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Table 2 Learning health system pillars and accelerators

From: A framework for value-creating learning health systems

Pillar Elements Examples of accelerators
Scientific • Scientific expertise
• Academic or research institutes, centres, and groups
• Research training programmes and knowledge-sharing activities
• Research funding agencies and programmes
• Kaiser Permanente Learning Health System Program for research that drives continuous learning and improvement [46]
• Armstrong Institute for Patient Safety and Quality, a transdisciplinary group that coordinates research, training and quality improvement across the Johns Hopkins Medicine system [47]
• NUCAT’s Center for Data Science and Informatics [48]
• CATALyst Scholar Program at Kaiser Permanente Washington Health Research Institute [49]
• Funding programmes for research on new delivery models and patient-centred outcomes from the Agency for Healthcare Research and Quality and the PCORI [50]
Social • Multi-stakeholder networks and learning communities
• Service or partnership agreements
• Stakeholder engagement mechanisms (e.g. committees, advisory groups)
• Multidisciplinary teams and working groups within strategic clinical networks in Alberta [51]
• ‘Clinical communities’ bringing together clinicians and researchers at Johns Hopkins Medicine [47]
• DARTNet learning communities enabling learning from high performing clinical sites [52]
• Geisinger Health System Patient and Family Advisory Council and Patient Experience Steering Committee [30]
• ImproveCareNow Exchange online knowledge and resource hub [53]
• Change Group within regional community of practice in lung cancer care [29]
Technological • Expertise in information technology and data science
• Information technology systems
• Health technologies or devices
• Data infrastructures (e.g. electronic health records, clinical or administrative databases, clinical registry)
• Communication technologies and platforms
• Web or mobile applications
• Data warehouses and marts
• Interoperability frameworks
• Kaiser Permanente HealthConnect electronic health records system [54]
• PCORNet Distributed Research Network Architecture [55]
• EHR-linked multicentre clinical registries [32, 56]
• Data warehouses supporting research and clinical care [48, 57,58,59]
• Open source tools for data access, queries and analysis [31, 58]
• Dashboards for visualisation of EHR or clinical registry data [29, 34, 60]
• Electronic systems for capturing patient-reported outcomes data [61, 62]
• Machine learning algorithms used in CancerLinQ [63]
• Listserv for communication across IBD care centres [60]
Policy • Governance and accountability structures and systems
• LHS policies
• LHS performance frameworks and incentive systems
• Funding mechanisms for LHS operations and sustainability
• Steering and advisory committees of the PaTH LHS [58]
• Governance Councils and performance milestones within LHSNet [64]
• Data collaboration agreements governing sharing and use of data across sites [59]
• Accountability chain at Johns Hopkins Medicine [47]
• Merit-based incentive system for EHR adoption through the MACRA [65, 66]
• Data quality assessment policies and procedures [61, 63]
Legal • Privacy legislation
• Laws governing healthcare institutions, organisations and professionals
• Other laws, regulations and rules relevant to LHS activities
• HITECH Act [67]
• MACRA Act [66]
Ethical • Ethics expertise
• Ethical review boards and committees
• Ethics guidelines, frameworks and rules
• CancerLinQ regulatory framework and guiding principles for the ethical management and use of data [63, 68]
• Educational initiative for Geisinger Health system Institutional Review Board members on the ethical challenges of research and innovation within LHSs [30]
• Regulatory Workgroup in LHSNet to streamline IRB processes and enable more rapid project start-up and IRB approval [64]
• ‘Triple use’ registry protocol describing how registry data would be simultaneously used for chronic care management, quality improvement and research [32]
  1. EHR electronic health record; HITECH Health Information Technology for Economic and Clinical Health; IBD inflammatory bowel disease; IRB institutional review board; LHS learning health system; LHSNet Patient-Centered Network of Learning Health Systems; MACRA Medicare Access and CHIP Reauthorization Act; NUCAT Northwestern University Clinical and Translational Sciences Institute; PaTH University of Pittsburgh/UPMC, Penn State College of Medicine, Temple University Hospital, and Johns Hopkins University; PCORI Patient-Centered Outcomes Research Institute