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Realizing a Learning Health System:
A Vision for Education to Transform
the Future of Health
Charles Friedman
Joshua Rubin
Thank You!
Disclosure
Chuck and Josh are wearing two hats today:
1) University of Michigan
2) Learning Health Community
We will try to be a clear as possible as to
when we are wearing each one.
The Learning Health System
4
Health systems--at any level of scale--become
learning systems when they can, continuously
and routinely, study and improve themselves
Perspective: Jan 3, 2013
“Code Red and Blue — Safely Limiting
Health Care’s GDP Footprint”
Arnold Milstein, M.D., M.P.H.
…U.S. health care needs to adopt new work
methods, outlined in the Institute of Medicine’s
vision for a learning health system…
Inspiration
• I believe that people are
naturally drawn to visionary that
stimulate imagination
• LHS = the “Big Idea” we have
needed for a long time
5
LHS Themes
• Learn from every patient!
• A system problem needs a system
solution!
• 17 years to 17 months to 17 weeks
to 17 days (to 17 hours)!
6
The Actual Idea: What is an LHS?
Three Views:
• Checklist
• Macro view from earth orbit
• Micro view from the ground
7
Checklist View: Properties of a
Health System That Can Learn
Every consenting patient’s characteristics
and experience are available to learn from
Best practice knowledge is immediately
available to support decisions
Improvement is continuous through ongoing
study
An infrastructure enables this to happen
routinely and with economy of scale
All of this is part of the culture 8
9
9
View from Earth Orbit: An Ultra-Large Scale
System
Patient Groups
Governance
Engagement
Data Aggregation
Analysis
Dissemination
Insurers
Pharma
Universities
Government/Public
Health
Healthcare
Delivery
Networks
Research
Institutes
Tech Industry
All-Inclusive Decentralized ReciprocalTrusted
View from the Ground
How Learning Happens : “Virtuous
Cycles” of Study and Change
10
Assemble
Experience Data
Take
Action
Interpret
Results
Analyze
Data
Tailored Messages
to Decision-Makers
A Problem of
Interest
Decision to Study
Example of A Virtuous Learning Cycle
11
Assemble Data:
How do we prevent
falls?
What is the fall rate?
Take Action: Change
Current Practice:
In whole or part…
Interpret Results:
Are the results credible?
What advice should be given?
Analyze Data:
What practices
associate with
lower fall
rates?
Tailored Messages:
Based on your current
practice, you might
want to consider…
Decision to study falls
Assemble Data:
How do we prevent
falls?
What is the fall rate?
Reducing Falls
in Nursing
Homes
The LHS and Big Data
• The LHS is bigger than Big Data
• Better health = BD2K + K2P
12
A Problem of
Interest
BD2K K2P
Better Health Requires This
13
Assemble
Relevant Data
Take Action to Change
Practice
Interpret
Results
Analyze
Data
Deliver Tailored
Message
A Problem of
Interest
Decision to Study
Not This
14
Assemble
Relevant Data
Take Action to Change
Practice
Interpret
Results
Analyze
Data
Deliver Tailored
Message
A Problem of
Interest
Decision to Study
Journals?
Learning at Scale Requires an
Infrastructure/Platform
15
Different
Problems
Rapid Cycle
Slower Cycle
SUPPORTING PLATFORM
People
ProcessTechnology
Policy
(At Least) Two Questions for
Discussion
1. How do we educate the workforce of the future
to serve the needs of the member organizations
of the Alliance for Continuing Education in the
Health Professions in a Learning Health System?
2. What are opportunities for synergies and
collaboration?
Thanks and Write to Us…
• Charles Friedman
– cpfried@umich.edu
• Joshua Rubin
– rubinjc@umich.edu
www.LearningHealth.orghttp://lhs.medicine.umich.edu
Realizing a Learning Health System:
A Vision for Education to Transform
the Future of Health
Charles Friedman
Joshua Rubin
Thank You!
Disclosure
Chuck and Josh are wearing two hats today:
1) University of Michigan
2) Learning Health Community
We will try to be a clear as possible as to
when we are wearing each one.
The Learning Health System
Health systems--at any level of scale--become
learning systems when they can, continuously
and routinely, study and improve themselves
Perspective: Jan 3, 2013
“Code Red and Blue — Safely Limiting
Health Care’s GDP Footprint”
Arnold Milstein, M.D., M.P.H.
…U.S. health care needs to adopt new work
methods, outlined in the Institute of Medicine’s
vision for a learning health system…
17 years to 17 months to
17 weeks to 17 days…!
Realizing a Learning Health System: A Vision for Education to Transform the Future of Health
www.LearningHealth.org
Checklist View: Properties of a
Health System That Can Learn
Every consenting patient’s characteristics
and experience are available to learn from
Best practice knowledge is immediately
available to support decisions
Improvement is continuous through ongoing
study
This happens routinely, economically and
almost invisibly
All of this is part of the culture
Learning Systems Can Exist at Any
Level of Scale
25
Mono-organizational, inter-organizational,
state/regional, national, global…
View from the Ground
How Learning Happens: “Virtuous
Cycles” of Study and Change
Assemble
Experience Data
Take
Action
Interpret
Results
Analyze
Data
Tailored Messages
to Decision-Makers
A Problem of
Interest
Decision to Study
The LHS Must Do This
Assemble
Relevant Data
Take Action to
Change Practice
Interpret
Results
Analyze
Data
Deliver Tailored
Message
A Problem of
Interest
Decision to Study
Not This
Assemble
Relevant Data
Take Action to
Change Practice
Interpret
Results
Analyze
Data
Deliver Tailored
Message
A Problem of
Interest
Decision to Study
Journals?
The LHS Infrastructure
Challenge
We have:
Problem 1
Problem 3
Problem 2
• A set of learning
loops, each
addressing a
different problem.
• An efficient large
scale system:
But we need:
The Scale of the System = The Scope
of the Platform
Inter-organizational Data Federations
and Networks: They Need a Platform
31
So What’s in a Complete Platform?
Mechanisms for
managing
communities of
interest
New Science?
• National workshop explored the
research challenges inherent in
realizing a high functioning LHS
• April, 2013: 45 invited attendees
• At the end, it was suggested that
these challenges may equate to a
new science
New International Journal
LHS Journal
• Editorial office in Ann Arbor
• Three Associate Editors
– Brendan Delaney
– Jonathan Silverstein
– Kevin Sullivan
• 46-member Editorial Board
(nine countries)
• Article types
– Research reports
– Experience reports
– Briefs
– Commentaries
Envisioning (and Democratizing)
the Future…
•50X
•73 Days
A Department of Learning Health
Sciences at the U of Michigan
• Research: Generate and communicate
new knowledge that advances the
sciences of learning applied to health
– New academic journal
• Service: Promote learning and learning
systems at all levels of scale
• Education: Prepare a next generation of
learning scientists; fold learning science
into health professional curricula
– New graduate degree program: Health
Infrastructures and Learning Systems
Educating a Cohort of “Health
Infrastructuralists” to Transform Health
The Workforce to Drive the Future of
Health, Enthusiastically Recommended
“The proposed PhD in HILS program couples data
science with myriad other key disciplines spanning
the social, computational, and biomedical sciences.
Some are well established, and others are
themselves emerging. Together, training in these
disciplines and the continued development of a new
science at their intersection holds the potential to
capture, harness, and unleash the power of this
data – and to optimally utilize the knowledge
generated from it. I wholeheartedly endorse this
program, and look forward to collaboration
opportunities in the future.”
HILS Curriculum
Alignment with the QIE Roadmap
(At Least) Two Questions for
Discussion
1. How do we educate the workforce of the future
to serve the needs of the member organizations
of the Alliance for Continuing Education in the
Health Professions in a Learning Health System?
2. What are opportunities for synergies and
collaboration?
www.LearningHealth.org
www.LearningHealth.org
https://lillypad.lilly.com/entry.php?e=8284
www.LearningHealth.org
103 Endorsements of the LHS Core Values*
(As of 5/9/2016)
The Center for Learning Health Care
Siemens Health Services
GE Healthcare IT
*To be included on the www.LearningHealth.org website.
SecureHealthHub, LLC
Department of Primary Care
and Public Health
Program in Health
Informatics, SONHP
Veterans Health Administration
Office of Informatics & Analytics
Division of Health and
Social Care Research
“Learning How to Learn”
A Learning Health System (LHS)…
A System of Health Learners…
• Every Human Health Experience…
• Every Decision Affecting Health…
• Every Person…
Two Questions to Consider*
1. What can a LHS
do for me?
2. What can I do
for a LHS?
*In your role as a health professional, as a
patient/caregiver, as a citizen, and in other roles.
Thanks and Write to Us…
• Charles Friedman
– cpfried@umich.edu
• Joshua Rubin
– rubinjc@umich.edu
www.LearningHealth.orghttp://lhs.medicine.umich.edu

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Realizing a Learning Health System: A Vision for Education to Transform the Future of Health

  • 1. Realizing a Learning Health System: A Vision for Education to Transform the Future of Health Charles Friedman Joshua Rubin
  • 3. Disclosure Chuck and Josh are wearing two hats today: 1) University of Michigan 2) Learning Health Community We will try to be a clear as possible as to when we are wearing each one.
  • 4. The Learning Health System 4 Health systems--at any level of scale--become learning systems when they can, continuously and routinely, study and improve themselves Perspective: Jan 3, 2013 “Code Red and Blue — Safely Limiting Health Care’s GDP Footprint” Arnold Milstein, M.D., M.P.H. …U.S. health care needs to adopt new work methods, outlined in the Institute of Medicine’s vision for a learning health system…
  • 5. Inspiration • I believe that people are naturally drawn to visionary that stimulate imagination • LHS = the “Big Idea” we have needed for a long time 5
  • 6. LHS Themes • Learn from every patient! • A system problem needs a system solution! • 17 years to 17 months to 17 weeks to 17 days (to 17 hours)! 6
  • 7. The Actual Idea: What is an LHS? Three Views: • Checklist • Macro view from earth orbit • Micro view from the ground 7
  • 8. Checklist View: Properties of a Health System That Can Learn Every consenting patient’s characteristics and experience are available to learn from Best practice knowledge is immediately available to support decisions Improvement is continuous through ongoing study An infrastructure enables this to happen routinely and with economy of scale All of this is part of the culture 8
  • 9. 9 9 View from Earth Orbit: An Ultra-Large Scale System Patient Groups Governance Engagement Data Aggregation Analysis Dissemination Insurers Pharma Universities Government/Public Health Healthcare Delivery Networks Research Institutes Tech Industry All-Inclusive Decentralized ReciprocalTrusted
  • 10. View from the Ground How Learning Happens : “Virtuous Cycles” of Study and Change 10 Assemble Experience Data Take Action Interpret Results Analyze Data Tailored Messages to Decision-Makers A Problem of Interest Decision to Study
  • 11. Example of A Virtuous Learning Cycle 11 Assemble Data: How do we prevent falls? What is the fall rate? Take Action: Change Current Practice: In whole or part… Interpret Results: Are the results credible? What advice should be given? Analyze Data: What practices associate with lower fall rates? Tailored Messages: Based on your current practice, you might want to consider… Decision to study falls Assemble Data: How do we prevent falls? What is the fall rate? Reducing Falls in Nursing Homes
  • 12. The LHS and Big Data • The LHS is bigger than Big Data • Better health = BD2K + K2P 12 A Problem of Interest BD2K K2P
  • 13. Better Health Requires This 13 Assemble Relevant Data Take Action to Change Practice Interpret Results Analyze Data Deliver Tailored Message A Problem of Interest Decision to Study
  • 14. Not This 14 Assemble Relevant Data Take Action to Change Practice Interpret Results Analyze Data Deliver Tailored Message A Problem of Interest Decision to Study Journals?
  • 15. Learning at Scale Requires an Infrastructure/Platform 15 Different Problems Rapid Cycle Slower Cycle SUPPORTING PLATFORM People ProcessTechnology Policy
  • 16. (At Least) Two Questions for Discussion 1. How do we educate the workforce of the future to serve the needs of the member organizations of the Alliance for Continuing Education in the Health Professions in a Learning Health System? 2. What are opportunities for synergies and collaboration?
  • 17. Thanks and Write to Us… • Charles Friedman – cpfried@umich.edu • Joshua Rubin – rubinjc@umich.edu www.LearningHealth.orghttp://lhs.medicine.umich.edu
  • 18. Realizing a Learning Health System: A Vision for Education to Transform the Future of Health Charles Friedman Joshua Rubin
  • 20. Disclosure Chuck and Josh are wearing two hats today: 1) University of Michigan 2) Learning Health Community We will try to be a clear as possible as to when we are wearing each one.
  • 21. The Learning Health System Health systems--at any level of scale--become learning systems when they can, continuously and routinely, study and improve themselves Perspective: Jan 3, 2013 “Code Red and Blue — Safely Limiting Health Care’s GDP Footprint” Arnold Milstein, M.D., M.P.H. …U.S. health care needs to adopt new work methods, outlined in the Institute of Medicine’s vision for a learning health system… 17 years to 17 months to 17 weeks to 17 days…!
  • 24. Checklist View: Properties of a Health System That Can Learn Every consenting patient’s characteristics and experience are available to learn from Best practice knowledge is immediately available to support decisions Improvement is continuous through ongoing study This happens routinely, economically and almost invisibly All of this is part of the culture
  • 25. Learning Systems Can Exist at Any Level of Scale 25 Mono-organizational, inter-organizational, state/regional, national, global…
  • 26. View from the Ground How Learning Happens: “Virtuous Cycles” of Study and Change Assemble Experience Data Take Action Interpret Results Analyze Data Tailored Messages to Decision-Makers A Problem of Interest Decision to Study
  • 27. The LHS Must Do This Assemble Relevant Data Take Action to Change Practice Interpret Results Analyze Data Deliver Tailored Message A Problem of Interest Decision to Study
  • 28. Not This Assemble Relevant Data Take Action to Change Practice Interpret Results Analyze Data Deliver Tailored Message A Problem of Interest Decision to Study Journals?
  • 29. The LHS Infrastructure Challenge We have: Problem 1 Problem 3 Problem 2 • A set of learning loops, each addressing a different problem. • An efficient large scale system: But we need:
  • 30. The Scale of the System = The Scope of the Platform
  • 31. Inter-organizational Data Federations and Networks: They Need a Platform 31
  • 32. So What’s in a Complete Platform? Mechanisms for managing communities of interest
  • 33. New Science? • National workshop explored the research challenges inherent in realizing a high functioning LHS • April, 2013: 45 invited attendees • At the end, it was suggested that these challenges may equate to a new science
  • 35. LHS Journal • Editorial office in Ann Arbor • Three Associate Editors – Brendan Delaney – Jonathan Silverstein – Kevin Sullivan • 46-member Editorial Board (nine countries) • Article types – Research reports – Experience reports – Briefs – Commentaries
  • 36. Envisioning (and Democratizing) the Future… •50X •73 Days
  • 37. A Department of Learning Health Sciences at the U of Michigan • Research: Generate and communicate new knowledge that advances the sciences of learning applied to health – New academic journal • Service: Promote learning and learning systems at all levels of scale • Education: Prepare a next generation of learning scientists; fold learning science into health professional curricula – New graduate degree program: Health Infrastructures and Learning Systems
  • 38. Educating a Cohort of “Health Infrastructuralists” to Transform Health
  • 39. The Workforce to Drive the Future of Health, Enthusiastically Recommended “The proposed PhD in HILS program couples data science with myriad other key disciplines spanning the social, computational, and biomedical sciences. Some are well established, and others are themselves emerging. Together, training in these disciplines and the continued development of a new science at their intersection holds the potential to capture, harness, and unleash the power of this data – and to optimally utilize the knowledge generated from it. I wholeheartedly endorse this program, and look forward to collaboration opportunities in the future.”
  • 41. Alignment with the QIE Roadmap
  • 42. (At Least) Two Questions for Discussion 1. How do we educate the workforce of the future to serve the needs of the member organizations of the Alliance for Continuing Education in the Health Professions in a Learning Health System? 2. What are opportunities for synergies and collaboration?
  • 46. 103 Endorsements of the LHS Core Values* (As of 5/9/2016) The Center for Learning Health Care Siemens Health Services GE Healthcare IT *To be included on the www.LearningHealth.org website. SecureHealthHub, LLC Department of Primary Care and Public Health Program in Health Informatics, SONHP Veterans Health Administration Office of Informatics & Analytics Division of Health and Social Care Research
  • 47. “Learning How to Learn” A Learning Health System (LHS)… A System of Health Learners… • Every Human Health Experience… • Every Decision Affecting Health… • Every Person…
  • 48. Two Questions to Consider* 1. What can a LHS do for me? 2. What can I do for a LHS? *In your role as a health professional, as a patient/caregiver, as a citizen, and in other roles.
  • 49. Thanks and Write to Us… • Charles Friedman – cpfried@umich.edu • Joshua Rubin – rubinjc@umich.edu www.LearningHealth.orghttp://lhs.medicine.umich.edu