realising the potential of learning health systems

Strong health systems are learning health systems - PLOS Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. In 2016, Budrionis and Bellika [13] conducted a systematic review of the LHS literature, revealing that of the 32 identified papers, only 13 (40.6%) empirically examined the implementation or testing of an LHS. Embedding in organisational contexts is thus necessary to support 'learning health systems' with locally relevant data and deliberation [106,107,108,109]. We have focused limited attention on the review of service and patient outcomes measured and reported in the included studies, and this warrants further investigation. Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, Estabrooks PA. RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review. Morain SR, Kass NE. A summary of the key characteristics of the included studies is presented in Table 2 (also see Multimedia Appendix 1 for details of all included studies). Learning Health Systems | Learning Health Sciences | Michigan Medicine Increase in publications on LHS over time, 2007-2020 (generated using data from PubMed on publications returned using the search term learning health system OR learning health care system). Learning Health Systems are complex by nature, and must be co-designed with local stakeholders. However, it is not a how to guide. This raises the meta-question, Have the benefits of an LHS been empirically demonstrated prior to implementation? Holdsworth LM, Safaeinili N, Winget M, Lorenz KA, Lough M, Asch S, Malcolm E. Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU. Success of an international learning health care system in hematopoietic cell transplantation: The American Society of Blood and Marrow Transplantation Clinical Case Forum. When autocomplete results are available use up and down arrows to review and enter to select. 5 years on from that early LHS review. Organizing for collaboration: an actor-oriented architecture in ImproveCareNow. Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Comprehensive reporting of implementation and evaluation efforts is an important step in moving the LHS field forward. Macquarie University, Posted Jun 04, 2018 By Sarah Greene, M.P.H. There were many barriers to the implementation of LHS systems. Learning health systems: pathways to progress A flagship report from the Alliance for Health Policy and Systems Research 6 September 2021 | Global report Download (1.8 MB) Overview Learning - at individual, team, organization and cross-organization levels - is fundamental to health systems strengthening and the achievement of health goals. Its precise impact will depend on a variety of factors, such as the mix and importance of different functions, as well as the scale of an industry's revenue (Exhibit 4). Sarkies MN, Francis-Auton E, Long JC, Partington A, Pomare C, Nguyen HM, Wu W, Westbrook J, Day RO, Levesque J, Mitchell R, Rapport F, Cutler H, Tran Y, Clay-Williams R, Watson DE, Arnolda G, Hibbert PD, Lystad R, Mumford V, Leipnik G, Sutherland K, Hardwick R, Braithwaite J. May 17, 2021 Reports This report offers guidance for building a Learning Health System, focusing on tools, models and frameworks that might be helpful. While local uptake was positive, transformative potential will require longer-term engagement, and with higher levels of the system. What have been the key areas of research? 1, 2, 3 The learning component of LHS can occur at multiple levels, including the personal level for individual actors (when . Finally, a review showcasing case exemplars in promoting LHSs would be beneficial as empirical contributions continue to flourish. Realising the Potential of Learning Health Systems In addition, 3 (3.9%) of 76 studies examined LHS-specific research issues through the exploration of barriers and enablers to engaging participants, including clinicians and patients and carers, in research for health care organizations seeking to become LHSs [77-79]. Par G, Trudel M, Jaana M, Kitsiou S. Synthesizing information systems knowledge: a typology of literature reviews. Learning Health Systems ( LHS) is an international, open access, peer-reviewed journal published in collaboration with the University of Michigan. Objective This study performed a scoping review of empirical research within the LHS domain. If LHSs are intended to directly improve clinical care delivery, then a comparable evidence standard would be required to demonstrate benefits and reassure decision makers regarding potential unintended consequences [90]. As the first point of contact, primary health care that provides comprehensive . Learning health systems: a review of key topic areas and bibliometric trends. Gerrard Cowan on LinkedIn: Realising the Potential of Learning Health A scoping review method, which examines the extent, range, and nature of empirical work on a topic, was used to identify gaps and provide suggestions to improve future empirical research on LHSs [21]. Important enablers included the timely provision of clear data that are understood, trusted, and clinically useful [34,36,40]; facilitation of clinician willingness to volunteer data [41]; and flexible systems that are embedded within electronic health records and support engagement with data as part of the normal clinical workflow and joint decision making [34,36,40,42]. Search and review strategy. Seid M, Hartley DM, Dellal G, Myers S, Margolis PA. Progress is clearly being made in empiricizing the LHS in differing settings and jurisdictions. sharing sensitive information, make sure youre on a federal Digital health interventions (DHIs) hold immense promise to revolutionize and strengthen health systems. It examines the major challenges facing healthcare, defines a Learning Healthcare System, outlines the building blocks that must be in place to realise it, provided use cases that are already in operation and discusses the longer term implications. 2-5 The Institute of Medicine 6 defines an LHS as a system "in which science, informatics, incentives, and culture are aligned for . Integrating qualitative research methods into care improvement efforts within a learning health system: addressing antibiotic overuse. Friedman C, Rubin J, Brown J, Buntin M, Corn M, Etheredge L, Gunter C, Musen M, Platt R, Stead W, Sullivan K, Van Houweling D. Toward a science of learning systems: a research agenda for the high-functioning learning health system. (Stockport E-Book), The Cost of Sepsis Care in the UK: Final Report, Guidance on implementing the overseas visitor charging regulations, Guidance on investigating cases, clusters and outbreaks of Legionnaires disease: For Public Health England health protection teams, Clinical Commissioning Policy Statement: Nusinersen for genetically confirmed Spinal Muscular Atrophy (SMA) type 1 for eligible patients under the Expanded Access Programme (EAP), Multi-professional framework for advanced clinical practice in England, Pharmaceutical Services Negotiating Committee. and transmitted securely. Notably, almost three-quarters of the studies were from the United States. A total of 76 studies were included in this review. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Shulman R, Chafe R, Guttmann A. This resulted in a focused review of empirical studies rather than a broader and more theoretical (eg, one that included commentaries and opinion pieces) contribution [13,14]. The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%); stakeholder perspectives of LHSs (5/76, 6.6%); or LHS-specific research strategies and tools (8/76, 10.5%). In answering these questions, it is important to determine what the right evidence standard is for assessing LHS studies. The learning healthcare system: where are we now? All authors provided critical feedback and helped shape the final manuscript. The "Every School a Great School" policy framework. The site is secure. Franklin et al [31] developed an implementation framework to guide PROM data collection, interpretation, and use. The Science of Learning Health Systems: Scoping Review of Empirical Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunalp ?, Straus SE. Over half of the studies (n=42, 55.3%) were quantitative studies, around one-third (n=27, 35.5%) were qualitative and the remaining (n=7, 9.2%) were mixed-methods studies. Children's perspectives on the benefits and burdens of research participation. Medical innovations must typically undergo an evaluation of effectiveness, safety, and cost-effectiveness. It must be co-designed by the stakeholders and . There has been little adoption of LHS in practice due to challenges and barriers that limit adoption of new data-driven technologies in healthcare. Two academic databases (PubMed and Scopus) were searched using the terms learning health* system* for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Political pressures to implement therapies or technologies with uncertain or little evidence [34], technical challenges and implications for security of patient data [36,37], practical constraints in reconfiguring clinician-patient relationships [36,38], and the ability to meet patient expectations and satisfaction regarding care [39] were also frequently reported barriers. McWilliams A, Schoen M, Krull C, Bilancia J, Bacon M, Pena E, McCall A, Howard D, Roberge J. What study designs and research methods have been used? 607609. Safaeinili N, Brown-Johnson C, Shaw JG, Mahoney M, Winget M. CFIR simplified: pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for evaluation of a patient-centered care transformation within a learning health system. The search identified a total of 529 citations. Two academic databases (PubMed and Scopus) were searched from January 1, 2016, to January 31, 2021, using the term learning health* system*. Study protocols, review papers, journal commentaries, and editorials were excluded. Budrionis A, Bellika JG. Sydney, The location of studies was predominantly restricted to high-income countries, with most coming from the United States (n=55, 72.4%), followed by the United Kingdom (n=9, 11.8%), and Canada (n=3, 3.9%). Stakeholder perspectives on system barriers were also identified, including the usability of systems and time constraints working in an LHS [71]. Careers, Unable to load your collection due to an error. A framework for understanding, designing, developing and evaluating The size of the node is indicative of frequency (larger nodes indicate a higher number of papers using the keyword). Novel tools for a learning health system: a combined difference-in-difference/regression discontinuity approach to evaluate effectiveness of a readmission reduction initiative. Alliance for Health Policy and Systems Research SCI, Celebrating over two decades of advancing and supporting health policy and systems research, Explore the interactive executive summary >. These categories of focus are considered separately later. Users can access the training at the Aged Care Quality and Safety Commission's aged care learning information system - Alis. Realising the Potential of System Leadership 1 David Hopkins Chapter First Online: 01 January 2009 1592 Accesses 5 Citations Part of the Studies in Educational Leadership book series (SIEL,volume 10) Abstract Traditional leadership and management approaches are well able to accommodate technical problems. Although their approach allowed precise prospective mapping of data elements within electronic health records, the authors found that patient-related outcome measures (PROMs) are less often completed electronically than they are in paper form. Keim-Malpass J, Kitzmiller RR, Skeeles-Worley A, Lindberg C, Clark MT, Tai R, Calland JF, Sullivan K, Randall Moorman J, Anderson RA. Realising the Potential of System Leadership1 | SpringerLink Learning Health Systems - Wiley Online Library The systemic potential of networking and collaborations requires new arrangements for governance and agency; and. To overcome this, studies suggested that the segregation between research and quality improvement was not appropriate and collective governance was recommended for all improvement practices [61] as were accelerated ethical processes [65]. The most common keywords (ie, those with the highest in-degree score) were learning health system (n=20), electronic health records (n=11), and leaning health care system (n=8). During data cleaning, keywords were consolidated in the case of plurals (eg, intervention vs interventions); however, keywords were kept independent in the case of arguably consistent meaning but different phrasing (eg, learning health care system vs learning health system) in order to represent the variability of terms used in the LHS field. McLennan S. The ethical oversight of learning health care activities in Switzerland: a qualitative study. A systematic review. Realising the Potential of Primary Health Care. For example, clinicians often reject decision support system recommendations when patients present with complex comorbidities that might not be adequately considered by the system [32]. Psek et al [73], for example, interviewed 41 senior leaders across an integrated health delivery system, identifying 10 themes related to operationalizing an LHS, such as balancing learning and workflow and integrating cultural and operational silos. Although not strictly implementation evaluation studies, all 5 studies under this category identified barriers and facilitators relevant to the realization of an LHS, including the usability of systems [71] and time constraints, such as time for participation in quality improvement activities [70]. Before Relevant information was extracted at the full-text review stage using a purpose-designed workbook in Microsoft Excel 365 and included (1) publication details (paper title, year, country of residence of corresponding author, paper type, and paper keywords); (2) primary study focus (thematically coded after data extraction); (3) study context (clinical, hospital, health care system); (4) study design (quantitative, qualitative, mixed methods); (5) study data type (primary or secondary); (6) implementation framework, model, or theory used; and (7) implementation determinants or outcomes examined. Congratulations to Tom Foley and his co-authors on the publication of 'Realising the Potential of Learning Health Systems', from The Health Foundation and PDF www3.ncrn.cornell.edu Lee SS, Kelley M, Cho MK, Kraft SA, James C, Constantine M, Meyer AN, Diekema D, Capron AM, Wilfond BS, Magnus D. Adrift in the gray zone: IRB perspectives on research in the learning health system. Although none of these studies examined implementation effectiveness, each study explored broad ethical, policy, or governance barriers and enablers to achieving an LHS. Steiner J, Shainline M, Bishop M, Xu S. Reducing missed primary care appointments in a learning health system. Combining lean and applied research methods to improve rigor and efficiency in acute care outcomes research: a case study. Exploring learning health care systems - The Health Foundation Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. For example, effectiveness-implementation hybrid studies are increasingly being applied in implementation science, and these provide an appropriate design for the study of LHSs, where interventions tend to be complex and where multiple interrelated factors need to be considered to ensure implementation is both sustained and effective [83]. Large-scale LHS implementation efforts can also be slowed down by challenges arising from system and contextual complexities [13]. This will enrich our understanding of how to make progress toward an LHS. Barned C, Dobson J, Stintzi A, Mack D, O'Doherty KC. Can learning health systems help organisations deliver personalised Understanding these barriers and enablers is a key first step toward unlocking the mechanisms that could trigger lasting improvements in how health care is delivered [87]. policy documents and organisational reports). Mayo RM, Summey JF, Williams JE, Spence RA, Kim S, Jagsi R. Qualitative Study of oncologists Views on the CancerLinQ Rapid Learning System. Munoz-Plaza CE, Parry C, Hahn EE, Tang T, Nguyen HQ, Gould MK, Kanter MH, Sharp AL. 1 Investments in learning activities tend to be a remarkably small proportion of overall investments in health programmes and systems, and learning-focused activities have historically not found place or favour in budgets when compared with other health system priorities. The Alliance for Health Policy and Systems Research20 avenueAppia,1211 GenevaSwitzerlandTel. Empirical evidence standards for the LHS remain unclear at this stage of the fields development. The authors emphasized that future efforts may need to focus on optimizing the delivery of PROMs within LHSs. We also recognize the need for more rapid implementation science approaches that are flexible and can accommodate rapid-system adaptation. In addition, 9 (16.9%) of 53 studies reported on the validation of a specific LHS program or system. Realising the Potential of Primary Health Care The rapid spread of COVID-19 added urgency to the need to address long-standing pressures on health systems, linked to growing citizens' expectations, population ageing and more complex and costly health care needs. The implications of sharing data were a central concern in all 10 studies. It wouldve been nice if they interpreted the data a little bit. LHS research is a radically applied field of inquiry that lends itself well to real-world evaluations, utilizing natural experiments in situ [81,82]. There is now widespread recognition that what is needed is a health care system that consistently delivers reliable performance and constantly improves, systematically and seamlessly, with each care experiencein short, a system with an ability to learn [6]. employ them, must recognize the potential for medical errors during the provision of emergency medical services, and appreciate the subsequent learning opportunities that are created when these errors are appropriately analyzed and managed. Five (6.6%) of 76 studies described the novel development and application of LHS-specific research tools or frameworks [18,31,46,75,76], and 3 (60%) of these 5 studies outlined the development of rapid analytic tools to address the need for timely feedback and evaluation [18,46,76] and to address the limitations of traditional plan-do-study-act (PDSA) models [18]. AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Franklin P, Chenok K, Lavalee D, Love R, Paxton L, Segal C, Holve E. Framework to guide the collection and use of patient-reported outcome measures in the learning healthcare system. As a library, NLM provides access to scientific literature. This progression from the predominantly theoretical contributions to the LHS literature to more applied and empirical evaluations has begun to uncover the potential methodological flaws and limitations of data systems in realizing the promise of an LHS. Here, we supplement the interviews and workshops conducted for that report with five new expert workshops, a purposeful literature review and six more years of experience building Learning Health Systems. Even included studies that did not explicitly focus on implementation identified system barriers relating to ethics, policy, and governance, with issues associated with data sharing featuring most prominently [60-69]. Brown-Johnson C, Safaeinili N, Zionts D, Holdsworth LM, Shaw JG, Asch SM, Mahoney M, Winget M. The Stanford Lightning Report Method: a comparison of rapid qualitative synthesis results across four implementation evaluations. A Learning Health System is described as a health system in which outcomes and experience are continually improved by applying science, informatics, incentives and culture to generate and use knowledge in the delivery of care. Decoding digital health: understanding how digital innovations are Porat T, Marshall IJ, Sadler E, Vadillo MA, McKevitt C, Wolfe CDA, Curcin V. Collaborative design of a decision aid for stroke survivors with multimorbidity: a qualitative study in the UK engaging key stakeholders. Geng EH, Peiris D, Kruk ME. Realising the Potential: Integrating Libraries into Adult Education Strategies 14 June 2022 Introduction Libraries are arguably one of the original lifelong learning institutions. Every School a Great School - Realising the Potential of System Although we identified relatively few studies incorporating an implementation science framework, we expect to see that application of such frameworks, and also tailored frameworks, will grow in the coming years and move us a step closer to realizing more of the potential of the LHS vision. Despite enthusiasm for big data and AI as the learning cornerstones, the question remains whether there is compelling evidence for the successful implementation of programs, systems, and services that are making marked progress toward approximating the normative descriptions of the LHS. Matheny ME, Whicher D, Thadaney Israni S. Artificial intelligence in health care: a report from the National Academy of Medicine. Five (6.6%) of 76 studies examined stakeholders perspectives on particular components of an LHS, including quality improvement [70], electronic prescribing and medicines administration systems [71] and diagnostic practices [72]. This report advances a comprehensive understanding of what is meant by and how to create learning health systems. Rausch T, Judd T. Using Integrated Clinical Environment Data for Health Technology Management. A framework for understanding, designing, developing and evaluating Learning Health Systems. The 72 papers were spread widely across 54 different journals, with Learning Health Systems (n=7, 9.7%) and eGEMS (Generating Evidence & Methods to Improve Patient Outcomes; n=4, 5.6%) being the most popular. Based on the full-text assessment, a further 13 (14.6%) of 89 studies did not meet the inclusion criteria, and hence 76 (85.4%) studies were included in this review (Figure 2). PDF Realising the Potential: Integrating Libraries into Adult Education
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