Against this backdrop of opportunity and urgency, the Institute of Medicine (IOM) of the National Academies, sponsored by the Office of the National Coordinator for Health Information Technology (ONC), convened a series of expert meetings to explore strategies for accelerating the development of the digital infrastructure for the learning health system. Presentations and major elements of those discussions are summarized in this publication, Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care.
In 2001, the IOM report Crossing the Quality Chasm called national attention to untenable deficiencies in health care, noting that every patient should expect care that is safe, effective, patient-centered, timely, efficient, and equitable (IOM, 2001). Based on the determination that health care is a complex adaptive system—one in which progress on its central purpose is shaped by tenets that are few, simple, and basic—the report identified several rules to guide health care. In particular, these rules underscore the importance of issues related to the locus of decisions, patient perspectives, evidence, transparency, and waste reduction. The report envisioned, in effect, engaging patients, providers, and policy makers alike to ensure that every healthcare decision is guided by timely, accurate, and comprehensive health information provided in real time to ensure constantly improving delivery of the right care to the right person for the right price.
The release of the IOM Chasm report stimulated broad activities related to clinical quality improvement and the effectiveness of health care, including the eventual creation by the IOM of the Roundtable on Value & Science-Driven Health Care. Begun in 2006 as the IOM Roundtable on Evidence-Based Medicine, it has explored ways to improve the evidence base for medical decisions and sought the development of a learning health system “designed to generate and apply the best evidence for collaborative health choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.” From its inception, the Roundtable has conducted The Learning Health System Series of public meetings to consider the capture of emerging innovations—such as those occurring in IT, research methods, and care delivery—as building blocks in the foundation of a learning health system. Characteristics of such a system are noted in Box S-1 and in matrix form in Appendix A. In broad terms, they represent delivery of best practice guidance at the point of choice, continuous learning and feedback in both health and health care, and seamless, ongoing communication among participants, all facilitated through the application of IT.