Learning Health Systems (LHS)

From Clinfowiki
Revision as of 05:51, 22 October 2018 by Misram (Talk | contribs)

Jump to: navigation, search

Background

In 2007, the Washington-based Institute of Medicine (IOM), a nonprofit, nongovernmental organization that is part of the National Academies of Science, released a book-length report titled The Learning Healthcare System (LHS)[1]. This report was the first of a series of dozen reports from IOM’s Roundtable on Evidence-Based Medicine, now the Roundtable on Value & Science-Driven Health Care. This report envisioned the creation of LHS by integrating two disparate fields, clinical research and clinical medicine. The report defined LHS as:

A learning healthcare system is [one that] is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care [1].

Part of the reason for envisioning such a system was that clinical decision making based on clinical practice guidelines were not adequately supported by high quality evidence [2]. Evidence generated by randomized clinical trials are considered as gold standards, but most often they are not generalizable due to rigid inclusion criteria. Moreover, such trials are costly and time consuming. An interconnected system of Electronic Health Records (EHRs) and databases with the ability to share data and generate insight using state of the art information technology and analytics would provide better evidence to guide the decisions made by health systems, care providers, and patients and their families.

Elements of LHS

Four elements essential for LHS are [2]:

1. An organizational architecture that facilitates formation of communities of patients, families, front-line clinicians, researchers and health system leaders who collaborate to produce and use big data;

2. Large electronic health and health care data sets (big data);

3. Quality improvement for each patient at the point of care brought about by the integration of relevant new knowledge generated through research; and

4. Observational research and clinical trials done in routine clinical care settings.

Challenges to Building the Learning Healthcare System

1. EHRs, Data Standards, Interoperability & Computable Phenotypes

A major challenge to LHS is lack of interoperable EHRs. A mutually agreed upon data standards and definitions, such as those developed by HL7, will enable more interoperable systems and will facilitate data exchange. There is also the need for computable electronic phenotypes in order to identify patients with similar conditions.

2.Professional/Health System Interactions

Research under the LHS model essentially uses clinical data collected during the routine delivery of care. Such type of research has blurred the line between research and clinical practice. The new paradigm of doing research has created new challenges for regulatory bodies, such as Institutional Review Boards (IRBs). IRBs are often wary of research activities conducted using patient data and have sought to maintain the distinction between research and standard of care activities.

3.Ethics/Regulatory Challenges

Research under the LHS model essentially uses clinical data collected during the routine delivery of care. Such type of research has blurred the line between research and clinical practice. The new paradigm of doing research has created new challenges for regulatory bodies, such as Institutional Review Boards (IRBs). IRBs are often wary of research activities conducted using patient data and have sought to maintain the distinction between research and standard of care activities.


4.Statistical Methods 5.Patient-Reported Outcomes

References

1.Institute of Medicine. The Learning Healthcare System: Workshop Summary. Olsen L, Aisner D, McGinnis JM, eds. Washington, DC: National Academies Press; 2007. Available at: http://www.iom.edu/Reports/2007/The-Learning-Healthcare-System-Workshop-Summary.aspx. Accessed April 4, 2014.

2.Tricoci P, Allen JM, Kramer JM, et al. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 2009;301:831–841. PMID: 19244190. doi: 10.1001/jama.2009.205.

Submitted by Meenakshi Mishra