. "Appendix A Workshop Agenda." The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine). Washington, DC: The National Academies Press, 2007.
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The Learning Healthcare System: Workshop Summary
Appendix A
Workshop Agenda
THE LEARNING HEALTHCARE SYSTEM
A WORKSHOP OF THE IOM ROUNDTABLE ON EVIDENCE-BASED MEDICINE
THE KECK CENTER OF THE NATIONAL ACADEMIES
WASHINGTON, DC 20001
JULY20-21, 2006
MEETING AGENDA
OBJECTIVE: To characterize the key features of the Learning Healthcare System, to identify the most important hindrances to its evolution, and to posit some remedies.
DAY 1: THE LEARNING HEALTHCARE SYSTEM
8:30
WELCOME ANDOPENINGREMARKS
Harvey Fineberg, Institute of Medicine
Darrell Kirch, Association of American Medical Colleges
What would be the features of a healthcare system designed not to learn—how might it be corrected?
9:00
SESSION1: HINTS OF ADIFFERENTWAY—LEARNING FROMEXPERIENCECASESTUDIES INPRACTICE-BASEDEVIDENCEDEVELOPMENT
CHAIR: Carolyn Clancy, Agency for Healthcare Research andQuality (AHRQ) and EBM Roundtable Member
What “best practices” might be spotlighted to illustrate ways to use the health care experience as a practical means of both generating and applying evidence for health care? Are there lessons from certain examples that can help identify the most promising approaches?
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The Learning Healthcare System: Workshop Summary
Appendix A
Workshop Agenda
THE LEARNING HEALTHCARE SYSTEM
A WORKSHOP OF THE IOM ROUNDTABLE ON EVIDENCE-BASED MEDICINE
THE KECK CENTER OF THE NATIONAL ACADEMIES
WASHINGTON, DC 20001
JULY 20-21, 2006
MEETING AGENDA
OBJECTIVE: To characterize the key features of the Learning Healthcare System, to identify the most important hindrances to its evolution, and to posit some remedies.
DAY 1: THE LEARNING HEALTHCARE SYSTEM
8:30
WELCOME AND OPENING REMARKS
Harvey Fineberg, Institute of Medicine
Darrell Kirch, Association of American Medical Colleges
What would be the features of a healthcare system designed not to learn—how might it be corrected?
9:00
SESSION 1: HINTS OF A DIFFERENT WAY—LEARNING FROM EXPERIENCE CASE STUDIES IN PRACTICE-BASED EVIDENCE DEVELOPMENT
CHAIR: Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ) and EBM Roundtable Member
What “best practices” might be spotlighted to illustrate ways to use the health care experience as a practical means of both generating and applying evidence for health care? Are there lessons from certain examples that can help identify the most promising approaches?
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The Learning Healthcare System: Workshop Summary
15-minute presentations followed by discussion session
Peter Bach, Centers for Medicare & Medicaid Services (CMS)
Coverage with evidence development: Lung volume reduction surgery
Jed Weissberg, Permanente Federation
Use of large system databases: Cyclooxygenase-2 (COX-2) inhibitors
Stephen Soumerai, Harvard Pilgrim Health Care
Potential of quasi-experimental designs for evaluating health policy
Sean Tunis, Health Technology Center
Practical clinical trials
Alan Morris, Latter Day Saints Hospital and University of Utah
Computerized protocols to assist clinical research*
10:30
SESSION 2: THE EVOLVING EVIDENCE BASE—METHODOLOGIC AND POLICY CHALLENGES
CHAIR: Don Steinwachs, Johns Hopkins University and EBM Roundtable Member
What challenges confront methodologically rigorous learning from experience? How can alternatives to randomized controlled trials (RCTs) and innovative approaches to generating evidence be used to confront emerging challenges: broader post-marketing surveillance; linking Phase III and coverage requirements; increasingly complex patterns of comorbidity; subgroup analysis, and heterogeneity in treatment outcomes? How might learning that is more nimble also foster innovation and discovery?
15-minute presentations followed by discussion session
Robert Califf, Duke Clinical Research Institute
Alternatives to large RCTs
David Goldstein, Duke Institute for Genome Sciences and Policy
Engaging the implications of subgroup heterogeneity— prospects for pharmacogenetics
Harlan Weisman, Johnson & Johnson
Broader post-marketing surveillance for insights on risk and effectiveness
Telba Irony, Food and Drug Administration (FDA)
Evaluating interventions in a rapid state of flux
David Eddy, Archimedes Inc.
Mathematical models to fill the gaps in evidence*
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Sheldon Greenfield, University of California at Irvine
Heterogeneity of treatment effects: subgroup analysis*
Steve Teutsch, Merck & Co. Inc.
Adjusting evidence generation to the scale of effects*
Janlori Goldman, Health Privacy Project
Protecting privacy while linking patient records*
12:00
Lunch
1:00
SESSION 3: NARROWING THE RESEARCH-PRACTICE DIVIDE—SYSTEM CONSIDERATIONS
CHAIR: Cato Laurencin, University of Virginia and EBM Roundtable Member
What system changes are needed for the healthcare delivery environment to facilitate the generation and application of better evidence? What are the needs and implications for structuring “built-in” study designs, managing the data burden, and defining appropriate levels of evidence needed? What is needed to turn clinical data into an “epidemiologic utility,” a public good?
15-minute presentations followed by discussion session
Brent James, Intermountain Healthcare
Feedback loops to expedite study timeliness and relevance
Walter Stewart, Geisinger Health System
Clinical data system structure and management for better learning
Steven Pearson, America’s Health Insurance Plans
Implications for standards of evidence
Robert Galvin, General Electric
Implications for innovation acceleration
2:30
SESSION 4: PANEL DISCUSSION—KEY BARRIERS AND PRIORITIES FOR ACTION
CHAIR: Denis Cortese, Mayo Clinic and EBM Roundtable Member
Members of the Roundtable on Evidence-Based Medicine
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DAY 2: ACCELERATING THE PROGRESS
8:30
OPENING REMARKS
Denis Cortese, Mayo Clinic and EBM Roundtable Chair
What are some of the key challenges and opportunities if the development of a sustainable capacity for real-time learning is to be accelerated?
9:00
SESSION 5: HINTS OF A DIFFERENT WAY—LEARNING SYSTEMS IN PROGRESS
CHAIR: Jonathan Perlin, Department of Veterans Affairs and EBM Roundtable Member
What experiences of healthcare systems highlight the opportunities and challenges in integrating the generation and application of evidence for improved care? What’s needed to take to scale?
15-minute presentations followed by discussion session
Joel Kupersmith, Veterans Health Administration
Implementation of evidence-based practice in the Veterans Administration
George Isham, HealthPartners
AQA (Ambulatory Care Quality Alliance)
Robert Phillips, Robert Graham Center
Practice-Based Research Networks
Lynn Etheredge, George Washington University
A rapid learning health system
10:30
SESSION 6: DEVELOPING THE TEST BED: LINKING INTEGRATED DELIVERY SYSTEMS
CHAIR: Helen Darling, National Business Group on Health and EBM Roundtable Member
How can integrated healthcare delivery systems be better engaged for structured real-time learning? How can the organizational, logistical, data system, reimbursement and regulatory issues be addressed?
15-minute presentations followed by discussion session
Stephen Katz, National Institutes of Health (NIH)
NIH Roadmap initiatives use of integrated delivery systems
Cynthia Palmer, Agency for Healthcare Research and Quality
Turning research to ACTION through delivery systems
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Eric Larson, Group Health Cooperative
Health Maintenance Organization Research Network (HMORN)
Michael Mustille, Permanente Federation
Council of Accountable Physician Practices
12:00
LUNCH
12:30
SESSION 7: THE PATIENT AS A CATALYST FOR CHANGE
CHAIR: Andrew Stern, Service Employees International Union and EBM Roundtable Member
What is the changing role of the patient in an age of the Internet and the personal health record? Reengineering a system focused on patient needs and built around best care requires improved communication of evidence. How does patient preference fit into evidence development?
15-minute presentations followed by discussion session
Janet Marchibroda, eHealth Initiative
The Internet, eHealth, and patient empowerment
Andrew Barbash, Apractis Solutions
Joint patient-provider management of the electronic health record (EHR)
James Weinstein, Dartmouth-Hitchcock Medical Center
Evidence and shared decision making
1:35
SESSION 8: TRAINING THE LEARNING HEALTH PROFESSIONAL
CHAIR: Nancy Nielsen, American Medical Association and EBM Roundtable Member
What are the educational needs for the health professional in the Learning Healthcare System? How must qualification exams and continuing education be adjusted? What approaches can bring the processes of learning and application into seamless alignment?
15-minute presentations followed by discussion session
Mary Mundinger, Columbia University School of Nursing
Health professions education and teaching about evidence
William Stead, Vanderbilt University
Providers and the electronic health record as a learning tool
Mark Williams, Emory University School of Medicine
Redefining continuing education around evolving evidence
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2:40
SESSION 9: STRUCTURING THE INCENTIVES FOR CHANGE
CHAIR: John Rother, AARP and EBM Roundtable Member
What policies can provide the incentives for the developments necessary to build learning—evidence development and application—into every healthcare encounter?
15-minute presentations followed by discussion session
Alan Rosenberg, WellPoint
Opportunities for private insurers
Steve Phurrough, Centers for Medicare and Medicaid Services
Opportunities for CMS
Wayne Rosencrans, Jr., AstraZeneca
Opportunities for manufacturers
Margaret O’Kane, National Care Quality Alliance
Opportunities for standards organizations
4:00
CONCLUDING SUMMARY REMARKS
Denis Cortese, Mayo Clinic and EBM Roundtable Chair J. Michael McGinnis, Institute of Medicine
4:30
ADJOURN
*Presentation included in workshop materials, but not delivered.
