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] |