The United States health system is plagued by rising costs, inconsistent outcomes in health and safety, delays in applying the latest medical advances, and an inefficient public health and biomedical research infrastructure. Many believe creating a national-scale Learning Health System (LHS) will help solve these problems. An LHS enables patients and their families, along with their health care providers, to make better-informed decisions by making their health-related data available in digital form. In addition, this rapidly mobilized data could improve the overall quality of health care in this country and empower public health and biomedical research.
The LHS is envisioned to be a fully integrated health data analysis network—a critical national infrastructure designed to transform healthcare and promote health. It will serve the needs of all stakeholders, including patients, clinicians, researchers, public health professionals, healthcare providers and payers, and many others. A sophisticated LHS will enable health-related data from across the country to be rapidly mobilized, aggregated, continuously analyzed, converted into actionable knowledge, and applied to decision-making processes.
The creation of an LHS at national scale is a monumental socio-technical challenge, one that invokes a broad scope of scientific questions that, to date, have not been clearly identified. At the center of Friedman’s research project was a two-day workshop held in Washington D.C. on April 11-12, 2013, engaging 45 of the nation’s leading scientists. These interdisciplinary scientists came together to identify key barriers and questions in creating an LHS on a national scale, providing direction for addressing issues that are vital to Americans’ health and well-being.
The participants were challenged to view the LHS as a “system after next” and identified the research challenges related to the four broad system requirements for a high-functioning LHS:
- Requirement 1: An LHS that is trusted and valued by the public
- Requirement 2: An LHS that is economically sustainable
- Requirement 3: An LHS that is stable, certifiable, adaptable, and self-improving
- Requirement 4: An LHS that is capable of generating valid knowledge
The challenges and specific research questions—organized into four areas corresponding to the above requirements of a high-functioning LHS—constitute one level of the workshop’s findings. On a higher level, the findings and their multiple interactions give rise to a novel scientific perspective. Rising to the challenge of the LHS may require a new science of large-scale learning systems best seen as an evolution from the science of information systems, through a science of cyber-physical, and ultimately to a science of cyber-physical-social ecosystems. Friedman foresees his research being applicable to a wider range of problems in health care systems and innovative educational programs that could potentially spawn a new generation of scientists.
To view a full report, agenda and other information about the workshop, please visit the U-M Health Informatics website here.
To see Charles Friedman deliver a presentation on Learning Health Systems, please watch the YouTube video here.