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Summit Meeting to Focus on Learning Health System

May 4, 2012
by David Raths
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Bi-directional feedback would share best practices for continuous improvement
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On May 17, a group of 80 stakeholder organizations will come together in Washington, D.C., for a two-day meeting to discuss plans for a nationwide learning health system. “This meeting could be for healthcare what the Dumbarton Oaks meeting was for the United Nations,” said Charles Friedman, Ph.D., director of the Health Informatics Program in the University of Michigan Schools of Information and Public Health & former chief scientific officer for the Office of the National Coordinator for Health Information Technology.

Speaking April 27 at the 5th Annual Healthcare Informatics Symposium sponsored by the Children’s Hospital of Philadelphia, Friedman said the goal is for “consensus endorsement of a set of principles to govern and guide a learning health system.”
What is a learning health system? The Institute of Medicine defines it as one in which progress in science, informatics and care culture align to generate new knowledge as an ongoing, natural byproduct of the care experience. A learning health system would seamlessly refine and deliver best practices for continuous improvement in health and health care.
Friedman noted that a learning health system, which is a key goal of the national health IT strategy, would make several things possible, including:
  • Nationwide post-market surveillance of a new drug-dosing algorithm. A modified decision support rule could be created and implemented in electronic health record systems;
  • During an epidemic, new cases are reported directly from EHRs. As the disease spreads into new areas, clinicians are alerted; and
  • A patient faces a difficult medical decision. She bases that decision on the experiences of other patients like her.

Friedman stated that the meaningful use framework is necessary but not sufficient for a learning health system. “Meaningful use is a status achieved individually by eligible professionals and hospitals,” he said. A learning health system requires elements not contemplated by meaningful use, with goals at a higher aggregation level, and it involves the inclusion of broader stakeholders.”

Friedman envisions the learning health system as a single infrastructure with a limited set of standards. It would be a decentralized federation of some type, not a centralized database. “I see this being successful to the extent that it is outside of government,” he said, adding that he expects the governance to be something like the U.K.’s National Information Governance Board, an independent statutory body established to promote, improve and monitor information governance in health and adult social care.

Friedman expressed great hope for the May meeting, which is being sponsored by the Kanter Family Foundation. Although a learning health system may seem like a pipedream to some, “we are further along than you might think,” he said. “I would describe our current state as an archipelago, with many islands of excellence. Within its boundaries components of a learning health system are already taking place.”