The Department of Learning Health Sciences, University of Michigan Medical School: A First-of-Its Kind Department Chaired by Charles P. Friedman, PhD Prepared for the MIDAS Symposium, October 6, 2015

1. LHS.medicine.umich.edu @umichDLHS
The Department of
Learning Health Sciences,
University of Michigan
Medical School:
A First-of-Its Kind Department
Chaired by Charles P. Friedman, PhD
Prepared for the MIDAS Symposium,
October 6, 2015

2. Content Title
A New Basic Science Department
The Department of Learning Health Sciences
is a new basic science department dedicated
to the learning sciences in health, from
individuals up to ultra large scale systems that
span states and nations.
The Department was created in May 2014 as
an evolution of the Department of Medical
Education.

3. A New Perspective on Learning
Learning is a continuous process
of study, reflection, and change
leading to improvement.
This learning can happen at
multiple levels, by:
• Individuals
• Teams
• Organizations
• Regional, national, and international
systems.
Individual
Team
Organization
Large Scale System

4. A New Perspective on Learning

5. A Learning Health System is an organization
or network of organizations that can
continuously study and improve itself.
Fundamental to the concept, which was
pioneered by the Institute of Medicine in
2007, is the capacity and commitment to
reshape every healthcare interaction to
rapidly study and adapt the system.
Creating a Scalable and Sustainable
Learning Health System

6. A Learning Health System
is based on learning cycles
that include data and
analytics to generate
knowledge and feedback
of knowledge to
stakeholders, with the goal
to change behavior and
transform practice.
Creating a Scalable and Sustainable
Learning Health System

7. “A LHS works through the implementation of virtual
cycles of studying, learning and improvement. The
key to where we eventually want to go, very
importantly, needs to be understood as not only
including establishing a number of learning cycles
going on, but also creating a platform that sits
underneath all of them, supports all of them, and
makes them efficient.”
Charles P. Friedman
Creating a Scalable and Sustainable
Learning Health System

8. 1. Every consenting patient’s characteristics
and experience are available for study
2. Best practice knowledge is immediately
available to support decisions
3. Improvement is continuous through
ongoing study
4. This happens routinely, economically and
almost invisibly
5. All of this is part of the culture
Creating a Scalable and Sustainable Learning
Health System, where:

9. Healthcare delivery systems & research
networks must run many complete learning
cycles simultaneously, each addressing a
different problem.
High functioning learning health systems raise
many deep scientific challenges.
Enabling learning that is effective, continuous,
sustainable, routine, and at any level of scale
requires multiple disciplines.
Creating a Scalable and Sustainable Learning
Health System

10. Through its Learning Health System initiatives,
the department has research and service
partnerships that reach across clinical areas
across the medical school, across disciplines
across 10 schools and colleges at the University
of Michigan, and around the world through
partnerships with other health organizations.
Bringing Together Diverse, World-Class
Expertise

11. • Data Science
• Machine Learning
• Semantics
• Knowledge
Representation
• Knowledge
Management
• Decision Science
• Communication
• Human Factors
• Organizational
Psychology
• Behavior Change
• Implementation
Science
• Economics
• Policy Analysis &
Design
• Complexity & System
Science
Bringing Together Diverse, World-Class
Expertise in:

12. The Division of Learning and Knowledge Systems
primarily focuses on learning at the organizational and
system levels.
The Division of Professional Education primarily
addresses learning by individuals and teams in
preparation for careers as health educator-leaders.
The Clinical Simulation Center focuses on learning by
individuals and teams in environments with advanced
simulation technology that model the real world of
clinical practice.
Bringing Together Diverse, World-Class
Expertise

13. The department aims
to generate and
communicate new
knowledge that
advances the
sciences of learning
applied to health.
Future Direction:
Research

14. On October 1, 2015,
University of Michigan
began a three-year
contract with PCORI to
create a new Clinical
Data Research Network
called LHSnet with 9
partner organizations
across U.S.
Future Direction:
Research

15. A national scale Learning Health System, with meaningful use of electronic
medical records, widespread participation by multiple diverse entities, and an
appropriate technical architecture can spur the construction of a highly
participatory rapid learning system that stretches from coast to coast.
Source: Charles P. Friedman et al., Sci Transl Med 2010;2:57cm29 Published by AAAS
Future Direction: Research

16. The
department
aims
to
prepare
a
next
genera1on
of
educators
and
learning
scien1sts
by
developing
new
graduate
level
programs
and
by
integra1ng
learning
sciences
into
health
professional
curricula.
Future Direction: Education

17. The
department
promotes
learning
and
learning
systems
at
all
levels
of
scale.
Locally,
together
with
the
Brehm
Center
for
Diabetes
Research,
we
are
engaging
individuals
across
the
university
to
create
a
scalable
and
replicable
diabetes-­‐focused
Learning
Health
System
within
the
University
of
Michigan
Health
System.
Several
clinicians
have
joined
as
faculty
champions.
Topics
for
learning
cycles
are
in
discussion.
Future Direction: Service

18. Across
the
state,
the
department
ac1vely
supports
an
ini1a1ve
called
Learning
Health
for
Michigan,
first
convened
by
the
Center
for
Healthcare
Research
in
July
2014.
Learning
Health
for
Michigan
is
a
collabora1ve
grassroots
effort
among
mul1ple
and
diverse
stakeholders
statewide
aimed
at
realizing
a
state-­‐level
Learning
Health
System
across
Michigan.
Future Direction: Service

19. “As we were talking to some of our leading authorities
[in University of Michigan] on quality-related research [in
Diabetes], they expressed frustration at the challenge
of getting their findings adopted even at their
own institution because there’s no system in place to do
that. A learning health system bridges that gap
between research and clinical care. We’ll do things that
aren’t quite formalized research but will allow our
system to learn from patients and enhance our care.”
Dorene Markel
Bridging Research and Clinical Care

20. Beyond Precision Medicine
“[In our envisioned Learning Health System approach for
Diabetes], as more and more patients are tracked, [our
app] would discover – based on the last 100 patients like
you who had similar levels of activity, blood sugar, and
diet – this is the way the correction factor should be
modified. Over time the phrase ‘like you’ would
become more and more refined… We want to create
an interaction where this app is like a trusted friend who
delivers messages in way that reinforces a patient’s
values and goals for her health.”
Larry An

21. Learning Systems Beyond Health
“The Learning Health System (LHS) requires a new and
significant crossing of capabilities that today are present
only in largely disconnected communities… There will
be important lessons for how to leverage large amounts
of real-world data, mechanisms for learning from such
data, feedback components aimed at mobilizing lessons
learned to inform decisions and actions, and cyber-social
ecosystems - entailing networks of computers, machines,
people, and organizations - to improve performance and
bring about transformation in many other sectors
outside of health.”
Friedman et al. Toward a Science of Learning Systems. JAMIA, Nov. 2014