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
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
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
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.”
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