UPMC Conference on Accelerating Stakeholder-Driven PCOR/CER in a Learning Health System

Why Health Systems Must Learn How to Learn

In order to provide the best quality health care to patients, health systems need to incorporate evidence-based practices into their daily processes. And to do that successfully, they must learn.

The health care industry is buzzing with transformational initiatives focused on creating more patient-centric, value-based care. The goal of this wave of innovation is to improve patients’ experiences and achieve better health outcomes while making the health care system as a whole more efficient and financially sustainable. But these types of system-level improvements will be impossible to achieve if medical knowledge continues to be “lost in translation” from research to practice and the patient experience. According to the Institute of Medicine, the failure of today’s health care system to systematically incorporate insights, evidence, and data into routine service delivery creates missed opportunities for better care, wasted time and treatments, and the potential to do more harm than good (Figure 1).

Health care cost conversations are often focused on rising health plan premiums, skyrocketing drug prices, or other types of out-of-pocket costs consumers pay for health care services. But there is another type of cost conversation that needs to be had. There is a huge cost to the amount of time, roughly 17 years, that it takes for research conclusions to be translated into every day care delivery. This wasted time all but guarantees that there are missed opportunities to create and deliver more safe, effective, tailored treatments and interventions that could improve patient outcomes and improve overall quality-of-life.

So if accelerating the process from research to care practice is essential, how might health systems rethink their operations so that stakeholders can systematically use all available insights, data, and evidence to provide high-quality, safe, and effective care? The answer is ….

Figure 1

Figure 1: Where knowledge is lost in the transformation from research to the patient experience. Institute of Medicine of the National Academies. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. In: America CotLHCSi, ed. Washington, D.C.: The National Academies Press; 2012.

Building a learning health system

The concept of a learning health system was introduced by the Institute of Medicine in 2007. The idea is to integrate all available internal data and experience with external evidence and put that knowledge into practice. This cycle is continuous, creating a health system that is constantly evaluating its practices and proactively addressing stakeholder needs based on data collected throughout the patient care journey, including EHRs, claims, labs, and, perhaps most importantly, patient-reported outcomes.

In a learning health system, leadership creates a culture of learning, where all available data is leveraged effectively, stakeholders are actively engaged, and business incentives are aligned. The combination of these characteristics results in the ability to accelerate the time from research to practice, rapidly scale promising interventions, and improve care value.

Why create a learning health system now?

Recently, the learning health system approach is garnering increased attention among health care organizations. Key macro-trends driving the importance of learning health systems include:

  • Patient engagement: More than ever, patients want to be informed of their treatment options and engaged in care decisions with their doctors. They are interested in learning not just how to manage their current conditions, but how to stay healthy and avoid disruptive health events, such as emergencies and surgeries. When faced with such an event, patients want treatments that are best suited for their individual circumstances. In a learning health system, it is possible to generate patient-by-patient insights for tailored treatment plans.
  • Data-driving health systems: Health systems have been collecting data relevant to patient care and the patient experience for years but advances in analytics and other technologies now allow for the transformation of that data into insights that can optimize a health system’s performance and better tailor interventions and treatments to meet patient’s where they are in their health journey.
  • Provider experience and support: Licensed health care practitioners, from primary care physicians to nurses and behavioral health specialists, have a wealth of knowledge and expertise from their years practicing medicine. But everyone needs a little help from time to time, and the data, insights, and evidence-based guidelines developed by data-driven health systems can now provide the clinical decision support needed to ensure the care delivered to a patient is holistic and reflective of their individual values and health circumstances.

Each health care organization will approach building a learning health system in the way that aligns with the priorities of its stakeholders and makes the most sense for its day-to-day circumstances. From any perspective, now is the time to act to improve experiences for patients and providers alike. Driven by the pursuit of more value-based, patient-centered care, the only thing left to do is to get started.

To learn more about building a learning health system, join the UPMC Center for High-Value Health Care and the Wolff Center at UPMC for a day-long conference on May 7, 2019, to discuss accelerating stakeholder-driven research in a learning health system. Learn more and register here.