019 Nov 14]. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Available from: http://www.hcsrn.org/en/. The first is a collection of simultaneously operating learning cycles of the type illustrated in Figure 1, with each cycle addressing a unique identified health problem and operating under the aegis of its own learning community. The University of Wisconsin developed a framework for learning health system development and sustainability through their Health Innovation Program, which focuses on research being an equal component to health care [41]. Learning Healthcare System - The Learning Healthcare Project Google Scholar. Google Scholar. Search strategies for Medline, Embase and IEEE Xplore. They conduct similar activities regardless of scale, giving them a fractal property. BMJ Open. Weir CR, Butler J, Thraen I, Woods PA, Hermos J, Ferguson R, et al. Reporting checklist for systematic reviews, . 2012;31(6):119. Creating a large-scale physically integrated electronic health record data system to support a learning healthcare system. This report shines a light on the challenges facing the NHS in improving the uptake of new ideas and We are seeking a supplier to develop case studies of integrated models of chronic disease care at Join us at the Rapid evaluation in health care conference 2023. Additional publications not directly related to a specific project may also be found here. Kaiser Permanente Southern California developed an Outpatient Safety Net Program, which uses clinical surveillance software to regularly scan outpatient EHR data to identify care gaps [33]. CMAJ. An Implementation Roadmap was also developed to scale up these initiatives and to help clinicians sustain them in practice [48]. A learning system minimally requires two components. Kilbourne AM, Braganza MZ, Bowersox NW, Goodrich DE, Miake-Lye I, Floyd N, et al. Dore D, Ciofani D, Davis S, Nunes A, Bradley J, Seeger J, et al. We then reviewed all references from Budrionis and Bellika (2016) and other systematic reviews that were found from our database search [8]. 2017;55(7):S4-12. We could not identify any documented specific LHS projects for Johns Hopkins. Your US state privacy rights, Most of these LHSs were in the hospital setting, and its not clear how many also included primary care [8]. Developing learning health systems in the UK: Priorities for action Available from: https://thrive.kaiserpermanente.org/care-near-you/southern-california/. Available from: https://www.ahrq.gov/sites/default/files/wysiwyg/lhs/lhs_case_studies_denver_health.pdf. eGEMs. 2019 [cited 2019 Nov 14]. Three of the LHSs identified were in Europe [53, 59, 61], where the remaining were in the United States. Elements of a LHS are being adopted and implemented increasingly in the U.S. As interest in Learning Health Systems grows, The Berman Institute of Bioethics is deeply engaged in scholarly work on both the ethical foundations and ethical requirements of a LHS. This report, part of Health Data Research UKs (HDR UKs) Better Care programme, was informed by a literature review, interviews, a survey of more than 100 expert stakeholders and a series of practical case studies, offering real-world examples of LHS approaches already being taken. Leadership perspectives on operationalizing the learning health care system in an integrated delivery system. Confirmation of eligibility by reaching out to authors confirmed inclusion for one data source and confirmed exclusion for two. Provided by the Springer Nature SharedIt content-sharing initiative. On the other hand, many primary care providers work in small independent community practices and use one of various EHR vendors, making it difficult to link data across different practices, especially in Canada [9]. 2017;65(11):244651. Ann Intern Med. Smith MA, Nordby PA, Yu M, Jaffery J. Budrionis and Bellika (2016) completed the most recent systematic review on LHSs and found 13 papers that described implementation of an LHS [8]. Hardie T, Horton T, Thornton-Lee N, Home J, Pereira P. Developing learning health systems in the UK: Priorities for action. How should patients be informed about research that compares commonly used treatments or widely practiced medical procedures? About learning health systems [Internet]. We identified 13 integrated LHSs in our review, all of which are in the United States. 2018;13(10):e0205419.https://doi.org/10.1371/journal.pone.0205419. [2] The elements considered in this report are relevant at each scale, as illustrated by Figure A. TRANSFoRm was originally developed for three purposes: 1) prospective study recruitment including randomized trials, 2) retrospective analyses, and 3) decision support for clinical care [62, 63]. The Agency for Healthcare Research and Quality (AHRQ) in the United States highlighted the following three large integrated healthcare organizations on their journeys to becoming LHSs: 1) Baylor Scott and White Health the largest not-for-profit health system in Texas, 2) Denver Health providing comprehensive care to a third of all Denver residents, and 3) University of Utah Health an academic healthcare system in Salt Lake City, Utah [16, 17, 40]. ZB further reviewed full-text articles for eligibility and charted the data from the eligible articles, while DMN reviewed and confirmed all information. Your privacy choices/Manage cookies we use in the preference centre. The rationale for developing a Learning Health System often includes some or all of the following, which were explored in more detail in the earlier Learning Healthcare Project report [1]: To improve patient outcomes and experience: While most health systems seek to improve the quality and safety of care, many fail even to measure comprehensive and robust outcomes. There are some limitations of our review that should be noted. "A simple way of understanding a network is by assuming that a set of objects are connected by some sort of link," he explains. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Amid all the pressures the health and care services are facing, we should be wary about seeing LHSs as a nice to have. Primary care is a patients first point of contact with the healthcare system, and typically providers focus on primary and secondary prevention of chronic diseases and acute episodes. Horwitz LI, Kuznetsova M, Jones SA. They also developed a prediction model to identify patients who would benefit most from this program. PDF For Your Health - Kaiser Permanente Springer Nature. Electronic clinical surveillance to improve outpatient care: diverse applications within an integrated delivery system. Operationalizing the learning health care system in an integrated delivery system. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Building the Workforce. Connected Health Cities. 5600 Fishers Lane In: Institute of Medicine, editor. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. This will ensure that our scholars are fluent in the linking skills it takes to not only generate data but bring evidence to practice, evaluate its success in and across health systems, and meet the operational needs of the health system in knowing what works and why. Figure A shows that each of the elements considered in this report can be co-designed at the local, regional, national and international level. Introduction of an area deprivation index measuring patient socio-economic status in an integrated health system: implications for population health. Health care has, in many ways, always been a form of learning system. Writing a successful population research proposal Professor Brendan Delaney [Internet]. This may reduce the cost for a given outcome in other words, doing things right. Available from: https://healthy.kaiserpermanente.org/. Northwestern University. We recognize that our definition may be a simplification of the concept. Health systems recognize that they need to take a hard look at CPOE as an important element of an overall patient safety strategy. Furthermore, learning activities are generally funded by patient care revenue, so savings or improvements can be directly applied, thus providing an ideal platform for a self-sustaining LHS. However, this may have biased our review to identifying more LHSs in the United States where this concept is more established, rather than other parts of the world where organizations may not realize that they are functioning as an LHS. In some cases, the Learning Health System concept has been used as a marketing label, applied to existing systems. Initiatives that help learning health systems learn. Finally, we only had one individual available at the time to perform the title and abstract review, even though guidelines recommend that two people should be involved at this step. 2018;2(3):27. Optum Labs describes the ability to use their healthcare data to conduct N of 1 studies, so healthcare providers can generate evidence that is directly applicable to complex, unique patients at the point of care [72]. Available from: https://www.highvaluehealthcare.org/. It can host prospective pragmatic trials or retrospective observational studies. We also identified 16 additional data networks / organizations (based on 14 peer-reviewed research articles and 16 websites) that included primary care data, but did not meet our definition of a fully-functioning LHS, since they were mostly platforms for conventional research and knowledge translation, rather than building internal systems for directly identifying gaps and cycling knowledge to improve care (Additional file 4). 2015;8(4):26971. The Healthcare Systems Research Network (HCSRN) as an environment for dissemination and implementation research: a case study of developing a multi-site research study in precision medicine. Califf RM. J Biomed Inform. NYU Langone Health has six hospitals and eight primary care and specialty centers [38]. Available from: https://www.cancerresearchuk.org/funding-for-researchers/research-features/2019-03-07-writing-a-successful-population-research-proposal-professor-brendan-delaney?_ga=2.267090246.913723477.1572876178-858616111.1572876178. Learning health systems - PubMed It is the final output of HDR UKs Better Care Catalyst Programmes Policy and Insights workstream, which researched the barriers and enablers for implementing LHS approaches in the UK. NYU Langone Health seems to be moving in this direction with their rapid-cycle testing of various healthcare interventions usingrandomized clinical trials [39]. Learning Health Systems (LHS) was first envisioned by the Institute of Medicine in 2001 and later defined as: A system 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 as active participants in all elements, and new knowledge is captured as an integral by-product of the care experience. Most (18/21) self-identified as an LHS, where three did not: Health Care Systems Research Network (HCSRN), High Value Healthcare Collaborative (HVHC), and Intermountain Healthcare [13,14,15]. The Health Foundation; 2022 (https://doi.org/10.37829/HF-2022-I06). Available from: http://www.auditor.on.ca/en/content/annualreports/arreports/en16/v1_303en16.pdf. Through this program, 20 nurses and social workers were hired as case managers to provide telephone support to these patients. DMN and MZ drafted the initial manuscript. We did not include pediatric LHSs, since this is considered specialty care in some countries including Canada. The Learning Healthcare System, the first in the series, explores the various dimensions evidence development and standards, care culture, system design and operation, health data, clinical research, information technology, value on which emerging insights and scientific advances can be applied for health care in which both evidence developm. In Psek (2015), they reported a framework for nine components of an LHS and outlined how Geisinger meets these components including data and analytics, people and partnerships, patients and family engagement, ethics and oversight, evaluation and methodology, funding, organization, prioritization, and deliverables [20]. i~HD. 2015;13(3):1416. However, these solutions were presented at a high level and may need to be described in more detail to be useful for other organizations and networks looking to apply them. OHSU is an equal opportunity affirmative action institution. PubMed Learning health systems in primary care: a systematic scoping review. Registered charity number 286967. The learning healthcare system: where are we now? Demonstrating Respect and Acceptable Consent Strategies: What Matters to Patients in PCOR? Kilbourne AM, Goodrich DE, Miake-Lye I, Braganza MZ, Bowersox NW. This means that many elements will be reusable as Learning Health Systems scale up. Addressing the ethical and regulatory issues related to research that arise in PCORIs work, Realizing the Goals of Continuous Learning, Insights on Ethics & Implementation from Institutional Leaders in Learning Health Care, Ethics of Integrating Research and Treatment, Filling in the knowledge and policy gaps to ensure high-value health care outcomes, Stakeholder Views on Streamlined Informed Consent. Health Aff. Covidence. 2019 [cited 2019 Nov 14]. 2016;4(3):9. 2014;2(1):9. These can be developed on top of the infrastructure required to support other Learning Health System functions [16]. Nash, D.M., Bhimani, Z., Rayner, J. et al. ZB further reviewed full-text articles for eligibility, and both authors discussed discrepancies. Receive the latest news and updatesfrom the Health Foundation. Optum Labs [Internet]. Charted data elements and definitions or scenarios for meeting certain criteria. If you continue to use this site we will assume that you are happy with it. Intermountain Healthcare is a not-for-profit integrated health system serving patients primarily in Utah, southern Idaho, and southern Nevada [23]. Please upgrade your browser, REAL Centre: making health and care services more sustainable, Improving national health and care policy, Learning health systems priority action areas, Figures and charts Developing learning health systems in the UK, 'Learning systems' can help get the NHS off its knees, ITT: International case studies of integrated models of chronic disease care at the primary-secondary care interface that deliver improved health care quality and efficiency, Rapid evaluation in health care conference 2023, Missed target means patients continue to pay the price for NHS crisis. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Article 2019;28(4):2523. All authors read and approved of the final manuscript. We only included studies published after the IOM report in 2007 [6], and we restricted the search to English language articles only. Instead, our framework assumes that the quality, efficiency and fairness of health care is improved when research and practice are integrated and provides an ethical framework for doing so. We originally searched databases on March 24, 2019 and updated searches on January 2, 2020. eGEMs. List of charted data elements abstracted from the included articles and definitions or scenarios for meeting certain criteria, . This means that data from ongoing health care encounters are continuously aggregated and analyzed, and what is learned from ongoing health care is incorporated into the improvement of future care, creating a natural feedback loop. The case for knowledge translation: shortening the journey from evidence to effect. Learning Health Systems have been called many different things, including data hubs, living labs, innovation or informatics hubs, learning networks, learning laboratories, community-clinician participatory data healthcare research, data driven improvement initiatives, interventional informatics, practice-based data networks, circular data-driven healthcare, Learning Healthcare Systems and Rapid Learning Health Systems[6]. Lots of things that you do every day count as major life activities, like walking, breathing, eating, thinking, communicating, learning, or going to school. Integrated health systems are at an advantage of having access to large amounts of healthcare data and delivering care to patients, compared to organizations that have access to healthcare data but are not directly responsible for delivering care. Figure A The Learning Health System Framework. Network of networks, such as Optum Labs [72, 73], also use a different approach than the integrated health systems, which has some advantages and disadvantages. AMIA Annu Symp Proc. Each child or adult with a learning disability is unique; each shows a different combination and severity of problems. We did not find any documented primary care-specific LHS initiatives for Geisinger. BMC Fam Pract 22, 126 (2021). After all eligible data sources were found we completed a targeted search using Pubmed and Google for other sources of information further describing these LHSs. Baylor Scott and White Health is planning to transition all their sites to a single EHR and create value-based dashboards for all primary care physicians to standardize information [16]. 5, 6 The cycle begins at "5 o'clock" with the establishment of a multi-stakeholder learning community. Priest EL, Klekar C, Cantu G, Berryman C, Garinger G, Hall L, et al. A collaborative of leading health systems finds wide variations in total knee replacement delivery and takes steps to improve value. ZB charted the data from the eligible articles and websites, and DMN reviewed and confirmed all information entered in the spreadsheet against the original data source. Many years before the concept was applied to healthcare, a learning organisation was defined as an organization skilled at creating, acquiring, and transferring knowledge, and at modifying its behaviour to reflect new knowledge and insights [3]. Veterans health administration [Internet]. About LHS | OHSU One example is the development of a National Antibiotic Prescribing Dashboard, which uses anonymous data to allow primary care physicians to compare their antibiotic prescribing practices to national and local averages, and allows them to identify higher risk patients [53]. Available from: https://thrive.kaiserpermanente.org/care-near-you/northern-california/. We also completed a Google search to identify gray literature. Implementing the learning health system: from concept to action. We used search terms for primary care in the IEEE Xplore database search but not for the other databases, since this narrowed the articles retrieved and did not capture integrated health systems. NIH Health Care System Research Collaboratory Regulatory/Ethics Core, Navigating regulatory and ethical complexities associated with pragmatic clinical trials in health care systems. Projects are being advanced within the SLHS including themes of innovation in service delivery, health promotion and prevention, and health systems guidance and intelligence [60]. Available from: https://www.va.gov/health/. 2019 [cited 2019 Nov 15]. A Learning Health System can exploit the newly available data and increase the value of existing Health IT infrastructure. NYU Langone Health. However, even internally-funded LHSs, such as Geisinger Health System, raised concerns about financial sustainability of their learning activities [75]. J Gen Intern Med. DMN screened all article titles and abstracts through Covidence and selected ones eligible for full-text review, and then completed the full-text review. Subst Abus. They implemented a rapid-cycle initiative to evaluate existing practices in randomized trials to determine whether they should continue or be modified, and to eventually test new quality improvement initiatives. 2019;7(1):19. Psek W, Davis FD, Gerrity G, Stametz R, Bailey-Davis L, Henninger D, et al. DMN created the data charting form and tested it on five articles to ensure all information would be captured. It can help identify potential participants for traditional randomised controlled trials.