Infrastructure to support learning health systems: are we there yet? Innovative solutions and lessons learned from American Recovery and Reinvestment Act CER investments

Holve, Erin; Segal, Courtney

doi:10.2217/cer.14.72

Cited by 5 publications

(6 citation statements)

References 15 publications

(12 reference statements)

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“…By 2020, the volume of health data generated worldwide is expected to reach 25,000 petabytes, a 50-fold increase from the amount of data generated in 2012 [ 1 ]. The Health Information for Economic and Clinical Health (HITECH) Act [ 2 3 ], the Patient Protection and Affordable Care Act [ 4 ], and the American Recovery and Reinvestment Act [ 5 ] facilitated an unprecedented collection of electronic health data [ 6 7 ] in an effort to improve patient care. As a result of HITECH, the adoption and use of electronic health records (EHRs) [ 3 ] has drastically increased.…”

Section: Introductionmentioning

confidence: 99%

“…The utility of EHR in data-driven decision making and comparative effectiveness research (CER) faces many challenges including: governance and stakeholder misalignment [ 21 ] and lack of mutually accepted guidelines for data sharing [ 6 22 ], data integration and aggregation [ 23 ], DQ [ 18 24 25 26 27 ], data standards [ 24 ], infrastructure and data management [ 6 21 ], and record linkage [ 18 ]. Further, guidelines for security and privacy [ 6 10 28 ] and analytics and tool development are under-developed [ 21 28 30 ]. The most informative health data (e.g., data stored in EHRs, personal wellness devices, and medical research applications) are not ‘off-the-shelf’ ready for analysis; [ 31 ] these data are subject to different regulations and standards, and often violate fundamental assumptions of DQ [ 26 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Reporting Data Quality Assessment Results: Identifying Individual and Organizational Barriers and Solutions

Callahan¹,

Barnard²,

Helmkamp³

et al. 2017

eGEMs

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Introduction:Electronic health record (EHR) data are known to have significant data quality issues, yet the practice and frequency of assessing EHR data is unknown. We sought to understand current practices and attitudes towards reporting data quality assessment (DQA) results by data professionals.Methods:The project was conducted in four Phases: (1) examined current DQA practices among informatics/CER stakeholders via engagement meeting (07/2014); (2) characterized organizations conducting DQA by interviewing key personnel and data management professionals (07-08/2014); (3) developed and administered an anonymous survey to data professionals (03-06/2015); and (4) validated survey results during a follow-up informatics/CER stakeholder engagement meeting (06/2016).Results:The first engagement meeting identified the theme of unintended consequences as a primary barrier to DQA. Interviewees were predominantly medical groups serving distributed networks with formalized DQAs. Consistent with the interviews, most survey (N=111) respondents utilized DQA processes/programs. A lack of resources and clear definitions of how to judge the quality of a dataset were the most commonly cited individual barriers. Vague quality action plans/expectations and data owners not trained in problem identification and problem-solving skills were the most commonly cited organizational barriers. Solutions included allocating resources for DQA, establishing standards and guidelines, and changing organizational culture.Discussion:Several barriers affecting DQA and reporting were identified. Community alignment towards systematic DQA and reporting is needed to overcome these barriers.Conclusion:Understanding barriers and solutions to DQA reporting is vital for establishing trust in the secondary use of EHR data for quality improvement and the pursuit of personalized medicine.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reporting Data Quality Assessment Results: Identifying Individual and Organizational Barriers and Solutions

Callahan¹,

Barnard²,

Helmkamp³

et al. 2017

eGEMs

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“…A number of organizations have begun to use the LHS model to organize for learning although application of the model remains largely conceptual. 3 – 8 Senior leadership support and operational-research partnerships have been identified as key components of successful LHS activity, 9 – 15 yet little has been published to provide guidance on important operational issues and strategies for systemwide learning and operationalization of the LHS model. 16 – 18 A recent survey of leaders and managers from organizations involved in patient-centered network programs funded by the Patient-Centered Outcomes Research Institute (PCORI) recognized that research had a beneficial role to play in care delivery, but discussed a number of challenges with integrating research into clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System

Psek

Davis

Gerrity

et al. 2016

eGEMs

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Introduction:Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders’ perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders’ perspectives on the LHS and learning activities in an integrated delivery system.Methods:A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders’ responses were categorized into themes.Findings:Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals.Discussion:Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed.Conclusion:Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

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“…The concept of a “learning network” was used to refer to either learning collaboratives or learning systems [ 122 , 123 ]. However, learning networks could also be defined as a method for bringing learning systems together around a common theme such as primary care [ 86 , 124 , 125 ]. There are few studies in the literature on learning networks, in particular on a global scale.…”

Section: Resultsmentioning

confidence: 99%

Aiming for quality: a global compass for national learning systems

Sarakbi

Mensah-Abrampah

Kleine-Bingham

et al. 2021

Health Res Policy Sys

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Introduction Transforming a health system into a learning one is increasingly recognized as necessary to support the implementation of a national strategic direction on quality with a focus on frontline experience. The approach to a learning system that bridges the gap between practice and policy requires active exploration. Methods This scoping review adapted the methodological framework for scoping studies from Arksey and O’Malley. The central research question focused on common themes for learning to improve the quality of health services at all levels of the national health system, from government policy to point-of-care delivery. Results A total of 3507 records were screened, resulting in 101 articles on strategic learning across the health system: health professional level (19%), health organizational level (15%), subnational/national level (26%), multiple levels (35%), and global level (6%). Thirty-five of these articles focused on learning systems at multiple levels of the health system. A national learning system requires attention at the organizational, subnational, and national levels guided by the needs of patients, families, and the community. The compass of the national learning system is centred on four cross-cutting themes across the health system: alignment of priorities, systemwide collaboration, transparency and accountability, and knowledge sharing of real-world evidence generated at the point of care. Conclusion This paper proposes an approach for building a national learning system to improve the quality of health services. Future research is needed to validate the application of these guiding principles and make improvements based on the findings.

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Infrastructure to support learning health systems: are we there yet? Innovative solutions and lessons learned from American Recovery and Reinvestment Act CER investments

Cited by 5 publications

References 15 publications

Reporting Data Quality Assessment Results: Identifying Individual and Organizational Barriers and Solutions

Reporting Data Quality Assessment Results: Identifying Individual and Organizational Barriers and Solutions

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System

Aiming for quality: a global compass for national learning systems

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