Learning system aims to cut education cycle by years
We live in a time when X-rays are delivered to clinicians within minutes and text messages deliver diagnostic alerts within seconds. And yet the time required for the learning cycle to play out is being measured in months.
Rebecca Kush, founder and president of Clinical Data Standards Consortium (CDSC), told the audience at the session “Achieving a Functioning Learning Health System by 2024 – The Challenges and Benefits of a Successful Journey” that the length of time it takes for an initial medical finding to make its way through the complete cycle of learning is 17 years.
It’s a situation that Kush labelled “unacceptable” as she outlined the causes. Data sharing among physicians is not good. Research and healthcare operate in separate worlds. And even as EHR use is increasing, it is not used prospectively for research; data from the EHR is often re-entered when doing research.
A solution is being developed by the Learning Health Community, a self-organizing multi-stakeholder coalition. It currently has 70 organizations endorsing its Core Values, including GE Healthcare, GlaxoSmithKline, Epic and leading hospitals and universities. The work has been organized into a framework – called Essential Standards to Enable Learning or ESTEL – that will break down some of the silos that slow down the educational process.
The goal for ESTEL is to define a minimum core set of standards to enable a standards-based and scalable learning health system that will ease the burden of clinicians. When possible, existing standards will be supported, such as HL7 data-interoperability guidelines and Consolidated-Clinical Document Architecture (C-CDA).
Holt Anderson, chair, Learning Health System Governance & Policy Framework Initiative at Learning Health Strategies, emphasized “this learning system will be a structured, multi-stakeholder, multi-party agreement.”
“How do we set up reciprocity?” he said. “Control of data is very precious to people. How do we encourage someone with a new advance to put it into the knowledge base? How do we sanction someone who steps out of line?”
Ricky Bloomfield, MD, director of mobile technology strategy for Duke Health, gave the perspective of a busy clinician. He described situations in his medical practice where he is looking for the most advanced treatments and wishes there were a way to get the information to the clinical level. He is optimistic that a combined learning health system is how we’re going to speed delivery of research to clinicians.
“The fix for the learning health system is partly government, partly medicine and partly technology. But unless we are motivated to fix this, it will never work,” he said.
Bloomfield pointed out that technology companies like Google, Facebook and Apple have been active in setting standards for health records that are open to developers. He also urged the audience to learn more about Smart + FHIR. “If you don’t know about it you need to stop and go learn about it.”