Domain

Learning Health System

Type

Conceptual or Process Model/Framework

Theme

operations

Start Date

7-6-2014 10:25 AM

End Date

7-6-2014 11:45 AM

Structured Abstract

Introduction

The Learning Health System (LHS) seeks to integrate clinical operations, research and patient participation in order to generate knowledge and disseminate successful practices. Transitioning from concept to practical application of a LHS across an integrated health system presents many challenges but can yield many opportunities for discovery and improvement. At Geisinger Health System a planning committee representing multiple stakeholders is developing a plan for operationalizing the LHS across the delivery system. We describe key issues and challenges identified through the ongoing planning process and present a framework for operationalizing a LHS in an integrated delivery system.

Background

While many health systems have elements of the LHS in place and have applied them to specific research and clinical areas, few have attempted to transition their entire organization to a LHS. In 2013, the Geisinger Center for Clinical Innovation began planning for system-wide integration of the LHS. The goal was to transform patient care through development of LHS technologies that engage patients, lower cost and increase quality and efficiency of evaluation of innovations and measurement of value.

Findings

Key issues centered around the themes of 1) resources, infrastructure and organization needed to transition to a LHS; 2) patient and community engagement; 3) ethical implications of a learning health system; 4) integration and oversight of clinical activity, research and quality improvement. Early challenges included building senior leadership support and defining a LHS vision that appealed to multiple stakeholders. Ongoing challenges include integrating medical education, funding infrastructure and organizational redesign, ethical oversight of learning activities, and appropriately involving our patient community as an active partner.

Based on the identified themes and challenges, we developed a framework to guide our work and inform organizations seeking to broadly operationalize the LHS. The framework is purposefully broad for application across different organizational contexts. It addresses steps in LHS planning, and focuses on the LHS vision, people and partnerships, data and analytics, funding, evaluation, prioritization, and organization.

Lessons Learned

A realistic assessment of the capacity and capabilities of the organization and its data and analytic infrastructure is critical to defining scope of operationalization, setting expectations and estimating resources and cost. Integration of clinical operations, research and patients may be influenced by many factors including misaligned goals and resources. These factors point to the importance of addressing organizational culture and attitudes towards learning early in the planning process and throughout the system.

Patient engagement requires trust, redefined relationships with the system, and consideration of health literacy so that patients can successfully navigate new LHS practices. Finally, integrating patients, clinical care and various modes of discovery, including quality improvement and comparative effectiveness research, requires a defensible ethical framework that undergirds a system of strong but flexible oversight.

Conclusion

The LHS is a recent concept and there is limited literature and practical experience available in operationalizing the LHS across an integrated health system. Findings from our ongoing work and the framework begin to add to this knowledge base and may inform other organizations considering the transition.

Acknowledgements

N/A

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 10:25 AM Jun 7th, 11:45 AM

Operationalizing the Learning Health System in an Integrated Delivery System

Introduction

The Learning Health System (LHS) seeks to integrate clinical operations, research and patient participation in order to generate knowledge and disseminate successful practices. Transitioning from concept to practical application of a LHS across an integrated health system presents many challenges but can yield many opportunities for discovery and improvement. At Geisinger Health System a planning committee representing multiple stakeholders is developing a plan for operationalizing the LHS across the delivery system. We describe key issues and challenges identified through the ongoing planning process and present a framework for operationalizing a LHS in an integrated delivery system.

Background

While many health systems have elements of the LHS in place and have applied them to specific research and clinical areas, few have attempted to transition their entire organization to a LHS. In 2013, the Geisinger Center for Clinical Innovation began planning for system-wide integration of the LHS. The goal was to transform patient care through development of LHS technologies that engage patients, lower cost and increase quality and efficiency of evaluation of innovations and measurement of value.

Findings

Key issues centered around the themes of 1) resources, infrastructure and organization needed to transition to a LHS; 2) patient and community engagement; 3) ethical implications of a learning health system; 4) integration and oversight of clinical activity, research and quality improvement. Early challenges included building senior leadership support and defining a LHS vision that appealed to multiple stakeholders. Ongoing challenges include integrating medical education, funding infrastructure and organizational redesign, ethical oversight of learning activities, and appropriately involving our patient community as an active partner.

Based on the identified themes and challenges, we developed a framework to guide our work and inform organizations seeking to broadly operationalize the LHS. The framework is purposefully broad for application across different organizational contexts. It addresses steps in LHS planning, and focuses on the LHS vision, people and partnerships, data and analytics, funding, evaluation, prioritization, and organization.

Lessons Learned

A realistic assessment of the capacity and capabilities of the organization and its data and analytic infrastructure is critical to defining scope of operationalization, setting expectations and estimating resources and cost. Integration of clinical operations, research and patients may be influenced by many factors including misaligned goals and resources. These factors point to the importance of addressing organizational culture and attitudes towards learning early in the planning process and throughout the system.

Patient engagement requires trust, redefined relationships with the system, and consideration of health literacy so that patients can successfully navigate new LHS practices. Finally, integrating patients, clinical care and various modes of discovery, including quality improvement and comparative effectiveness research, requires a defensible ethical framework that undergirds a system of strong but flexible oversight.

Conclusion

The LHS is a recent concept and there is limited literature and practical experience available in operationalizing the LHS across an integrated health system. Findings from our ongoing work and the framework begin to add to this knowledge base and may inform other organizations considering the transition.