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. 2022 May 20;7(1):e10315.
doi: 10.1002/lrh2.10315. eCollection 2023 Jan.

A framework for understanding, designing, developing and evaluating learning health systems

Tom Foley  1 , Luke Vale  2
Affiliations

A framework for understanding, designing, developing and evaluating learning health systems

Tom Foley et al. Learn Health Syst. .

Abstract

Introduction: A Learning Health System is not a technical project. It is the evolution of an existing health system into one capable of learning from every patient. This paper outlines a recently published framework intended to aid the understanding, design, development and evaluation of Learning Health Systems.

Methods: This work extended an existing repository of Learning Health System evidence, adding five more workshops. The total was subjected to thematic analysis, yielding a framework of elements important to understanding, designing, developing and evaluating Learning Health Systems. Purposeful literature reviews were conducted on each element. The findings were revised following a review by a group of international experts.

Results: The resulting framework was arranged around four questions:What is our rationale for developing a Learning Health System?There can be many reasons for developing a Learning Health System. Understanding these will guide its development.What sources of complexity exist at the system and the intervention level?An understanding of complexity is central to making Learning Health Systems work. The non-adoption, abandonment, scale-up, spread and sustainability framework was utilised to help understand and manage it.What strategic approaches to change do we need to consider?A range of strategic issues must be addressed to enable successful change in a Learning Health System. These include, strategy, organisational structure, culture, workforce, implementation science, behaviour change, co-design and evaluation.What technical building blocks will we need?A Learning Health System must capture data from practice, turn it into knowledge and apply it back into practice. There are many methods to achieve this and a range of platforms to help.

Discussion: The results form a framework for understanding, designing, developing and evaluating Learning Health Systems at any scale.

Conclusion: It is hoped that this framework will evolve with use and feedback.

Keywords: implementation science; informatics; learning health systems; learning healthcare systems; quality improvement.

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Conflict of interest statement

Prof Luke Vale has no conflicts of interest to report. Dr Tom Foley has been commissioned by Health Education England to apply the framework to their efforts to become part of a national Learning Health System.

Figures

FIGURE 1
FIGURE 1
The Learning Health System Framework
FIGURE 2
FIGURE 2
Rationale for a Learning Health System
FIGURE 3
FIGURE 3
Sources of complexity in a Learning Health System (based on NASSS Framework)
FIGURE 4
FIGURE 4
Strategic approaches to change in a Learning Health System
FIGURE 5
FIGURE 5
Technical building blocks of a Learning Health System
See this image and copyright information in PMC

References

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    1. McGinnis JM, Stuckhardt L, Saunders R, Smith M. Best Care at Lower Cost: the Path to Continuously Learning Health Care in America. Washington (DC): National Academies Press; 2013. - PubMed
    1. University of Michigan . Revolutionizing Learning, Transforming Health. University of Michigan. https://medicine.umich.edu/dept/learning-health-sciences.

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