Learning Health Systems

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OSU Medical Center CEO Steven Gabbe, MD delivers a talk on facilitating learning healthcare systems: Focus on approaches to leverage Health IT investments for advancements in research and personalized healthcare and learning from every patient.

This session will focus on the usages of HIT to learn from every patient so that this knowledge can be used to further the practice of medicine. The discussion will address the implications for research, privacy, and HIT to change the paradigm of advancing healthcare discoveries so that it is a continuous process driven through every patient interaction.

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  • .
  • The United States has the highest health expenditures per capita—twice the per capita average for other developed countries—yet consistently rates poorly (currently 37th) on overall health system performance and on key component measures such as infant mortality (39th) and life expectancy (36th). Advances in biological research, clinical medicine, IT and operations research provide powerful tools for health system improvement—potentially transformative if applied in a manner that promotes the mutually dependent aims of science, value and patient-centered care.  integral links among the three key aims of care delivered—science-driven, patient-centered, and value-enhancing; and identify priorities, policy levers and public engagement strategies necessary for advancement. 
  • What does accountable care look like?
  • Becoming an accountable care organization-- foundation of your heath or ACO is p4 medicine
  • What is the value of healthcare?Outcome measurement is the single most important tool to drive innovation in health care delivery
  • Fundamental need for data driven decision making and performance management to meet P4 and value needsDelivering P4 medicine to a patient today means delivering the right care at the right time and in the right place. In order transform the entire health care delivery system, we must capture the results of this care and then be able to study them for continued improvement in a real time setting. That is where a Learning Health Care System is imperative. And, it not only advances clinical care but also advances scientific discovery
  • Feedback Loop
  • Meeting these objectives requires biomedical informactics. Biomedical informatics is the study and process of efficiently gathering, storing, managing, retrieving, analyzing,communicating, sharing and applying biomedical information to improve the detection, prevention, and treatment of disease
  • Biomedical informatics allows us to put data to use
  • When we look back at P4 medicine, Biomedical Informatics plays a huge role in making this type of approach possible.
  • Applies to research and clinical delivery (examples from article)
  • http://e-patients.net/archives/2009/05/meaningful-use-a-pivotal-definition-for-new-wave-medical-records-systems.htmlIn an effort to make a LHCS a reality nationwide and to help speed up the process, the federal government is involved.Federal Stimulus ProgramThe US Federal government ratified the American Recovery and Reinvestment Act (ARRA) in 2009 and allocated roughly $20 billion to promote the adoption of Health Information Technology (HIT).The ARRA HIT stimulus program has a detailed qualification criteria to define how incentive payments are to be made to qualified doctors over the next five years beginning in 2011.
  • A nationwide network. Meaningful use of EHRs, widespread participation by multiplediverse entities, and an appropriate technical architecture can spur the construction of a highlyparticipatory rapid learning system that stretches from coast to coast. T he resulting rapid learningsystem can be used, for example, to support biomedical research and augment public health data,with the ultimate goal of improving the quality of health care.
  • We are uniquely positioned with a CCTS, CPHC, Dept of Biomedical Informatics and Center for IT Innovation in Healthcare.
  • Here at OSUMC we are implementing an electronic health recordEPIC system purchasedNecessary for success in reform environmentBest for patient – safety, quality, outcomes
  • The successful development of clinical data as an engine for real-time knowledge generation has the potential to transform health and health care in America. Nurturing clinical data as a resource for continuous learning can allow patients, health professionals, and health care researchers to have the best information on which to base care decisions, health strategies, and scientific recommendations. However, broader access to and use of health care data requires not only fostering reliable and accessible data systems, but also addressing the issues such as individual data ownership and patient and public perception of clinical data as a carefully stewarded public good.
  • Learning Health Systems

    1. 1. Bridging Health IT Innovation:Facilitating a Learning Health Care System<br />Steven Gabbe, MD CEO OSU Medical Center<br />April 18, 2011 <br />
    2. 2. The future of health care<br />The learning health care system<br />How we can bring it together to speed the delivery of better outcomes and safer care<br />Agenda<br />
    3. 3. Total healthcare spending $2.5 trillion in 2009, ~17.6% of the GDP; likely to reach $4 trillion by 2016<br />75-90% spent on managing and treating chronic illnesses that are preventable and effectively managed<br />On a per-person basis, healthcare costs 50% higher than second most costly nation<br />Drugs prescribed are effective in fewer than 60% of treated patients. Costs of development have skyrocketed<br />Health Care: The Need for Transformation<br />3<br />
    4. 4. Bridging Clinical Care, Research and Education<br />Emergence of Accountable Care Organizations<br />Growing demand for personalized medicine<br />Pay for quality/outcomes<br />Fundamental need for data-driven decision making and performance management to meet these needs<br />4<br />
    5. 5. 5<br />
    6. 6. 6<br />Predict<br />Prevent<br />Personalize<br />Participate<br />
    7. 7. Personalized Health Care is P4 Medicine<br />7<br />
    8. 8. P4 Medicine<br />8<br />
    9. 9. Value in Health Care:Outcome MeasurementDrives Innovation<br />9<br />Risk Adjusted<br />Quality<br />Safety<br />OVER TIME<br />Outcomes<br />Value =<br />Cost<br />Full cycleof care<br />Full setof outcomes<br />Porter, M.E. N Engl J Med 2010; 363:2477-81 Appendices 1 and 2<br />
    10. 10. 10<br />The Creation of a Learning Health Care System<br />The Right Care <br />at the Right Time, <br />at the Right Place <br />and then capture the results for clinical improvement<br />
    11. 11. 11<br />The Creation of a Learning Health Care System<br />Research -> Routine Practice Gap is 17 years <br />Need a more efficient, effective,safe healthcare system requiringa more rapid progression of knowledge <br />
    12. 12. Objectives of a Learning Healthcare System<br />Learn from every patient encounter<br />Improvecare patientreceives<br />Improve thecare of thepatient’scommunity<br />Improve the care of the patient’s family<br />
    13. 13. Apply Biomedical Informatics to Improve Lives Through Personalized Health Care<br />The study and process of efficiently gathering, storing, managing, retrieving, analyzing, communicating, sharing and applying biomedical information to improve the detection, prevention, and treatment of disease<br />13<br />
    14. 14. Learning Health Care System:Only Achievable with an Electronic Medical Record<br />Delivering timely and contextually appropriate data, information, and knowledge in support of basic science, clinical and translational research, clinical care, and public health.<br />
    15. 15. P4 Medicine in Biomedical Informatics<br />15<br />
    16. 16. 16<br />Institution plans a clinical trial for a new drug<br />How a Learning Health Care System Might Operate<br />Track the spread of outbreak of an infectious disease<br />Monitor new drug safety after drug is approved for routine use<br />Obtain clinical data from large group of patients taking a new drug that may reveal a modified dosage needed<br />
    17. 17. Federal Health IT Strategic Plan 2011-15<br />The Adoption and Meaningful use of EMRs<br />Medical practices that have EMRs and put them to “meaningful use” will get higher reimbursement from the government.<br />The Health Information Exchange –Develop a clear path for building a “learning health system”<br />Aggregate, analyze, and leverage health information to improve clinical knowledge transfer across populations<br />17<br />Source: Office of the National Coordinator for Health Information Technology (ONC)<br />
    18. 18. Rapid Learning Using Electronic Medical Record Databases <br />Rapidly advance the U.S. evidence base for clinical care <br />Fill major knowledge gaps<br />Health care costs <br />The benefits and risks of drugs and procedures<br />Geographic variations <br />Environmental health influences<br />Health of special populations, and personalized medicine<br />18<br />
    19. 19. Community Medical Practices<br />Health ITOrganizations<br />ResearchInstitutes & Industry<br />State Public Health Agencies<br />Achieving a Nationwide Network<br />Biomedical Research<br />Public Health<br />Health Care Quality Improvement<br />Federal Agencies<br />Beacon Communities<br />Academic HealthCenters<br />
    20. 20. 20<br />Building a Learning Health Care System<br />
    21. 21. Building Our Learning Health Care Systemat OSU Medical Center<br />21<br />Department of Biomedical Informatics<br />Center for IT Innovation in Healthcare (CITIH)<br />
    22. 22. EPIC/EHR atOSUMC Integrated Health Information System<br />Ambulatory services installed<br />Big Bang October 15, 2011<br />Provide patient information at every care site<br />Enhances quality and safety<br />OSU MyChart<br />22<br />
    23. 23. OSUCCC & caBIGLinking Science with Clinical Outcomes<br />Linking data that is stored in multiple locations<br />The primary or core development and support site for caGrid<br />Create the software and provide the expertise needed for deployment<br />Actively disseminating CaGrid to all interested NCI CCCs in USA<br />Timeline of caGrid development and deployment at OSU<br />Jan-04<br />Jan-05<br />Jan-06<br />Jan-07<br />Jan-08<br />Jan-09<br />Concept<br />12/1/03<br />BetaRelease 1.0<br />07/06<br />Release1.0<br />12/06<br />Release1.1<br />09/07<br />Release1.2<br />03/08<br />Release1.3<br />03/09<br /><ul><li>OSUCCC maintains a public training grid for use nationally & internationally</li></li></ul><li>Role of Information Technology in an Effective Learning Health Care Environment<br />Electronic medical records<br />Data warehousing, analytical tools and real time metrics<br />Making research part of the fabric of healthcare delivery<br />24<br />AND<br />Addressing data ownership issues<br />Managing public perception of data use<br />

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