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A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research.

Marsolo K, Margolis PA, Forrest CB, Colletti RB, Hutton JJ - EGEMS (Wash DC) (2015)

Bottom Line: Additional standards are needed in order for this vision to be achieved, however.We have successfully implemented a proof-of-concept Learning Health System while providing a foundation on which others can build.We have also highlighted opportunities where sponsors could help accelerate progress.

View Article: PubMed Central - PubMed

Affiliation: Cincinnati Children's Hospital Medical Center.

ABSTRACT

Introduction: We collaborated with the ImproveCareNow Network to create a proof-of-concept architecture for a network-based Learning Health System. This collaboration involved transitioning an existing registry to one that is linked to the electronic health record (EHR), enabling a "data in once" strategy. We sought to automate a series of reports that support care improvement while also demonstrating the use of observational registry data for comparative effectiveness research.

Description of architecture: We worked with three leading EHR vendors to create EHR-based data collection forms. We automated many of ImproveCareNow's analytic reports and developed an application for storing protected health information and tracking patient consent. Finally, we deployed a cohort identification tool to support feasibility studies and hypothesis generation. There is ongoing uptake of the system. To date, 31 centers have adopted the EHR-based forms and 21 centers are uploading data to the registry. Usage of the automated reports remains high and investigators have used the cohort identification tools to respond to several clinical trial requests.

Suggestions for future use: The current process for creating EHR-based data collection forms requires groups to work individually with each vendor. A vendor-agnostic model would allow for more rapid uptake. We believe that interfacing network-based registries with the EHR would allow them to serve as a source of decision support. Additional standards are needed in order for this vision to be achieved, however.

Conclusions: We have successfully implemented a proof-of-concept Learning Health System while providing a foundation on which others can build. We have also highlighted opportunities where sponsors could help accelerate progress.

No MeSH data available.


Landing Page for the RegistryNote: Users can access a variety of tools from this screen.
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Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4562738&req=5

f2-egems1168: Landing Page for the RegistryNote: Users can access a variety of tools from this screen.

Mentions: These requirements represent a higher-level abstraction of user needs that were identified through a strategic planning process undertaken by the leadership of ImproveCareNow and also elicited through e-mails, conference calls, and webinars with numerous clinicians within the network. Development occurred in an iterative process, with volunteers recruited from participating care centers to provide feedback, perform user acceptance testing, and make recommendations for additional features. Following the IHI Breakthrough Series model for improvement,29 ImproveCareNow holds networkwide in-person Learning Sessions twice a year, along with monthly webinars. Prior to deployment, major informatics developments were presented at either a Learning Session or a monthly webinar. Upon release, they were further discussed in targeted webinars or training sessions. As the informatics platform has matured, clinicians and coordinators within ImproveCareNow have been recruited to give presentations to their peers on how they have been able to successfully incorporate the tools into practice. All of the enhanced registry tools are accessible from the same front end screen, which is shown in Figure 2.


A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research.

Marsolo K, Margolis PA, Forrest CB, Colletti RB, Hutton JJ - EGEMS (Wash DC) (2015)

Landing Page for the RegistryNote: Users can access a variety of tools from this screen.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562738&req=5

f2-egems1168: Landing Page for the RegistryNote: Users can access a variety of tools from this screen.
Mentions: These requirements represent a higher-level abstraction of user needs that were identified through a strategic planning process undertaken by the leadership of ImproveCareNow and also elicited through e-mails, conference calls, and webinars with numerous clinicians within the network. Development occurred in an iterative process, with volunteers recruited from participating care centers to provide feedback, perform user acceptance testing, and make recommendations for additional features. Following the IHI Breakthrough Series model for improvement,29 ImproveCareNow holds networkwide in-person Learning Sessions twice a year, along with monthly webinars. Prior to deployment, major informatics developments were presented at either a Learning Session or a monthly webinar. Upon release, they were further discussed in targeted webinars or training sessions. As the informatics platform has matured, clinicians and coordinators within ImproveCareNow have been recruited to give presentations to their peers on how they have been able to successfully incorporate the tools into practice. All of the enhanced registry tools are accessible from the same front end screen, which is shown in Figure 2.

Bottom Line: Additional standards are needed in order for this vision to be achieved, however.We have successfully implemented a proof-of-concept Learning Health System while providing a foundation on which others can build.We have also highlighted opportunities where sponsors could help accelerate progress.

View Article: PubMed Central - PubMed

Affiliation: Cincinnati Children's Hospital Medical Center.

ABSTRACT

Introduction: We collaborated with the ImproveCareNow Network to create a proof-of-concept architecture for a network-based Learning Health System. This collaboration involved transitioning an existing registry to one that is linked to the electronic health record (EHR), enabling a "data in once" strategy. We sought to automate a series of reports that support care improvement while also demonstrating the use of observational registry data for comparative effectiveness research.

Description of architecture: We worked with three leading EHR vendors to create EHR-based data collection forms. We automated many of ImproveCareNow's analytic reports and developed an application for storing protected health information and tracking patient consent. Finally, we deployed a cohort identification tool to support feasibility studies and hypothesis generation. There is ongoing uptake of the system. To date, 31 centers have adopted the EHR-based forms and 21 centers are uploading data to the registry. Usage of the automated reports remains high and investigators have used the cohort identification tools to respond to several clinical trial requests.

Suggestions for future use: The current process for creating EHR-based data collection forms requires groups to work individually with each vendor. A vendor-agnostic model would allow for more rapid uptake. We believe that interfacing network-based registries with the EHR would allow them to serve as a source of decision support. Additional standards are needed in order for this vision to be achieved, however.

Conclusions: We have successfully implemented a proof-of-concept Learning Health System while providing a foundation on which others can build. We have also highlighted opportunities where sponsors could help accelerate progress.

No MeSH data available.