Demonstrating the learning health system through practical use cases.

Abstract

* Abbreviations: LHS — : learning health system QI — : quality improvement The study by Forrest et al1 on the evaluation of the effectiveness of anti-tumor necrosis factor (TNF)-α for Crohn disease has as its subtitle “Research in a Pediatric Learning Health System.” A quick review of the article and its abstract suggests that this is an exploration of anti-TNF-α; in reality, it is an exploration of the practical applicability of a learning health system (LHS) model to meaningfully generate generalizable knowledge. In techno-speak we would call this article a “use case,” a term derived from software and systems engineering; this is an attempt to develop, demonstrate, and refine the methods and application of LHS principles, data, and analytic techniques within the context of a practical real-world example. First, what is an LHS? According to the Institute of Medicine, an LHS is an organization in which “science, informatics, incentives, and culture are aligned for continuous improvement and innovation—with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.”2 Practically, the LHS is an environment in which the results and outcomes of clinical decisions and care for patients informs best practices and new research directions simultaneously. In an LHS, the care of an individual patient is informed by the care of similar patients before her or him, and her or his care is reinvested into … Address correspondence to Amy P. Abernethy, MD PhD, Duke University Medical Center, Box 3436, Durham, NC 27710. E-mail: amy.abernethy{at}duke.edu