- Learning health systems use EHRs to support research and personalized treatments based on data from patients with similar conditions and risk factors.
According to Nationwide Children’s Hospital, the “Learn from Every Patient” (LFEP) program yielded evidence that with “the implementation of a ‘local’ learning health system, clinical quality can be improved while simultaneously reducing health care cost.”
Children participating in the study “experienced a 43 percent reduction in total inpatient days; a 27 percent reduction in inpatient admissions [and] a 30 patient reduction in emergency department visits.”
The program also proved efficient cost-wise. A year of the program cost approximately $225,000. Comparatively, Nationwide Children’s Hospital reported “these costs were only 16 percent of the reduced total health care expenditures realized during the first year of the program, representing a savings of approximately $6 for each $1 invested.
In addition, the clinicians working in the CP clinic reported that this approach simplified their documentation, enabling more patients to be seen during each session.”
William E. Smoyer, MD, credits the introduction of EHR-supported care for the reductions in health care utilization and charges.
LFEP also yielded “robust research data that can be used for publication and for implementing evidence-based improvements in clinical care,” said author Gary Noritz, MD, medical director of the Cerebral Palsy Program at Nationwide Children’s Hospital and associate professor at The Ohio State University.
While the localized program showed learning health systems are successful in optimizing patient care, expanding this kind of program nationwide is not presently supportable. Due to issues with interoperability, learning health systems have been scaled down.
“There are numerous future challenges related to demonstrating the potential value of using local learning health systems to develop a national adaptable learning health system,” says Dr. Smoyer. “We still need to investigate whether local learning health systems can be successfully scaled across the wide variety of clinical programs that comprise the nation’s health care systems.”
With improved EHR exchange, these local programs could grow in breadth and effectiveness.
Implementing interoperability is a high priority for providers and health industry organizations. The Office of the National Coordinator for Health Information Technology (ONC) is making steps toward implementing the program at the federal level. The ONC Roadmap for nationwide interoperability was established in 2014 with the goal of paving the way for a nationwide learning health system.
ONC envisions the learning health system as “an environment that links the care delivery system with communities and societal supports in "closed loops" of electronic health information flow, at many different levels, to enable continuous learning and improved health.”
According to the roadmap, ONC’s 10-year plan aims to share EHR with health providers in a manner that is “appropriate, secure, timely, and reliable.”
Healthcare organizations have already begun making strides toward interoperability. Surescripts, in collaboration with Carequality, launched their National Record Locator System, which has so far grown to cover over 140 million patients.
Several major healthcare organizations, including Cedars-Sinai in the Greater Los Angeles area and Sutter Health in Northern California, have already gone live with the service. Surescripts intends to continue expanding to other health care organizations in the future, offering NRLS free of charge to all healthcare providers until 2019 as incentive for new members to jump on board.
NGA similarly posted a roadmap equipping states with information to improve health data exchange between providers at a state level.
NGA addresses issues with interoperability from both legal and market perspectives. Outlining solutions to the multipronged challenges of health data exchange allows states to take matters into their own hands instead of relying on federal organizations to spearhead the efforts toward interoperability.
The journey toward nationwide interoperable learning health systems is well underway. While significant challenges still remain, industry stakeholders are working toward surmounting the obstacles keeping providers from true interoperability.