There is a real struggle in the provision of quality and affordable healthcare to a larger scope of people in the United States. There is need to let the medical world grow with technology and keeping up with scientific developments is hard and expensive if not properly planned, designed and executed. The learning Health System is a plausible solution that can be used to rapidly apply the best available technological and scientific developments to clinical practice in real-time.
The Learning Health System is based on a simple concept whose workability despite not being entirely tested is promising. The system aims at harnessing the power provided by data and analytics to learn from each patient then using the feedback to deduce “what works best” and sharing the knowledge with stakeholders within the hospital as well as at other levels to create a cycle of continuous improvement.
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"What is the Learning Health System?".
The Learning Health System can therefore simply be defined as a process of progress in science and informatics of medical care culture to generate new knowledge and insight as a natural by-product of the care giving experience to seamlessly help in refining and delivering best practices to continuously improve health and healthcare.
The learning Health System is one robust infrastructure that serves multiple purposes as it is built on a strong foundation of meaningful use as a component of other health IT investments. The system takes advantage of the increase in amount of available health data captured digitally by analyzing it and converting it to actionable knowledge. This digitally captured available data is at about 30 % as of now with the expectations projecting it to be about 80 % by 2019.
How the Learning Health System works
The learning health system combines evidence and practice in a virtuous cycle and through influencing each other, they create working solutions for care provision. The administrators of the system align their research with the urgent questions and tasks that the clinicians and care givers need addressed first. The evidence collected is translated into practice and this practice forms policy; which is basic for the culture of the medical institutions and hence their reputation.
The medical world has already warmed up to the basis of such systems with the hospi”tals and doctors” offices increasingly shifting to electronic records. The development of more innovative technologies by the private industry is revolutionizing access to information. Using such tools hospitals just like other organizations can achieve impressive results in collection, storage and analysis of information.
Researchers and clinicians have come to realize that innovation alone is not enough to fix the health care system. There is urgent need to move these innovations immediately into the real-world health care setting. This can only be done through a system like the learning health systems. For the system to work there is need for ongoing communication, dedication, engagement, and flexibility and these are essential in keeping the system improving.
There is need for strong support from the leadership that fosters growth in partnership between the research and clinical operations. This kind of partnership fosters care culture and creates an infrastructure that facilitates rapid learning.
What does a working Learning Health System entails?
There is an intrinsic goal to identify the most important and basic principles that guide efforts in establishing a digital infrastructure that supports the learning health system within the hospital. There are a number of considerations that must be taken into account before establishment that act as the guiding principles of its functionality in service delivery.
The system must take into account the following factors;
Culture; it must have a culture of operations that will define its success and therefore affect the reputation of the hospital. The culture that the system adopts stresses the importance of teamwork as it is a transparent, team-based and participatory culture. The design and processes should be patient-anchored and tested to ensure that the patients reap full benefits. As a factor, the patients and the public are also considered and they should be engaged fully and actively during the information collection with considerations of their legal provisions as stipulated by law. The decisions arrived at should be coordinated, informed, shared and facilitated. All this should be done with projections of the core purpose that is provision of care and the care should always start with the best practice.
When such factors are considered, there are cost implications that come with quality but the outcomes and costs are in management assessable and measurable. They should be valued against the knowledge provided by the system that is a product of innovation and information and research and the learning provided is ongoing hence inculcating the culture of learning and discovery in the process of care provision. The Learning Health System provides the hospital with digital technology that will integrate wings and departments in a common database that will serve as an engine of quality and continuous improvements to the service provided and value addition to the quality of output. The health information that will be accessible should prove reliable and reusable and should be guaranteed security. The data should be used for the intended purpose in line with the interest of its sources and the legal provisions and should therefore serve the purpose of common good. How the data is handled, used and reused will be a key component in the creation of a strong and protected trust fabric that needs constant and active nurturing.
Advantages of using the Learning Health System
The commitment to creation of this system that takes advantage of information to harness scientific knowledge can enable the improvement of the institution as a point of care. It also helps in creation of a patient-centered care provision method that is current and has continuous developments. The doctors can be more judicious in decision making through diagnosis to prescription as there is a large database of information from the hospital as well as the affiliated clinics. The platform will help care givers have shared decision making that will ensure treatment is consistent with the values and preferences of the patient. These decisions will also be archived for use and reference in similar cases and will also be pivotal in learning for the medical school. The information collected and the analysis made on it proves pivotal in helping students of the medical college in pursuing conditions within new trajectories and theories. The ambulatory clinic also stands to benefit as there is quick response to cases through analytic deductions from similar cases on the best course of action. The database will also help in relaying information between the hospital and the ambulatory facilities on patient history and/or condition information. This value addition that rides on the value-based benefit design helps in providing patients with proven, effective and evident-based services. It increases the success rate in curative measures hence improving the hospital”s standings.
Learning Health Services at the national level
The Institute of Medicine (IOM) concerned with the nation’s current medical situation sat to device an investment in medical research that reduces costs while reaching a larger scope of people to provide quality. In their view, there was an urgent demand that clinicians do more with the knowledge that they generate. They were part of the design of the learning health systems and they assured the country returns on such an investment. The use of this system involves seeking information from multiple sources and publishes general public health records in open databases.
Such actions are governed by the federal privacy regulations. There are no clear and consistent rules with regard to access of health information aimed at making improvements to the quality of health care. Having such regulations bottleneck a rather good course. It slows down improvement of quality while lowering the cost implications of reaching a wider scope.
There are huge allocations in budgetary allocations made with around 47 billion set aside by congress for adoption of electronic health systems by individual doctors and hospitals to improve personal and population health. Congress allocated these funds due to the requirements of the Health Information Technology for Economic and Clinical Health Act 2009. The budgetary allocation will be used for reimbursements for doctors and hospitals that have used their finances to implement the electronic medical record systems.
The legislation also provides funding for the design and establishment of health information sharing infrastructure that will enable improve care coordination and provision for patients across health facilities. This is an integral part of the national reforms in the health care system. It is a requirement that such systems are put in place to reduce errors and disparities while improving the care systems at reduced costs.
The system definitely has its own emerging issues, as any other prudent innovation would. Of concern is the handling of patient health information in light of the contention that comes with health privacy. The process of collecting data and disclosing the health information is governed by state health privacy laws. There are variants on the entity of the law regarding the intended use of the information but primarily, the law is generally a disincentive in quick response to issues and quality provision of care.
Researchers have unanimously labeled the federal regulations on research as impeding the access of information for secondary learning and hence slowing the use of information and analytic processes to review information, build a suggestion and create working solutions. It is viewed as undermining to the basic goal of the process which is sharing if the information cannot be shared at the onset of the process.
The U.S. Department of Health has taken measures to reduce the speed bumps in the collection of information meant for secondary learning and the sharing of such information between facilities. The department has flaunted a study that seeks to reduce the requirements that must be observed in the vetting and approval of collection of information and the use of it thereof. The department proposes that researchers will only be required to file a short description of the research they want to carry out with the board and only one member of the board will vet it. On the other hand, patients will only be required to give short, oral consent.
Conclusion
Despite the obvious challenges that face the implementation of the system in cost implications and regulations, there is the promise of return in the investment from the provision of timely and quality care and the increase in repute for the institution.
