learning health: foundations, future, and provocations23rd annual conference september 11-12, 2017...
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23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Learning Health: Foundations, Future, and Provocations
Erich Huang, MD, PhD and Shelley Rusincovitch, MMCiMonday, September 11, 2017, 9:15–10:00 AM
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
In this session, the presenters will discuss the foundations and context of learning health systems, including background and relevance to interoperability, evidence generation, bridging of healthcare and research, systems-level improvement, population health, and levels of scale from local to national.
They will also pose ten provocative questions about learning health and future potential intended to fuel thought, engagement, and creativity from the attendees.
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Disclosures
• Erich Huang:– Founder, kelaHealth (Startup)– Founder, Stratus Medicine (Startup)
• Shelley Rusincovitch has no disclosures to report
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Today’s outline
• Foundations of Learning Health• What Can Learning Health Learn from
Data Science?• Provocations• Discussion
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Foundations of Learning Health
Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary (2011)https://www.nap.edu/catalog/12912/digital-infrastructure-for-the-learning-health-system-the-foundation-for
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Landscape
• LHS is responsive to new capabilities and rapidly-evolving capacity– EHR adoption (accelerated by Meaningful
Use)– Potential benefit from repurposing data– Recognizing where healthcare lags behind
state of the art in other industries
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Scale
• National• Networks• Cross-institutional• Regional• Local• Hyper-local
Current Initiatives Leading to an LHS Capability Include:
LHS = “Network of networks that connects islands of expertise”
The Core Values Underlying a National-Scale, Person-Centered, Continuous-Learning Health System (LHS)
1. Person-Focused
2. Privacy
3. Inclusiveness
4. Transparency
5. Accessibility
6. Adaptability
7. Governance
8. Cooperative and Participatory Leadership
9. Scientific Integrity
10.Value
PCORnet® : the National Patient-Centered Clinical Research Network
An innovative initiative funded by the Patient-Centered Outcomes Research Institute (PCORI), PCORnet is a large, highly representative, national patient-centered clinical research network.
Our vision is to support a learning U.S. healthcare system and to enable large-scale clinical research conducted with enhanced quality and efficiency.
Our mission is to enable people to make informed healthcare decisions by efficiently conducting clinical research relevant to their needs.
11
Resulting in a national evidence system with unparalleled research readiness
12
For clinical trials
For observational studies
MissingWhite Non-White
Female Male
Missing
22–64 65+0–4
57,000,000122,000,000
5–14 15–21
Pool of patients
Race
Sex
Age
PCORnet represents:
~122 million patientswho have had a medical encounter
in the past 5 years *some individuals may have visited more than one Network
Partner and would be counted more than once
http://onlinelibrary.wiley.com/doi/10.1002/lrh2.10018/full
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
IntentLHS exists as a concept to address challenges• Close the gap with evidence applications• Improve quality• Create continuous systems• Reduce barriers between research and practice• Population health: reaching beyond one patient at a
time• Respect the engagement and autonomy of patients
and caregivers• Recognize the challenges in clinical practice and
difficulties in implementation• Create a system-level appreciation and synergy
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Methods
• LHS draws upon existing knowledge and components, but seeks to apply efficiently and at scale.– Competencies– Learning from technology and data science
https://www.ncbi.nlm.nih.gov/pubmed/28777456
Domains:1. Systems Science2. Research Questions and
Standards of Scientific Evidence
3. Research Methods4. Informatics5. Ethics of Research and
Implementation in Health Systems
6. Improvement and Implementation Science
7. Engagement, Leadership, and Research Management
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
What Can Learning Health Learn from Data Science?
COST CONSTRAINTSIMPLEMENTATIONDATA-DRIVEN
Inpatient AdmissionsOutpatient Visits
Surgeries/EndoscopiesER visits
Hospital Labs
63,3121,280,51485,24866,8605,428,178
Necessary butnot sufficient
… IT’S STILL EARLY IN THE EVOLUTION…
< 1 pound
inference
population &precision healthapplications
EHR
“5 Tool Player”
“Catcher with a bad elbow converted to 1st baseman”
IDENTIFYING PREVIOUSLY HIDDEN VALUE
AN ACADEMIC HEALTH SYSTEM THAT LEARNS
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
Academic Glory
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
Academic Glory
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
Academic Glory
Academic Glory Academic Glory
SCALABLE?IMPLEMENTABLE?
SERVICE SERVICE
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
INTEGRATED APPLICATIONS
SERVICE SERVICE
INTEGRATED APPLICATIONS
{DATA SCIENCE
SERVICE SERVICE
INTEGRATED APPLICATIONS{DATA SCIENCE
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
Novel Platform
Compute Stack
Data Stack
Application Stack
Output
HARDENING
Knowledge among computer scientists about how to think of and approach the analysis of data is limited, just as the knowledge of computing environments by statisticians is limited. A merger of the knowledge bases would produce a powerful force for innovation.
—Bill Cleveland on Data Science (2001)
academicexercise
real world implementation
DUKE HEALTH DATA SCIENCE
NIGHTMARE #1
Book of Genesis
8 — “Therefore its name is called Babel,
because there the Lord confused the
language of all the earth; and from there the
Lord scattered them abroad over the face of
all the earth.”
http://spectrum.ieee.org/computing/software/the-2016-top-programming-languages
BTW: MUMPS/Cache isn’t even a blip
‘“Well Frank, now that you've discovered that I was correct about patient monitoring, what are you going to do with all this expensive computer equipment we bought you".
I looked at those steely blue eyes and said that I needed his help. He recommended that I learn some medicine, so that I would be better prepared to support doctors in what they did, instead of what they said they did.”’
—Frank Starmer
https://opensource.com/article/17/6/duke-university-using-containers-and-devops
DevOps and Continuous Integration
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Provocations
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
First Provocations (with thanks to Ed Hammond)
1. Can learning healthcare exist with only a single patient?2. Can we achieve learning health without first understanding the clinical setting?3. Are we any good at understanding a healthy state?4. What does learning health not encompass?5. Do we have the necessary standards available to achieve true comparability of data?
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Second Provocations (with thanks to Ed Hammond)
6. Why is learning health any different from any other initiative?7. If you only write a paper about it, how does it count as learning health?8. Are tomorrow’s quality measures going to be adequate to measure learning health?9. Is the current state of technology ready for learning health?10. Is learning health ready to insert itself into a torrent of change and rapid evolution?
“What we do is fall in love with words. But instead we should be thinking: What do we want to accomplish?”
—Ed Hammond
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Continuing the conversationVisit the website for the Duke Center for Health Data Science:
https://healthdatascience.duke.edu
Download these slides on GitHub:https://github.com/rusincovitch/portfolio
Tweet at us:@erichhuang and @rusincovitch
Drop us an e-mail:[email protected] / [email protected]
23rd Annual ConferenceSeptember 11-12, 2017Durham Convention Center
Contact Information
Shelley Rusincovitch, MMCiInformatics Architect
Duke Clinical and Translational Science Institute (CTSI)
Twitter: @rusincovitch
LinkedIn: @rusincovitch
Erich Huang, MD, PhDAssistant Dean of Biomedical Informatics
Duke University School of Medicine
Twitter: @erichhuang
LinkedIn: @erichhuang