realizing a learning health system: a vision for education to transform the future of health
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Realizing a Learning Health System:A Vision for Education to Transform
the Future of HealthCharles Friedman
Joshua Rubin
Thank You!
DisclosureChuck and Josh are wearing two hats today:
1) University of Michigan2) Learning Health Community
We will try to be a clear as possible as to when we are wearing each one.
The Learning Health System
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Health systems--at any level of scale--become learning systems when they can, continuouslyand routinely, study and improve themselves
Perspective: Jan 3, 2013“Code Red and Blue — Safely Limiting Health Care’s GDP Footprint”
Arnold Milstein, M.D., M.P.H.…U.S. health care needs to adopt new work
methods, outlined in the Institute of Medicine’s vision for a learning health system…
Inspiration• I believe that people are
naturally drawn to visionary that stimulate imagination
• LHS = the “Big Idea” we have needed for a long time
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LHS Themes
• Learn from every patient!• A system problem needs a system
solution!• 17 years to 17 months to 17 weeks
to 17 days (to 17 hours)!
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The Actual Idea: What is an LHS?Three Views:
• Checklist
• Macro view from earth orbit
• Micro view from the ground
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Checklist View: Properties of a Health System That Can Learn
Every consenting patient’s characteristics and experience are available to learn from
Best practice knowledge is immediately available to support decisions
Improvement is continuous through ongoing study
An infrastructure enables this to happen routinely and with economy of scale
All of this is part of the culture 8
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View from Earth Orbit: An Ultra-Large Scale System
Patient Groups
GovernanceEngagementData AggregationAnalysisDissemination
Insurers
Pharma
Universities
Government/Public Health
Healthcare Delivery Networks
ResearchInstitutes
Tech Industry
All-Inclusive Decentralized ReciprocalTrusted
View from the GroundHow Learning Happens : “Virtuous
Cycles” of Study and Change
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AssembleExperience Data
TakeAction
InterpretResults
AnalyzeData
Tailored Messagesto Decision-Makers
A Problem of Interest
Decision to Study
Example of A Virtuous Learning Cycle
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Assemble Data:How do we preventfalls?What is the fall rate?
Take Action: Change Current Practice:In whole or part…
Interpret Results:Are the results credible?What advice should be given?
Analyze Data:What practicesassociate withlower fallrates?
Tailored Messages:Based on your currentpractice, you might want to consider…
Decision to study falls
Assemble Data:How do we preventfalls?What is the fall rate?
Reducing Falls in Nursing
Homes
The LHS and Big Data
• The LHS is bigger than Big Data• Better health = BD2K + K2P
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A Problem of Interest
BD2K K2P
Better Health Requires This
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AssembleRelevant Data
Take Action to Change Practice
InterpretResults
AnalyzeData
Deliver Tailored Message
A Problem of Interest
Decision to Study
Not This
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AssembleRelevant Data
Take Action to Change Practice
InterpretResults
AnalyzeData
Deliver Tailored Message
A Problem of Interest
Decision to Study
Journals?
Learning at Scale Requires an Infrastructure/Platform
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DifferentProblems
Rapid Cycle
Slower Cycle
SUPPORTING PLATFORM
People
ProcessTechnology
Policy
(At Least) Two Questions for Discussion
1. How do we educate the workforce of the future to serve the needs of the member organizations of the Alliance for Continuing Education in the Health Professions in a Learning Health System?
2. What are opportunities for synergies and collaboration?
Thanks and Write to Us…
• Charles Friedman– [email protected]
• Joshua Rubin– [email protected]
www.LearningHealth.orghttp://lhs.medicine.umich.edu
Realizing a Learning Health System:A Vision for Education to Transform
the Future of HealthCharles Friedman
Joshua Rubin
Thank You!
DisclosureChuck and Josh are wearing two hats today:
1) University of Michigan2) Learning Health Community
We will try to be a clear as possible as to when we are wearing each one.
The Learning Health SystemHealth systems--at any level of scale--become learning systems when they can, continuously and routinely, study and improve themselves
Perspective: Jan 3, 2013“Code Red and Blue — Safely Limiting Health Care’s GDP Footprint”
Arnold Milstein, M.D., M.P.H.…U.S. health care needs to adopt new work
methods, outlined in the Institute of Medicine’s vision for a learning health system…
17 years to 17 months to 17 weeks to 17 days…!
Checklist View: Properties of a Health System That Can Learn
Every consenting patient’s characteristics and experience are available to learn from
Best practice knowledge is immediately available to support decisions
Improvement is continuous through ongoing study
This happens routinely, economically and almost invisibly
All of this is part of the culture
Learning Systems Can Exist at Any Level of Scale
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Mono-organizational, inter-organizational, state/regional, national, global…
View from the GroundHow Learning Happens: “Virtuous
Cycles” of Study and Change
AssembleExperience Data
TakeAction
InterpretResults
AnalyzeData
Tailored Messagesto Decision-Makers
A Problem of Interest
Decision to Study
The LHS Must Do This
AssembleRelevant Data
Take Action to Change Practice
InterpretResults
AnalyzeData
Deliver Tailored Message
A Problem of Interest
Decision to Study
Not This
AssembleRelevant Data
Take Action to Change Practice
InterpretResults
AnalyzeData
Deliver Tailored Message
A Problem of Interest
Decision to Study
Journals?
The LHS Infrastructure Challenge
We have:
Problem 1
Problem 3
Problem 2• A set of learning
loops, each addressing a different problem.
• An efficient large scale system:
But we need:
The Scale of the System = The Scope of the Platform
Inter-organizational Data Federations and Networks: They Need a Platform
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So What’s in a Complete Platform?
Mechanisms for managing
communities of interest
New Science?• National workshop explored the
research challenges inherent in realizing a high functioning LHS
• April, 2013: 45 invited attendees• At the end, it was suggested that
these challenges may equate to a new science
New International Journal
LHS Journal• Editorial office in Ann Arbor• Three Associate Editors
– Brendan Delaney– Jonathan Silverstein– Kevin Sullivan
• 46-member Editorial Board (nine countries)
• Article types– Research reports– Experience reports– Briefs– Commentaries
Envisioning (and Democratizing) the Future…
•50X•73 Days
A Department of Learning Health Sciences at the U of Michigan
• Research: Generate and communicate new knowledge that advances the sciences of learning applied to health– New academic journal
• Service: Promote learning and learning systems at all levels of scale
• Education: Prepare a next generation of learning scientists; fold learning science into health professional curricula– New graduate degree program: Health
Infrastructures and Learning Systems
Educating a Cohort of “Health Infrastructuralists” to Transform Health
The Workforce to Drive the Future of Health, Enthusiastically Recommended
“The proposed PhD in HILS program couples data science with myriad other key disciplines spanning the social, computational, and biomedical sciences. Some are well established, and others are themselves emerging. Together, training in these disciplines and the continued development of a new science at their intersection holds the potential to capture, harness, and unleash the power of this data – and to optimally utilize the knowledge generated from it. I wholeheartedly endorse this program, and look forward to collaboration opportunities in the future.”
HILS Curriculum
Alignment with the QIE Roadmap
(At Least) Two Questions for Discussion
1. How do we educate the workforce of the future to serve the needs of the member organizations of the Alliance for Continuing Education in the Health Professions in a Learning Health System?
2. What are opportunities for synergies and collaboration?
https://lillypad.lilly.com/entry.php?e=8284www.LearningHealth.org
103 Endorsements of the LHS Core Values*(As of 5/9/2016)
The Center for Learning Health Care
Siemens Health Services
GE Healthcare IT
*To be included on the www.LearningHealth.org website.
SecureHealthHub, LLC
Department of Primary Careand Public Health
Program in HealthInformatics, SONHP
Veterans Health AdministrationOffice of Informatics & Analytics
Division of Health and Social Care Research
“Learning How to Learn”A Learning Health System (LHS)…
A System of Health Learners…• Every Human Health Experience…• Every Decision Affecting Health…• Every Person…
Two Questions to Consider*
1. What can a LHS do for me?
2. What can I do for a LHS?
*In your role as a health professional, as a patient/caregiver, as a citizen, and in other roles.
Thanks and Write to Us…
• Charles Friedman– [email protected]
• Joshua Rubin– [email protected]
www.LearningHealth.orghttp://lhs.medicine.umich.edu