The National Academies Press

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1 Introduction
Pages 53-70

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From page 53... ... Most changes will occur virtually out of sight, and the pace and profile of the transformation will be determined by stewardship that fosters alignment of technology, science, and culture in support of a continuously learning health system. In the context of growing concerns about the quality and costs of care, the nation's health and economic security are interdependently linked to the success of that stewardship. Read the entire page →
From page 54... ... The release of the IOM Chasm report stimulated broad activities related to clinical quality improvement and the effectiveness of health care, including the creation by the IOM of the Roundtable on Value & ScienceDriven Health Care. Begun in 2006 as the IOM Roundtable on EvidenceBased 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 in an effort to outline components of the conceptual foundation of the learning health system. Read the entire page →
From page 55... ... to inform and improve clinical care decisions, promote patient education and self-management, design public health strategies, and support research and knowledge development efforts in a timely manner. THE DIGITAL HEALTH INFRASTRUCTURE The digital infrastructure for the learning health system will not solely be the result of features designed and built de novo; there is a growing body of existing initiatives and resources actively in play at multiple levels. Read the entire page →
From page 56... ... . they continue to unfold, progress toward a digital health infrastructure depends on continuous improvement. Read the entire page →
From page 57... ... Care Management Resources Beyond publicly available digital resources, a vast array of specialized care management products have emerged to support a broad range of activities. A wide array of companies have emerged to support the various facets of clinical recordkeeping and information management needed to support clinical processes. Read the entire page →
From page 58... ... , Kaiser Permanente (see summary in Box 1-2, and the full written description in Appendix B) , Geisinger Health System, Vanderbilt, MD Anderson, Palo Alto Medical Foundation, Group Health Cooperative, several Harvard facilities, Children's Hospital of Philadelphia, Virginia Mason, and the Mayo Clinic, to name a few -- have invested substantially in the creation of advanced digital resources for administrative, patient care, and research functions. Read the entire page →
From page 59... ... To supplement the relatively limited pre-2009 public investments, independent sector leadership has come from foundations such as the Markle Foundation, the Robert Wood Johnson Foundation (RWJF) , and the California HealthCare Foundation (CHCF) Read the entire page →
From page 60... ... Examples from Outside Health Care The developing potential presents opportunities and challenges for stewardship. Issues related to interoperability, governance, engagement of patients and the general population, and privacy and security concerns resulting from the collection and use of health information will need to be better addressed for successful progress toward a learning health system. Read the entire page →
From page 61... ... system principles, includes applying an engineering approach to accommodate and network a wide variety of legacy nodes while allowing for continuous expansion and evolution without the use of a comprehensive internal design or rigid standardization. The Smart Grid case is summarized in Box 1-3 and the full written description is included in Appendix B Read the entire page →
From page 62... ... As conceived, the Smart Grid will • Enable active participation by consumers • Accommodate all generation and storage options • Enable new products, services, and markets • Provide power equality for the digital economy • Optimize asset utilization and operate efficiently • Anticipate and respond to system disturbances (self-heal) • Operate resiliently against attack and natural disaster Because there is no need for consensus among the nodes on how they should operate within local boundaries, the Smart Grid development methodology is not based on comprehensive internal design and operating standards for each node on the Grid to follow. Read the entire page →
From page 63... ... Several additional HHS agencies have activities important to the development of the digital infrastructure for the learning health system. CMS has had primary responsibility for establishing rules for meaningful use and requirements for uniform condition identifiers central to healthcare payment and research. Read the entire page →
From page 64... ... supports a number of programs to advance the digital utility for healthcare quality and safety. Currently these programs are focused on the areas of support for HIT program management, guidance, assessment, and planning; HIT technical assistance, content development, and program-related projects and studies; HIT dissemination, communication, and marketing; and HIT portal infrastructure management and website design and usability Read the entire page →
From page 65... ... A smaller working pilot of the Sentinel system has been developed, under contract from the FDA, by Harvard Pilgrim Health Care to test epidemiological and statistical methodologies on distributed data sources. As the federal focal point for programs in public health, the Centers for Disease Control and Prevention have supported several major HITanchored programs including the surveillance programs BioSense, EPI-X, and the National Healthcare Safety Network. Read the entire page →
From page 66... ... Additionally, the DOD and VHA are working together to create a Virtual Lifetime Electronic Record to allow for seamless availability of healthcare, benefits, and services information for service members from enlistment to death. Additional efforts include defining a plan for HIT in the Federal Communications Commission's National Broadband Plan, and Read the entire page →
From page 67... ... It sets out a series of recommendations intended to facilitate private, entrepreneurial initiatives through governmental action to speed development of a "universal exchange language" for health information, the application of which would maximize the ability to use existing and developing electronic record systems. Specifically, it recommends action by the federal government -- especially ONC and CMS -- accelerate the identification of standards required for health information exchange using metadata-tagged data elements, map various existing semantic taxonomies onto the tagged elements, develop incentives for product use of tagged elements; foster use of metadata for security and safety protocols, bring federal program capacity and policy leverage to bear in implementing and guiding the efforts, and develop metrics to assess progress. Read the entire page →
From page 68... ... Hand in hand with these were practical considerations including the increasing appreciation of the need to limit the burden of health data collection to the issues most important to patient care and knowledge generation. The three workshops in the series progressed from a broad exploration of the state of play and various stakeholder perspectives on a learning health system, to a more specific identification of strategic approaches to components of the challenge, and concluded with detailed discussions of strategic elements, stakeholder responsibilities, and key crosscutting challenges. Read the entire page →
From page 69... ... Yet, the discussions also underscored that without successful efforts to create the conditions necessary for seamless interoperability, to build the protocols for enhanced access and use of available information for knowledge generation, and to nurture a culture of engagement and support on behalf of the sort of information utility possible, the potential will go unmet. By thoroughly and candidly engaging in discussions on the vision, the current state of the system, the key priorities for future work, and the strategic elements for accelerating progress, participants have set in motion perspectives that can quicken the progress in building the digital infrastructure required for the continuously learning health system necessary to ensure better health for all. Read the entire page →
From page 70... ... 2007. The learning healthcare system: Workshop summary. Read the entire page →

From page 53...

... Most changes will occur virtually out of sight, and the pace and profile of the transformation will be determined by stewardship that fosters alignment of technology, science, and culture in support of a continuously learning health system. In the context of growing concerns about the quality and costs of care, the nation's health and economic security are interdependently linked to the success of that stewardship.

1 Introduction Pages 53-70

1 Introduction
Pages 53-70