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A
The Learning Health System and
the Digital Health Utility
251
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Foundational Elements
252
Learning Health System Characteristics
Data utility: data stewarded and Digital technology: the Trust fabric: strong, protected,Leadership: multi-
used for the common good engine for continuous and actively nurtured focal, networked,
improvement and dynamic
Care: starting with the best practice, Health information: Outcomes and costs: transparent Knowledge:
every time a reliable, secure, and and constantly assessed ongoing, seamless
reusable resource product of services
and research
Culture: participatory, team-based, transparent, Design and processes: Patients and public: fully and Decisions:
improving patient-anchored and tested actively engaged informed,
facilitated, shared,
and coordinated
Meaningful Use Requirementsa
Core structured personal data (age, sex, Core list of active problems Core structured Clinical decision Care coordination
ethnicity) clinical data support support/
(VS, meds, interoperability
[labs])
Outpatient medicines electronically Automated medication safeguard/ Visit-specific Automated patient e-Record patient
prescribed econciliation information reminders access (copy or
to patients patient portal)
Embedded clinical quality measures Security safeguards [Condition- [Public health [Advance
specific data reporting directives for
retrieval (reportable ages >65]
capacity] conditions)]
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Next-Generation Digital Infrastructure
LHS Digital Health Utility Strategy Elements Stakeholder
Next generation requirements Activities that advance: Responsibilitiesb
Technical Ultra-large-scale system perspective Ultra-large-scale system ONC works with NIST, other
Progress Distributed, local data maintenance perspective agencies and IT community to
Virtual interoperability Functionality focus advance interoperability and
Reliable use and system security System specifications/ security protocols
protocols interoperability NSF works with ONC/NIH on test
Standards vehicles for setting/ Workflow and usability beds for digital infrastructure
revising, metadata, vocabulary, Security and privacy safeguards component technologies
data transport, common core System innovation including ULS system approach
datasets, sentinel indicators, access Interoperability agreements
authorization/authentication, data among delivery systems utilizing
quality review protocols EHRs
CMS develops test beds for digital
infrastructure application in
care coordination/delivery
model innovation
Knowledge Core clinical data elements available Shared learning environment NIH, NSF, AHRQ, and FDA work
Generation/Use for quality improvement and Point of decision support and on innovative approaches to
research guidance research insights from clinical
Channels and protocols for integrating Research-ready records for data data
clinical and public health data reuse CDC develops templates/protocols
Capacity and protocols for query- Patient-generated data for integrating population and
driven data use in quality and Integration/use of data across clinical data
research and monitoring of sentinel sources Healthcare organizations form
indicators Distributed data repositories research collaboratives
Novel statistical and database tools for Sentinel indicators
reliable new insights Query capacity
Analytical tools and methods
innovation
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continued
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Patient/Population
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Engagement “New norm” for patient involvement Value proposition and patient AHRQ, FDA, NIH, and ONC use
Facilitated personal record interface confidence established links with patient
Clinician–patient electronic Shared learning culture community to foster active
partnership Patient–clinician outcome embracing of the digital health
Patient information access/control partnerships utility
Updated best practices delivered at Person-centric, lay-oriented Patient and clinician groups
point of decision health information mediate public engagement
Active patient support for data use in Closing the disparity gap and facilitate dialogue among
care improvement Continuous evaluation stakeholders to develop shared
Clinician–public health e-partnership learning culture/trust
Governance Progressively evolving requirements, The vision ONC works with other agencies,
specifications, process protocols Guiding principles the HIT community, and
for exchange, interoperability, and Participant roles and patient/clinician groups to foster
research responsibilities development of a governance
Cross-national harmonization to foster Process and protocol mechanism that encourages
the global e-health utility stewardship dynamic entrepreneurial growth
Broad ongoing evaluation capacity Implementation phasing while safeguarding personal
Continuous evaluation security and the common good
a Optional elements denoted with [ ]. See Appendix B for details.
b Sample list, neither definitive nor complete. See page xxiii for list of acronyms.
