Excerpt

The Learning Healthcare System is the first formal product of the Institute of Medicine (IOM) Roundtable on Evidence-Based Medicine. It is a summary of a two-day workshop held in July 2006, convened to consider the broad range of issues important to reengineering clinical research and healthcare delivery so that evidence is available when it is needed, and applied in health care that is both more effective and more efficient than we have today. Embedded in these pages can be found discussions of the myriad issues that must be engaged if we are to transform the way evidence is generated and used to improve health and health care—issues such as the potential for new research methods to enhance the speed and reliability with which evidence is developed, the standards of evidence to be used in making clinical recommendations and decisions, overcoming the technical and regulatory barriers to broader use of clinical data for research insights, and effective communication to providers and the public about the dynamic nature of evidence and how it can be used. Ultimately, our hope and expectation are that the process of generating and applying the best evidence will be natural and seamless components of the process of care itself, as part of a learning healthcare system.

Contents

• The National Academies
• Roundtable on Evidence-Based Medicine
• Reviewers
• Institute of Medicine Roundtable on Evidence-Based Medicine
• Foreword
• Preface
• Summary
  • About the Workshop
  • THE LEARNING HEALTHCARE SYSTEM WORKSHOP
  • PRESENTATION SUMMARIES
  • REFERENCES
• 1. Hints of a Different Way—Case Studies in Practice-Based Evidence
  • OVERVIEW
  • COVERAGE WITH EVIDENCE DEVELOPMENT
  • USE OF LARGE SYSTEM DATABASES
  • QUASI-EXPERIMENTAL DESIGNS FOR POLICY ASSESSMENT
  • PRACTICAL CLINICAL TRIALS
  • COMPUTERIZED PROTOCOLS TO ASSIST CLINICAL RESEARCH
  • REFERENCES
• 2. The Evolving Evidence Base—Methodologic and Policy Challenges
  • OVERVIEW
  • EVOLVING METHODS: ALTERNATIVES TO LARGE RANDOMIZED CONTROLLED TRIALS
  • EVOLVING METHODS: EVALUATING MEDICAL DEVICE INTERVENTIONS IN A RAPID STATE OF FLUX
  • EVOLVING METHODS: MATHEMATICAL MODELS TO HELP FILL THE GAPS IN EVIDENCE
  • HETEROGENEITY OF TREATMENT EFFECTS: SUBGROUP ANALYSIS
  • HETEROGENEITY OF TREATMENT EFFECTS: PHARMACOGENETICS
  • BROADER POST-MARKETING SURVEILLANCE FOR INSIGHTS ON RISK AND EFFECTIVENESS
  • ADJUSTING EVIDENCE GENERATION TO THE SCALE OF EFFECTS
  • HIPAA AND CLINICAL RESEARCH: PROTECTING PRIVACY
  • PROTECTING PRIVACY WHILE LINKING PATIENT RECORDS
  • REFERENCES
• 3. Narrowing the Research-Practice Divide—Systems Considerations
  • OVERVIEW
  • FEEDBACK LOOPS TO EXPEDITE STUDY TIMELINESS AND RELEVANCE
  • ELECTRONIC HEALTH RECORDS AND EVIDENCE-BASED PRACTICE
  • STANDARDS OF EVIDENCE
  • IMPLICATIONS FOR ACCELERATING INNOVATION
  • REFERENCES
• 4. New Approaches—Learning Systems in Progress
  • OVERVIEW
  • IMPLEMENTATION OF EVIDENCE-BASED PRACTICE IN THE VA
  • PRACTICE-BASED RESEARCH NETWORKS
  • NATIONAL QUALITY IMPROVEMENT PROCESS AND ARCHITECTURE
  • ENVISIONING A RAPID LEARNING HEALTHCARE SYSTEM
  • REFERENCES
• 5. Developing the Test Bed—Linking Integrated Service Delivery Systems
  • OVERVIEW
  • NIH AND REENGINEERING CLINICAL RESEARCH
  • AHRQ AND THE USE OF INTEGRATED SERVICE DELIVERY SYSTEMS
  • THE HMO RESEARCH NETWORK AS A TEST BED
  • COUNCIL OF ACCOUNTABLE PHYSICIAN PRACTICES
  • REFERENCES
• 6. The Patient as a Catalyst for Change
  • OVERVIEW
  • THE INTERNET, eHEALTH, AND PATIENT EMPOWERMENT
  • JOINT PATIENT-PROVIDER MANAGEMENT OF THE ELECTRONIC HEALTH RECORD
  • EVIDENCE AND SHARED DECISION MAKING
  • REFERENCES
• 7. Training the Learning Health Professional
  • OVERVIEW
  • CLINICIANS AND THE ELECTRONIC HEALTH RECORD AS A LEARNING TOOL
  • EMBEDDING AN EVIDENCE PERSPECTIVE IN HEALTH PROFESSIONS EDUCATION
  • KNOWLEDGE TRANSLATION: REDEFINING CONTINUING EDUCATION AROUND EVOLVING EVIDENCE
  • REFERENCES
• 8. Structuring the Incentives for Change
  • OVERVIEW
  • OPPORTUNITIES FOR PRIVATE INSURERS
  • OPPORTUNITIES FOR CMS
  • OPPORTUNITIES FOR PHARMACEUTICAL COMPANIES
  • OPPORTUNITIES FOR STANDARDS ORGANIZATIONS
  • REFERENCES
• Appendixes
  • Appendix A. Workshop Agenda
  • Appendix B. Biographical Sketches of Participants
  • Appendix C. Workshop Attendee List
  • Appendix D. IOM Roundtable on Evidence-Based Medicine

Suggested citation:

Institute of Medicine (IOM). 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.