Abstract
BackgroundLearning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions.MethodsWe completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature.ResultsWe reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research.ConclusionsWe identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.
Highlights
Learning health systems have been gaining traction over the past decade
We identified three network of networks, where two of these – the Healthcare Systems Research Network (HCSRN) and the High Value Healthcare Collaborative (HVHC) – each consists of 19 different healthcare systems across the United States, and Optum Labs which standardizes Electronic Health Records (EHRs) data from across 52 health systems in the United States [13, 14, 72]
Challenges and potential solutions The learning health system (LHS) included in this review identified challenges that they experienced or anticipated and potential solutions to these challenges in regards to data standardization or quality, ease of data access and use, financial sustainability, promoting a culture of learning, involvement of patients and the community, consistency across different sites within the same organization, prioritization of learning initiatives, the use of EHRs for quality improvement, and the move toward embedding evaluation and implementation of improved practices into usual care rather than traditional research projects (Table 2)
Summary
Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Budrionis and Bellika (2016) completed the most recent systematic review on LHSs and found 13 papers that described implementation of an LHS [8]. They categorized these into clinical data reuse (nine), Nash et al BMC Fam Pract (2021) 22:126 patient-reported outcomes (three), and collaborative learning (one). Most of these LHSs were in the hospital setting, and it’s not clear how many included primary care [8]. The primary care setting is both an opportune yet challenging setting to develop an LHS
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