134:
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.
587:(PCORI) has designated the realization of a national learning health system as one of their five national priorities for health, which is indicative of future funding opportunities. Funding provided to personnel within an organization (i.e., a health system) may be designated for internally-directed learning activities with no expectation about developing and publishing generalizable results. In this way, learning health system may be distinguished from traditional health services or informatics research and more closely resemble the funding and infrastructure that health systems designate for quality improvement activities. In 2015, the
345:
structure of care delivery, and regulatory environment affect the ability to support continuous learning. Patient involvement in the LHS has grown, partly due to the establishment of the
Patient-Centered Outcomes Research Institute, continued emphasis on shared decision-making, and the growing recognition of participatory medicine. However, the engagement of patients is not consistent across health systems and there is not a uniform template for patient engagement or approaches to educating patients about the value and significance of the LHS as a model for improving evidence-based care.
600:
anchored on seven essential obligations: (1) respecting dignity and rights of all patients; (2) respecting clinical judgment; (3) providing optimal care to every patient; (4) avoiding the introduction of non-clinical burdens and risks; (5) reducing health inequities; (6) ensuring responsible activities are conducted in a way that fosters learning; and (7) contributing to the overall aim of improving quality and value in health care. This framework and several companion articles were published as a special report from the
155:
evaluate how well an LHS improves outcomes was not well-explored in the literature. Subsequently, Platt examined progress of theories and implementation of the LHS, Nash focused a review on deployment of the LHS in primary care, and Ellis mapped empirical applications of the LHS. Easterling and colleagues (REF LHS 2022) proffer an elaborate taxonomy of LHS elements and use this to describe an LHS-IP, or “Learning Health System In
Practice” as a model for health care systems who seek to become an LHS.
361:
technology (both computational and statistical), an analysis of the amalgamated data can result in new evidence. Such knowledge generation can then spur changes in clinical practice, and thus to new patient data being collected. This is the optimum for the LHS. However, dissemination of implementation of new evidence can be operationally and technically challenging in many settings, including the original health system that identified a problem based on their own clinical data.
458:, two US funding agencies that also issue funding opportunities for LHS-related studies. A $ 40 million funding opportunity for mentored career development awards was issued in 2017 and 11 Centers of Excellence were awarded five years of federal funding in 2018 to support the training of clinician and research scientists to conduct patient-centered outcomes research within LHS.
405:
complex healthcare environment, sustained engagement of all health system stakeholders is necessary to successfully identify and prioritize evidence gaps, develop suitable interventions, analyze insights from the interventions, and deploy resulting changes. Hence, many disciplines and scientific domains may contribute various types of subspecialty expertise including:
323:. Still, much of the LHS development has been concentrated in large academic medical centers and health systems with a sizable footprint. Masica notes that nearly 85% of more than 6000 hospitals in the US are categorized as community hospitals, and the ability to develop and implement an LHS may be more challenging due to workforce and other constraints.
604:. Subsequent articles by Finkelstein et al, as well as Asch and colleagues seek to use examples of learning activities as a means to describe different approaches to research oversight and compliance. Rigorous deliberations about the approach to informed consent are also germane to the ethics of learning activities in the healthcare context.
454:
and
Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management. An 8th domain, Equity and Justice, was added in 2022 and a total of 38 competencies are now identified. These competencies form the backbone of a training program collaboratively funded by AHRQ and
591:(CMS) funded the Health Care Payment Learning and Action Network to ascertain what works with respect to alternative health care delivery arrangements, however, reimbursement for learning activities from insurers/payers is not currently a steady avenue for financial support to incentivize health system learning.
555:. Program offerings and emphases vary from institution to institution, but all involve training and professional development in topics related to improving health systems and the ability to generate and learn from evidence. Articles describing multidisciplinary workforce training efforts was published as
404:
The LHS is a multidisciplinary and multi-stakeholder model for improvement, wherein clinical practitioners, health system leaders, data analysts and health IT experts, operations personnel, and researchers bring requisite expertise to bear throughout the cycle of improving health and healthcare. In a
360:
The LHS leverages a clinical lifecycle. Patient data is collected, which can then be amalgamated across multiple patients to identify, define, and analyze a problem or a gap in the application of evidence-based care. These are activities largely driven by healthcare professionals. With the support of
141:
Given that the LHS has an expansive definition and scope, many of the early adopters of this approach were health systems that also had embedded research capabilities, such as a formal department or institute. The
Veterans Administration Health System, Group Health Cooperative, Kaiser Permanente and
88:
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
453:
convened a technical expert panel in 2016 to identify core competencies, which yielded 33 competencies spanning seven domains. These competency domains are (1) Systems
Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research
357:(EHRs) and must navigate the inherent challenges of EHRs. EHRs were primarily created to support billing for clinical services and tracking health insurance claims. Generation of rich real-world clinical data is an essential "byproduct" of this highly transactional purpose of the contemporary EHR.
137:
Nomenclature may vary in reference to the LHS concept. Some refer to a learning healthcare system, others refer to learning health systems or collaborative learning health systems. The architecture and objectives are similar, irrespective of the label—addressing evidence gaps, harnessing data, and
133:
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
92:
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,
150:
Early experiences with deploying the LHS have been instructive and have led to further adoption and spread. The LHS model is being applied in specific medical specialties such as pediatrics and oncology, and further examination of the environment and conditions that support learning have spurred
46:
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
599:
Bioethics scholars including Faden, Asch, Finkelstein, Morain, and Platt have averred that in a learning health system, consideration should be given to both clinical ethics and research ethics. Faden, Kass and colleagues have put forth an ethics framework for the learning health system that is
154:
Along with a growing body of peer-reviewed publications on the specific experience of different systems as they evolve toward continuous learning, review articles have been published to reflect on the growth of the LHS as a whole. A systematic review by
Budrionis observed that the ability to
344:
of the LHS. Another marker of the spread of the LHS is its international adoption. Australia, Canada, the United
Kingdom and other countries are applying the LHS concepts, offering opportunities to compare and contrast global experiences and develop a richer picture of how the local context,
30:
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
158:
The motivations for applying LHS concepts are largely and logically focused on improving the quality of care. Exemplar organizations are numerous and growing and include both community-based health systems and university-based academic health systems/medical centers in the United States:
1005:
Smith M, Saunders R, Stuckhardt L, McGinnis JM, Committee on the Learning Health Care System in America, Institute of Medicine, et al. (Committee on the Learning Health Care System in America; Institute of Medicine) (2013). Smith M, Saunders R, Stuckhardt L, McGinnis JM (eds.).
142:
Geisinger Health System were among the vanguard organizations who also published insights from their experience of launching formal learning health system activities. Increasingly, academic health systems have taken up the principles and practices espoused by the earliest adopters.
47:(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
310:
is an umbrella organization that has united many systems and health data organizations to develop shared principles and processes, and foster learning about the applications of technologies in the context of learning systems via a periodic virtual forum
339:
are dedicated to manuscripts that showcase the experience of those deploying or refining aspects of learning in real-world practices. Each has also published special issues with thematic emphases on LHS-related topics such as embedded research and
65:
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
326:
Dissemination of the activities and experiences of learning health systems has been an instrumental aspect of their growth and spread. While peer-reviewed literature on the LHS appears in a variety of journals, the creation of
2658:
Faden RR, Kass NE, Goodman SN, Pronovost P, Tunis S, Beauchamp TL (January 2013). "An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics".
974:
Faden RR, Kass NE, Goodman SN, Pronovost P, Tunis S, Beauchamp TL (2013). "An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics".
138:
effectively utilizing the best evidence at the point of need. Related concepts include the use of real-world data to generate real-world evidence, and mobilizing computable biomedical knowledge.
2507:
543:
was created by AHRQ and PCORI to fund Learning Health System Embedded Scientist Training and Research (LHS E-STaR) Centers. Other similar training and fellowship programs have been offered by
151:
development of increasingly detailed and specialized frameworks that can support further adoption and adaptation based on the needs, features, and capabilities of a particular health system.
2226:
Lewis G, Kirkham H, Duncan I, Vaithianathan R (April 2013). "How health systems could avert 'triple fail' events that are harmful, are costly, and result in poor patient satisfaction".
2452:
253:
84:
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.
190:
472:
CATALyST: Consortium for Applied Training to Advance the Learning Health System with Scholars/Trainees, Kaiser Permanente Washington Research Institute, Seattle, WA.
2482:
449:
As the LHS has matured, leaders and vanguard organizations have identified the requisite skills needed to lead and develop interventions that support learning. The
742:
315:). Given their centrality to the generation of health data and information, two of the largest EHR vendors have also created communities to support LHS: Cerner’s
1840:"Clarifying the concept of a learning health system for healthcare delivery organizations: Implications from a qualitative analysis of the scientific literature"
584:
455:
588:
2557:
576:
450:
2503:
705:
279:
504:
1889:"The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research"
532:
185:
2637:
2444:
2416:"AHRQ and PCORI Institutional Mentored Career Development Program (K12) to Support the Next Generation of Learning Health System Researchers"
1308:
1023:
915:
699:
647:
483:
2532:
2010:
511:
497:
490:
266:
518:
2423:
2317:"Health and demographic surveillance systems: a step towards full civil registration and vital statistics system in sub-Sahara Africa?"
1149:"Summary of third annual MCBK public meeting: Mobilizing computable biomedical knowledge-Accelerating the second knowledge revolution"
636:
Olsen L, Aisner D, McGinnis JM, et al. (U.S. Institute of Medicine) (2007). "The Learning Healthcare System: Workshop Summary".
2799:
2004:
482:
Leveraging Infrastructure to Train Investigators in Patient-Centered Outcomes Research in Learning Health System (LITI- PCORLHS),
69:
deployment of computational technologies and informatics approaches that organize and leverage large electronic health data sets,
383:
580:
274:
172:
93:
and patient-centered), and account for the ways in which health care has evolved since the publication of this 2001 report.
688:
Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care
661:
639:
Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care
572:
2474:
195:
39:
1225:
306:. Alongside these exemplar organizations, related initiatives and consortia have been established in recent years. The
2794:
2554:"Minnesota Learning Health System - Projects and Research Studies - School of Public Health - University of Minnesota"
302:
where the LHS concepts are applied. The University of Michigan has also established a formal academic department, the
230:
2036:"Making sense of the shadows: priorities for creating a learning healthcare system based on routinely collected data"
571:
Support for learning activities may be derived from federal, philanthropic, and other sources. Examples include the
2607:
763:
McLachlan S, Potts HW, Dube K, Buchanan D, Lean S, Gallagher T, Johnson O, Daley B, Marsh W, Fenton N (June 2018).
525:
428:
210:
1246:
Greene SM, Reid RJ, Larson EB (August 2012). "Implementing the learning health system: from concept to action".
812:
Greene SM, Reid RJ, Larson EB (August 2012). "Implementing the learning health system: from concept to action".
354:
2553:
466:
438:
200:
43:
2586:
284:
167:
31:
improvement, innovation, and equity, and seamlessly embed knowledge and best practices into care delivery
1381:
Forrest CB, Margolis PA, Bailey LC, Marsolo K, Del Beccaro MA, Finkelstein JA, et al. (2014-07-01).
1198:"Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice"
686:
476:
377:
Predictive patient risk modeling uses patterns in data to find groups at greater risk of adverse events.
35:
2630:"SPIRIT K12 - General Internal Medicine & Health Services Research - UCLA Health - Los Angeles, CA"
2475:"AHRQ and PCORI Announce Awards to Support The Next Generation of Learning-Health-System Researchers"
2132:
Friedman CP, Wong AK, Blumenthal D (November 2010). "Achieving a nationwide learning health system".
1147:
Williams M, Richesson RL, Bray BE, Greenes RA, McIntosh LD, Middleton B, et al. (January 2021).
857:"PEDSnet: how a prototype pediatric learning health system is being expanded into a national network"
48:
1292:
A Foundation for Evidence-Driven Practice: A Rapid Learning System for Cancer Care: Workshop Summary
517:
The Center of Excellence in Promoting LHS Operations and Research at Einstein/Montefiore (EXPLORE),
80:
quality improvement at the point of care for each patient using new knowledge generated by research.
2690:
Finkelstein JA, Brickman AL, Capron A, Ford DE, Gombosev A, Greene SM, et al. (October 2015).
1787:
Ellis LA, Sarkies M, Churruca K, Dammery G, Meulenbroeks I, Smith CL, et al. (February 2022).
613:
601:
540:
433:
2629:
380:
Predictive care risk and outcome models identify situations that are at greater risk of poor care.
2770:
2528:
2157:
2114:
1986:
1938:"A framework for analysing learning health systems: Are we removing the most impactful barriers?"
1626:
1510:
1430:
Abernethy AP, Etheredge LM, Ganz PA, Wallace P, German RR, Neti C, et al. (September 2010).
1271:
1080:
1037:
837:
794:
723:
409:
235:
2762:
2721:
2672:
2397:
2348:
2297:
2243:
2208:
2149:
2106:
2065:
2000:
1967:
1918:
1887:
Masica AL, Velasco F, Nelson TL, Medford RJ, Hughes AE, Pandey A, et al. (October 2022).
1869:
1820:
1769:
1718:
1667:
1618:
1600:
1561:
1502:
1461:
1412:
1363:
1332:
Psek WA, Stametz RA, Bailey-Davis LD, Davis D, Darer J, Faucett WA, et al. (2015-03-10).
1314:
1304:
1263:
1217:
1178:
1129:
1072:
1029:
1019:
987:
956:
921:
911:
878:
829:
786:
695:
653:
643:
531:
University of California-San Francisco Learning Health System K12 Career Development Program,
496:
Northwest Center of Excellence & K12 in Patient Centered Learning Health Systems Science,
258:
215:
27:
1581:"A framework for understanding, designing, developing and evaluating learning health systems"
2752:
2711:
2703:
2664:
2415:
2387:
2379:
2338:
2328:
2287:
2279:
2235:
2198:
2188:
2141:
2096:
2055:
2047:
1992:
1957:
1949:
1936:
McLachlan S, Dube K, Johnson O, Buchanan D, Potts HW, Gallagher T, Fenton N (October 2019).
1908:
1900:
1859:
1851:
1810:
1800:
1759:
1749:
1708:
1698:
1657:
1608:
1592:
1551:
1541:
1492:
1451:
1443:
1402:
1394:
1353:
1345:
1296:
1259:
1255:
1209:
1168:
1160:
1119:
1111:
1064:
1011:
979:
948:
903:
868:
825:
821:
776:
423:
180:
2268:"What role for learning health systems in quality improvement within healthcare providers?"
1687:"An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review"
539:
As the funding for the aforementioned Centers of Excellence concludes in 2023, a successor
510:
Stakeholder-Partnered Implementation Research and Innovation Translation (SPIRIT) program,
316:
312:
303:
735:
386:
use patient algorithms applied to patient data to make specific treatment recommendations.
118:
Transparent - Clear information related to the nature, use, costs, and results of services
85:
1988:
From Patient Data to Medical Knowledge: The Principles and Practice of Health Informatics
1479:
McLachlan S, Potts HW, Dube K, Buchanan D, Lean S, Gallagher T, et al. (June 2018).
465:
A Chicago Center of Excellence in Learning Health Systems Research Training (ACCELERAT),
2739:
Asch DA, Joffe S, Bierer BE, Greene SM, Lieu TA, Platt JE, et al. (December 2020).
2085:"Electronic patient-reported data capture as a foundation of rapid learning cancer care"
563:
summarizing the collective insights from the 11 initially funded Centers of Excellence.
556:
2716:
2691:
2392:
2367:
2343:
2316:
2292:
2267:
2203:
2176:
2060:
2035:
1962:
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1913:
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1407:
1382:
1358:
1333:
1173:
1148:
1124:
1099:
1055:
McGinnis JM, Fineberg HV, Dzau VJ (July 2021). "Advancing the Learning Health System".
503:
PEDSnet Scholars: A Training Program for Pediatric Learning Health System Researchers,
414:
225:
205:
2788:
2774:
1630:
1213:
1084:
1041:
544:
364:
McLachlan and colleagues (2018) suggest a taxonomy of nine LHS classification types:
245:
163:
124:
Adaptive - Continuous learning and improvement are integral to organizational culture
112:
Accessible - Effective services readily available where and when they are most needed
2161:
2118:
1514:
798:
103:
Effective - Evidence-based services tailored to understanding of each person's goals
1481:"The Heimdall Framework for Supporting Characterisation of Learning Health Systems"
1334:"Operationalizing the learning health care system in an integrated delivery system"
1275:
841:
765:"The Heimdall Framework for Supporting Characterisation of Learning Health Systems"
548:
419:
341:
335:
329:
115:
Measurable - Reliable and valid assessment of consequential activities and outcomes
2175:
Bradley EH, Curry LA, Ramanadhan S, Rowe L, Nembhard IM, Krumholz HM (May 2009).
2145:
2101:
2084:
1008:
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
552:
290:
In many cases, these institutions are engaged in research activities such as the
2757:
2740:
1398:
220:
2177:"Research in action: using positive deviance to improve quality of health care"
1754:
637:
489:
Minnesota Learning Health System Mentored Career Development Program (MN-LHS),
2239:
2083:
Abernethy AP, Ahmad A, Zafar SY, Wheeler JL, Reese JB, Lyerly HK (June 2010).
2051:
1789:"The Science of Learning Health Systems: Scoping Review of Empirical Research"
1662:
1645:
1546:
952:
873:
856:
240:
121:
Secure - Validated access and use safeguards for digitally-mediated activities
2707:
2333:
1604:
1447:
2383:
1349:
1197:
389:
Comparative effectiveness research determines the most effective treatments.
97:
Engaged - Informed engagement, options, and choices for those who are served
2766:
2725:
2676:
2401:
2352:
2301:
2247:
2212:
2193:
2153:
2110:
2069:
1971:
1922:
1873:
1824:
1773:
1722:
1671:
1622:
1565:
1506:
1497:
1480:
1465:
1416:
1367:
1318:
1267:
1221:
1182:
1133:
1076:
1033:
991:
960:
925:
882:
833:
790:
781:
764:
657:
395:
Surveillance monitors data for disease outbreaks or other treatment issues.
1996:
2692:"Oversight on the borderline: Quality improvement and pragmatic research"
2615:
1068:
524:
Transforming the Generation and Adoption of PCOR into Practice (T-GAPP),
74:
34:
The idea was first conceptualized in a 2006 workshop organized by the US
2368:"Development of the Learning Health System Researcher Core Competencies"
2741:"Rethinking ethical oversight in the era of the learning health system"
2445:"Supporting the Next Generation of Learning Health Systems Researchers"
2283:
1953:
1904:
1855:
1646:"The Learning Healthcare System: Where are we now? A systematic review"
1596:
1164:
1115:
1738:"Learning health systems in primary care: a systematic scoping review"
2668:
2529:"IU-Regenstrief receive award for learning health system researchers"
1838:
Easterling D, Perry AC, Woodside R, Patel T, Gesell SB (April 2022).
983:
560:
899:
Crossing the Quality Chasm: A New Health System for the 21st Century
371:
Positive deviance finds examples of better care against a benchmark.
106:
Equitable - Parity in opportunity to attain desired health and goals
1300:
1290:
1015:
907:
109:
Efficient - Optimal outcomes for accessible, non-wasteful resources
1805:
1703:
307:
897:
368:
Cohort identification looks for patients with similar attributes.
62:
generation, application, and improvement of scientific knowledge;
2578:
1528:
Menear M, Blanchette MA, Demers-Payette O, Roy D (August 2019).
2315:
Ye Y, Wamukoya M, Ezeh A, Emina JB, Sankoh O (September 2012).
392:
Intelligent assistance use data to automate routine processes.
2366:
Forrest CB, Chesley FD, Tregear ML, Mistry KB (August 2018).
295:
320:
291:
100:
Safe - Tested and up-to-date protocols to protect from harm
1196:
Demakis JG, McQueen L, Kizer KW, Feussner JR (June 2000).
330:
Healthcare: the Journal of Delivery Science and Innovation
1736:
Nash DM, Bhimani Z, Rayner J, Zwarenstein M (June 2021).
855:
Forrest CB, Margolis P, Seid M, Colletti RB (July 2014).
1530:"A framework for value-creating learning health systems"
353:
A large proportion of LHS research relies on the use of
349:
Electronic health data as a central component to the LHS
250:
Trillium Healthcare Institute for Better Health (Canada)
1387:
Journal of the American Medical Informatics Association
939:
Etheredge LM (2007). "A rapid-learning health system".
299:
1383:"PEDSnet: a National Pediatric Learning Health System"
902:. Washington DC: National Academy Press. p. 360.
547:
via their Delivery System Science Fellowship program,
254:
University of Alabama at Birmingham School of Medicine
374:
Negative deviance finds examples of sub-optimal care.
1100:"A science of collaborative learning health systems"
461:The LHS Centers of Excellence funded in 2018 were:
1010:. Washington, D.C.: The National Academies Press.
685:Grossmann C, Powers B, McGinnis JM, eds. (2011).
2504:"CATALyST K12 - Early Career Scientist Training"
680:
678:
2029:
2027:
1295:. Washington, D.C.: National Academies Press.
1098:Seid M, Hartley DM, Margolis PA (July 2021).
294:, Clinical and Translational Science Awards (
191:Cincinnati Children's Hospital Medical Center
8:
585:Patient-Centered Outcomes Research Institute
1485:Journal of Innovation in Health Informatics
769:Journal of Innovation in Health Informatics
758:
756:
754:
752:
1685:Platt JE, Raj M, Wienroth M (March 2020).
589:Centers for Medicare and Medicaid Services
551:, and the Veterans Administration via the
475:Learning Health System Scholar Program at
451:Agency for Healthcare Research and Quality
2756:
2715:
2391:
2342:
2332:
2291:
2202:
2192:
2100:
2059:
1961:
1912:
1863:
1814:
1804:
1763:
1753:
1712:
1702:
1661:
1644:Budrionis A, Bellika JG (December 2016).
1612:
1555:
1545:
1496:
1455:
1406:
1357:
1289:Institute of Medicine (US) (2010-07-02).
1172:
1123:
872:
780:
559:to the LHS Journal in 2022, including an
58:Cornerstone elements of the LHS include:
2261:
2259:
2257:
549:Kaiser Permanente’s Division of Research
280:Washington University School of Medicine
1432:"Rapid-learning system for cancer care"
1260:10.7326/0003-4819-157-3-201208070-00012
826:10.7326/0003-4819-157-3-201208070-00012
741:CS1 maint: location missing publisher (
631:
629:
625:
342:ethical, legal, and social implications
2455:from the original on February 19, 2020
731:
721:
533:University of California San Francisco
304:Department of Learning Health Sciences
2034:Deeny SR, Steventon A (August 2015).
1579:Foley, Tom; Vale, Luke (2022-05-20).
484:Indiana University School of Medicine
271:Veterans Administration Health System
7:
1985:Paul Taylor (2007). Taylor P (ed.).
1691:Journal of Medical Internet Research
512:University of California Los Angeles
498:Oregon Health and Science University
491:University of Minnesota, Minneapolis
267:Vanderbilt University Medical Center
1057:The New England Journal of Medicine
553:Seattle-Denver Center of Innovation
519:Albert Einstein College of Medicine
505:Children’s Hospital of Philadelphia
186:Children’s Hospital of Philadelphia
1534:Health Research Policy and Systems
14:
2266:Foley TJ, Vale L (October 2017).
1650:Journal of Biomedical Informatics
642:. National Academies Press (US).
384:Clinical decision support systems
42:(NAM)), building on ideas around
1214:10.1097/00005650-200006001-00003
2640:from the original on 2020-02-19
2589:from the original on 2021-09-09
2560:from the original on 2020-02-19
2535:from the original on 2020-02-19
2510:from the original on 2020-03-20
2485:from the original on 2021-05-22
2426:from the original on 2021-06-23
2013:from the original on 2021-06-17
1228:from the original on 2022-12-07
711:from the original on 2022-01-20
664:from the original on 2020-11-26
336:Learning Health Systems Journal
173:Baylor Scott & White Health
2134:Science Translational Medicine
896:Institute of Medicine (2001).
581:Robert Wood Johnson Foundation
400:Synergy with other disciplines
275:Wake Forest School of Medicine
1:
573:National Institutes of Health
567:Funding and financial support
2146:10.1126/scitranslmed.3001456
2102:10.1097/MLR.0b013e3181db53a4
1991:. Blackwell Publishing Ltd.
1436:Journal of Clinical Oncology
535:, San Francisco, California.
196:Denver Health Medical Center
40:National Academy of Medicine
2758:10.1016/j.hjdsi.2020.100462
1399:10.1136/amiajnl-2014-002743
1248:Annals of Internal Medicine
814:Annals of Internal Medicine
231:Feinberg School of Medicine
2816:
2661:The Hastings Center Report
1755:10.1186/s12875-021-01483-z
976:The Hastings Center Report
526:University of Pennsylvania
514:, Los Angeles, California.
16:Type of health care system
2663:. Spec No (s1): S16–S27.
2240:10.1377/hlthaff.2012.1350
2052:10.1136/bmjqs-2015-004278
1663:10.1016/j.jbi.2016.09.018
1547:10.1186/s12961-019-0477-3
953:10.1377/hlthaff.26.2.w107
874:10.1377/hlthaff.2014.0127
429:Organizational Psychology
355:electronic health records
308:Learning Health Community
211:Indiana University Health
2800:Decision support systems
2708:10.1177/1740774515597682
2372:Health Services Research
2334:10.1186/1471-2458-12-741
2040:BMJ Quality & Safety
1793:JMIR Medical Informatics
1448:10.1200/JCO.2010.28.5478
2384:10.1111/1475-6773.12751
2272:Learning Health Systems
1942:Learning Health Systems
1893:Learning Health Systems
1844:Learning Health Systems
1585:Learning Health Systems
1350:10.13063/2327-9214.1122
1153:Learning Health Systems
1104:Learning Health Systems
467:Northwestern University
439:Implementation Research
321:Health Research Network
317:Learning Health Network
201:Geisinger Health System
53:Learning Health Systems
44:evidence-based medicine
20:Learning health systems
2579:"PACT-K12 | OHSU"
2194:10.1186/1748-5908-4-25
2181:Implementation Science
1498:10.14236/jhi.v25i2.996
1208:(6 Suppl 1): I17–I25.
782:10.14236/jhi.v25i2.996
595:Ethical considerations
285:Weill Cornell Medicine
77:" for use in research;
1997:10.1002/9780470994702
583:(philanthropic). The
477:Vanderbilt University
36:Institute of Medicine
2608:"Scholars - PEDSnet"
2451:. October 27, 2017.
1069:10.1056/NEJMp2103872
486:, Indianapolis, Ind.
1742:BMC Family Practice
978:. Spec No: S16–27.
614:Real World Evidence
579:(federal); and the
541:funding opportunity
528:, Philadelphia, PA.
500:, Portland, Oregon.
434:Quality Improvement
177:Care South Carolina
146:Adoption and spread
2795:Health informatics
2634:www.uclahealth.org
2284:10.1002/lrh2.10025
2095:(6 Suppl): S32–8.
1954:10.1002/lrh2.10189
1905:10.1002/lrh2.10332
1856:10.1002/lrh2.10287
1597:10.1002/lrh2.10315
1165:10.1002/lrh2.10255
1116:10.1002/lrh2.10278
694:. Washington, DC.
507:, Philadelphia, PA
479:, Nashville, Tenn.
410:Health Informatics
319:and Epic System's
236:NYU Langone Health
28:healthcare systems
2321:BMC Public Health
1442:(27): 4268–4274.
1310:978-0-309-15126-9
1025:978-0-309-26073-2
917:978-0-309-46561-8
701:978-0-309-15416-1
649:978-0-309-10300-8
561:experience report
259:Michigan Medicine
216:Kaiser Permanente
89:places to work.”
26:) are health and
2807:
2779:
2778:
2760:
2736:
2730:
2729:
2719:
2687:
2681:
2680:
2669:10.1002/hast.134
2655:
2649:
2648:
2646:
2645:
2626:
2620:
2619:
2614:. Archived from
2604:
2598:
2597:
2595:
2594:
2575:
2569:
2568:
2566:
2565:
2550:
2544:
2543:
2541:
2540:
2525:
2519:
2518:
2516:
2515:
2500:
2494:
2493:
2491:
2490:
2471:
2465:
2464:
2462:
2460:
2441:
2435:
2434:
2432:
2431:
2412:
2406:
2405:
2395:
2378:(4): 2615–2632.
2363:
2357:
2356:
2346:
2336:
2312:
2306:
2305:
2295:
2263:
2252:
2251:
2223:
2217:
2216:
2206:
2196:
2172:
2166:
2165:
2129:
2123:
2122:
2104:
2080:
2074:
2073:
2063:
2031:
2022:
2021:
2019:
2018:
1982:
1976:
1975:
1965:
1933:
1927:
1926:
1916:
1884:
1878:
1877:
1867:
1835:
1829:
1828:
1818:
1808:
1784:
1778:
1777:
1767:
1757:
1733:
1727:
1726:
1716:
1706:
1682:
1676:
1675:
1665:
1641:
1635:
1634:
1616:
1576:
1570:
1569:
1559:
1549:
1525:
1519:
1518:
1500:
1476:
1470:
1469:
1459:
1427:
1421:
1420:
1410:
1378:
1372:
1371:
1361:
1329:
1323:
1322:
1286:
1280:
1279:
1243:
1237:
1236:
1234:
1233:
1193:
1187:
1186:
1176:
1144:
1138:
1137:
1127:
1095:
1089:
1088:
1052:
1046:
1045:
1002:
996:
995:
984:10.1002/hast.134
971:
965:
964:
936:
930:
929:
893:
887:
886:
876:
852:
846:
845:
809:
803:
802:
784:
760:
747:
746:
739:
733:
729:
727:
719:
717:
716:
710:
693:
682:
673:
672:
670:
669:
633:
424:Machine Learning
181:Cleveland Clinic
2815:
2814:
2810:
2809:
2808:
2806:
2805:
2804:
2785:
2784:
2783:
2782:
2738:
2737:
2733:
2696:Clinical Trials
2689:
2688:
2684:
2657:
2656:
2652:
2643:
2641:
2628:
2627:
2623:
2606:
2605:
2601:
2592:
2590:
2577:
2576:
2572:
2563:
2561:
2552:
2551:
2547:
2538:
2536:
2527:
2526:
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2513:
2511:
2502:
2501:
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2486:
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2472:
2468:
2458:
2456:
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2442:
2438:
2429:
2427:
2414:
2413:
2409:
2365:
2364:
2360:
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2313:
2309:
2265:
2264:
2255:
2225:
2224:
2220:
2174:
2173:
2169:
2131:
2130:
2126:
2082:
2081:
2077:
2033:
2032:
2025:
2016:
2014:
2007:
1984:
1983:
1979:
1935:
1934:
1930:
1886:
1885:
1881:
1837:
1836:
1832:
1786:
1785:
1781:
1735:
1734:
1730:
1684:
1683:
1679:
1643:
1642:
1638:
1578:
1577:
1573:
1527:
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1522:
1478:
1477:
1473:
1429:
1428:
1424:
1380:
1379:
1375:
1331:
1330:
1326:
1311:
1288:
1287:
1283:
1245:
1244:
1240:
1231:
1229:
1195:
1194:
1190:
1146:
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1141:
1097:
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1004:
1003:
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894:
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810:
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762:
761:
750:
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730:
720:
714:
712:
708:
702:
691:
684:
683:
676:
667:
665:
650:
635:
634:
627:
622:
610:
602:Hastings Center
597:
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469:, Chicago, Ill.
447:
415:Clinical Trials
402:
351:
168:Advocate Aurora
148:
131:
17:
12:
11:
5:
2813:
2811:
2803:
2802:
2797:
2787:
2786:
2781:
2780:
2731:
2702:(5): 457–466.
2682:
2650:
2621:
2618:on 2020-02-19.
2599:
2570:
2545:
2520:
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2466:
2436:
2407:
2358:
2307:
2253:
2228:Health Affairs
2218:
2167:
2140:(57): 57cm29.
2124:
2075:
2023:
2005:
1977:
1928:
1879:
1830:
1779:
1728:
1677:
1636:
1571:
1520:
1471:
1422:
1393:(4): 602–606.
1373:
1324:
1309:
1301:10.17226/12868
1281:
1254:(3): 207–210.
1238:
1188:
1139:
1090:
1047:
1024:
1016:10.17226/13444
997:
966:
947:(2): w107–18.
941:Health Affairs
931:
916:
908:10.17226/10027
888:
861:Health Affairs
847:
804:
748:
700:
674:
648:
624:
623:
621:
618:
617:
616:
609:
606:
596:
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568:
565:
537:
536:
529:
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515:
508:
501:
494:
487:
480:
473:
470:
446:
443:
442:
441:
436:
431:
426:
417:
412:
401:
398:
397:
396:
393:
390:
387:
381:
378:
375:
372:
369:
350:
347:
288:
287:
282:
277:
272:
269:
264:
261:
256:
251:
248:
243:
238:
233:
228:
226:Medstar Health
223:
218:
213:
208:
206:HealthPartners
203:
198:
193:
188:
183:
178:
175:
170:
147:
144:
130:
127:
126:
125:
122:
119:
116:
113:
110:
107:
104:
101:
98:
82:
81:
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63:
15:
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2798:
2796:
2793:
2792:
2790:
2776:
2772:
2768:
2764:
2759:
2754:
2751:(4): 100462.
2750:
2746:
2742:
2735:
2732:
2727:
2723:
2718:
2713:
2709:
2705:
2701:
2697:
2693:
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2683:
2678:
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2670:
2666:
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2654:
2651:
2639:
2635:
2631:
2625:
2622:
2617:
2613:
2609:
2603:
2600:
2588:
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2574:
2571:
2559:
2555:
2549:
2546:
2534:
2530:
2524:
2521:
2509:
2505:
2499:
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2484:
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2476:
2470:
2467:
2454:
2450:
2449:www.pcori.org
2446:
2440:
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2425:
2421:
2417:
2411:
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2399:
2394:
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2377:
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2359:
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2350:
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2326:
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2308:
2303:
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2278:(4): e10025.
2277:
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2269:
2262:
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2258:
2254:
2249:
2245:
2241:
2237:
2234:(4): 669–76.
2233:
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2222:
2219:
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2210:
2205:
2200:
2195:
2190:
2186:
2182:
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2094:
2090:
2086:
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2067:
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2053:
2049:
2046:(8): 505–15.
2045:
2041:
2037:
2030:
2028:
2024:
2012:
2008:
2006:9780470994702
2002:
1998:
1994:
1990:
1989:
1981:
1978:
1973:
1969:
1964:
1959:
1955:
1951:
1948:(4): e10189.
1947:
1943:
1939:
1932:
1929:
1924:
1920:
1915:
1910:
1906:
1902:
1899:(4): e10332.
1898:
1894:
1890:
1883:
1880:
1875:
1871:
1866:
1861:
1857:
1853:
1850:(2): e10287.
1849:
1845:
1841:
1834:
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1822:
1817:
1812:
1807:
1806:10.2196/34907
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1799:(2): e34907.
1798:
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1783:
1780:
1775:
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1766:
1761:
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1751:
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1739:
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1729:
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1704:10.2196/17026
1700:
1697:(3): e17026.
1696:
1692:
1688:
1681:
1678:
1673:
1669:
1664:
1659:
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1647:
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1637:
1632:
1628:
1624:
1620:
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1606:
1602:
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1594:
1591:(1): e10315.
1590:
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1567:
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1482:
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1437:
1433:
1426:
1423:
1418:
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1409:
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1377:
1374:
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1328:
1325:
1320:
1316:
1312:
1306:
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1282:
1277:
1273:
1269:
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1261:
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1242:
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1215:
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1207:
1203:
1199:
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1184:
1180:
1175:
1170:
1166:
1162:
1159:(1): e10255.
1158:
1154:
1150:
1143:
1140:
1135:
1131:
1126:
1121:
1117:
1113:
1110:(3): e10278.
1109:
1105:
1101:
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1091:
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1082:
1078:
1074:
1070:
1066:
1062:
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1017:
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970:
967:
962:
958:
954:
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923:
919:
913:
909:
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901:
900:
892:
889:
884:
880:
875:
870:
867:(7): 1171–7.
866:
862:
858:
851:
848:
843:
839:
835:
831:
827:
823:
820:(3): 207–10.
819:
815:
808:
805:
800:
796:
792:
788:
783:
778:
774:
770:
766:
759:
757:
755:
753:
749:
744:
737:
725:
707:
703:
697:
690:
689:
681:
679:
675:
663:
659:
655:
651:
645:
641:
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630:
626:
619:
615:
612:
611:
607:
605:
603:
594:
592:
590:
586:
582:
578:
574:
566:
564:
562:
558:
554:
550:
546:
545:AcademyHealth
542:
534:
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527:
523:
521:, Bronx, N.Y.
520:
516:
513:
509:
506:
502:
499:
495:
492:
488:
485:
481:
478:
474:
471:
468:
464:
463:
462:
459:
457:
452:
444:
440:
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432:
430:
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421:
418:
416:
413:
411:
408:
407:
406:
399:
394:
391:
388:
385:
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379:
376:
373:
370:
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366:
365:
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358:
356:
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331:
324:
322:
318:
314:
309:
305:
301:
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293:
286:
283:
281:
278:
276:
273:
270:
268:
265:
262:
260:
257:
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252:
249:
247:
246:Sutter Health
244:
242:
239:
237:
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232:
229:
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224:
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217:
214:
212:
209:
207:
204:
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199:
197:
194:
192:
189:
187:
184:
182:
179:
176:
174:
171:
169:
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164:Atrium Health
162:
161:
160:
156:
152:
145:
143:
139:
135:
128:
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120:
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108:
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56:
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41:
37:
32:
29:
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21:
2748:
2744:
2734:
2699:
2695:
2685:
2660:
2653:
2642:. Retrieved
2633:
2624:
2616:the original
2611:
2602:
2591:. Retrieved
2583:www.ohsu.edu
2582:
2573:
2562:. Retrieved
2548:
2537:. Retrieved
2523:
2512:. Retrieved
2498:
2487:. Retrieved
2479:www.ahrq.gov
2478:
2469:
2459:February 19,
2457:. Retrieved
2448:
2439:
2428:. Retrieved
2420:www.ahrq.gov
2419:
2410:
2375:
2371:
2361:
2324:
2320:
2310:
2275:
2271:
2231:
2227:
2221:
2184:
2180:
2170:
2137:
2133:
2127:
2092:
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