Learning health systems (LHS) are health and healthcare systems in which knowledge generation processes are embedded in daily practice to improve individual and population health. At its most fundamental level, a learning health system applies a conceptual approach wherein science, informatics, incentives, and culture are aligned to support continuous improvement, innovation, and equity, and seamlessly embed knowledge and best practices into care delivery
The idea was first conceptualized in a 2006 workshop organized by the US Institute of Medicine (now the National Academy of Medicine (NAM)), building on ideas around evidence-based medicine and "practice-based evidence". and around recognition of the persistent gap between evidence generated in the context of biomedical research and the application of that evidence in the provision of care. The need to close this gap was further underscored by the growth of electronic health records (EHR) and other innovations in health information technology and computational power, and the resulting ability to generate data that can lead to better evidence and better outcomes. There has since been increasing interest in the topic, including the creation of the Wiley journal Learning Health Systems.
Cornerstone elements of the LHS include: generation, application, and improvement of scientific knowledge; an organizational infrastructure that supports the engagement of communities of patients, healthcare professionals and researchers who collaborate to identify evidence gaps that could be addressed through research in routine healthcare settings; deployment of computational technologies and informatics approaches that organize and leverage large electronic health data sets, i.e. "big data" for use in research; quality improvement at the point of care for each patient using new knowledge generated by research.
Other compatible ways of describing the LHS co-exist alongside the NAM definition, including the definition used by AHRQ, the Agency for Healthcare Research and Quality. AHRQ defines a learning health system as "a health system in which internal data and experience are systematically integrated with external evidence, and that knowledge is put into practice. As a result, patients get higher quality, safer, more efficient care, and health care delivery organizations become better places to work.”
In 2023, the NAM established ten core principles of learning health organizations to serve as a unifying touchstone for the field. The principles reflect and build upon the six aims of the seminal "Crossing the Quality Chasm" report published in 2001 (safe, equitable, effective, efficient, timely, and patient-centered), and account for the ways in which health care has evolved since the publication of this 2001 report.
Engaged - Informed engagement, options, and choices for those who are served
Safe - Tested and up-to-date protocols to protect from harm
Effective - Evidence-based services tailored to understanding of each person's goals Equitable - Parity in opportunity to attain desired health and goals Efficient - Optimal outcomes for accessible, non-wasteful resources Accessible - Effective services readily available where and when they are most needed Measurable - Reliable and valid assessment of consequential activities and outcomes Transparent - Clear information related to the nature, use, costs, and results of services Secure - Validated access and use safeguards for digitally-mediated activities Adaptive - Continuous learning and improvement are integral to organizational culture
History
The NAM’s early efforts to develop the ideas underpinning the LHS began in 2006, via a series of workshops held over several years from 2006-2013. Among several early publications to express the need for a rapid learning health system was a commentary in Health Affairs in 2007 where Lynn Etheredge applied the term “rapid learning health system” in recognition of the opportunity to leverage electronic health records (EHR) to “learn” what works in health care. The series of NAM workshops generated several summary publications on topics under the mantle of the LHS, including publications focused on the digital infrastructure as well as on ethical considerations. In 2013, the workshops culminated in a seminal report, “Best Care at Lower Cost: the Path to Continuously Learning Health Care in America.” Summarizing the heretofore efforts, McGinnis and colleagues enumerate key milestones in the evolution of the LHS that include these reports as well as decades-old efforts to generate evidence from routine health care delivery.