Many health care providers have been preoccupied with the goal of achieving meaningful use of electronic health records (EHRs). For those that have not yet implemented an EHR system, this can seem to be a pretty lofty goal, though not insurmountable. But as lofty as the meaningful use goal may be, it is only a baby step at the start of a much longer health IT journey towards the building of a national learning health system.
The concept of a learning health system (LHS) is not new, said Charles Friedman, Chief Scientific Officer for the Office of the National Coordinator for Health Information Technology (ONC) during last week’s webinar, Introduction to the Learning Health System. He pointed out that improving public health has been part of the health IT strategic framework since 2004.
The LHS is “not a sideshow or afterthought,” said Friedman, but a key element of the national agenda. In fact, he noted the goal of achieving a learning health system was explicitly stated as one of five strategic objectives in the 2011 health IT strategic plan. Meaningful use is merely a building block that is needed to reach the goal of a national LHS.
The Institute of Medicine (IOM) defines a learning health system as “one in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by‐product of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and health care.”
In case you are having trouble wrapping your head around that lengthy definition, Friedman offers some examples of how a LHS might work to improve population health:
- Nationwide post-market surveillance of a new drug quickly reveals that personalized dosage algorithms require modification. A modified decision support rule is created and is implemented in EHR systems.
- During an epidemic, new cases are reported directly from EHRs. As the disease spreads into new areas, clinicians are alerted.
Friedman further put the LHS into context by citing a well-known IOM statistic that it currently takes 17 years for “a new validated item of biomedical knowledge with implications for health care to find its way into routine use in health care.” A learning health system could take that 17 years and bring it down to 17 months, 17 weeks or even 17 hours.
The LHS will be a federation of some type, but not a centralized database, Friedman said. And it would have to be grounded in public trust and patient engagement, with participatory governance and “just enough” standardization. He offered a visual diagram of what a learning health system might look like:
With so many players and so many moving parts, the LHS can make meaningful use look like a walk in the park.