An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review

Abstract

Background In the past decade, Lynn Etheredge presented a vision for the Learning Health System (LHS) as an opportunity for increasing the value of health care via rapid learning from data and immediate translation to practice and policy. An LHS is defined in the literature as a system that seeks to continuously generate and apply evidence, innovation, quality, and value in health care. Objective This review aimed to examine themes in the literature and rhetoric on the LHS in the past decade to understand efforts to realize the LHS in practice and to identify gaps and opportunities to continue to take the LHS forward. Methods We conducted a thematic analysis in 2018 to analyze progress and opportunities over time as compared with the initial Knowledge Gaps and Uncertainties proposed in 2007. Results We found that the literature on the LHS has increased over the past decade, with most articles focused on theory and implementation; articles have been increasingly concerned with policy. Conclusions There is a need for attention to understanding the ethical and social implications of the LHS and for exploring opportunities to ensure that these implications are salient in implementation, practice, and policy efforts.

Combining the Digital, Social and Physical Layer to Create Age-Friendly Cities and Communities

“…Since this original definition, there has been increasing recognition of the need to engage with various stakeholders including patients, participants, health care providers, and policy-makers among others to understand how to drive a sustainable LHS [ 39 ]. The bottom-up approach of citizen science involving diverse stakeholders and localised problem-solving is an effective way to translate knowledge to a broader audience and to support iterative evaluation processes within an LHS [ 40 ].…”

“…In this way, citizen science participation can be more open among other methodological approaches in that the citizens do not always need to be pre-selected by researchers or healthcare providers [ 41 , 42 ]. This allows for an agile model that focuses on evolving community needs rather than producing generalisable knowledge and which closely aligns with the notion of an LHS [ 39 , 43 ].…”

From Nihilism to Opportunity

“…The EHR contains a vast amount of health data that can be analyzed to generate real-time actionable health system knowledge that can be used to improve clinical care, track health outcomes, and guide decision making. The process of turning data into knowledge and then, into patient and system improvement is the foundation of the Learning Health System (LHS) (5). The ability to harness large amounts of health data contained in the EHR is a powerful means to engage learners in the LHS model and to address the Accreditation Council for Graduate Medical Education competencies of practice-based learning and improvement and systems-based care.…”

The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system

“…[9][10][11][12] While a common organizational foundation can promote the development of LHS approaches, significant cultural, and scalability challenges can impede their dissemination throughout all levels and sites. [16][17][18] 2. Trans-organizational LHSs include more than one organization and are typically focused on a shared, focused purpose.…”