Learning From What We Do, and Doing What We Learn: A Learning Health Care System in Action

Abstract

Different models of learning health systems are emerging. At Vanderbilt University Medical Center, the Learning Health Care System (LHS) Platform was established with the goal of creating generalizable knowledge. This differentiates the LHS Platform from other efforts that have adopted a quality improvement paradigm. By supporting pragmatic trials at the intersection of research, operations, and clinical care, the LHS Platform was designed to yield evidence for advancing content and processes of care through carefully designed, rigorous study.

Describing a complex primary health care population in a learning health system to support future decision support and artificial intelligence initiatives

“…When assessing data quality and completeness, which is emphasized by machine learning for EHR guidelines [2, 4, 19, 41, 42], the implications of pursuing LHS initiatives at different levels should also be considered. For example, a subset of CHCs capture self-reported measures of health, which are valuable research outcomes [43].…”

“…A first step towards any initiative is identifying needs of clients and providers, which is often driven by internal stakeholders. 4 Descriptive epidemiology is instrumental in outlining health states and needs of populations, 17 and may be beneficial to add into these early stages of LHS development both to identify new areas to explore and to support existing ideas. For example, describing how clients are represented in EHR data at a population level may complement clinical experience to identify potential bias or misrepresentation that analyses need to account for to obtain meaningful results.…”

“…1,2 LHS initiatives target quality improvement, research, or decision support; and usually rely on EHR data from the same population that the findings or end-product are intended to benefit. [2][3][4][5] These initiatives can support populations who have historically been excluded from medical research and clinical guideline development, such as those with complex health needs or barriers to participation. [6][7][8][9] Primary care (PC), first contact care provided in a community setting over the life course, is inherently complex.…”

Forty‐fifth ASPEN Presidential Address: Research in a pandemic—Why, what, how?

“…Well, it allows clinical research to be done within clinical practice. It uses clinical practice as the research infrastructure to understand the risks and benefits of usual practices 26 . Take an example in which a patient has a common condition and there are at least two available therapies: If evidence is available supporting one of those therapies, clinicians provide that therapy to the patient so that the patient receives the best available therapy.…”

“…It uses clinical practice as the research infrastructure to understand the risks and benefits of usual practices. 26 Take an example in which a patient has a common condition and there are at least two available therapies: If evidence is available supporting one of those therapies, clinicians provide that therapy to the patient so that the patient receives the best available therapy. However, if evidence is lacking that one of the therapies is better, clinicians do not know which of the two therapies is better for their patients, and therefore, those therapies are distributed almost arbitrarily or haphazardly to patients.…”