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BMC Medicine
Published in: BMC Medicine 1/2017

Open Access 01-12-2017 | Correspondence

Can learning health systems help organisations deliver personalised care?

Authors: Bright I. Nwaru, Charles Friedman, John Halamka, Aziz Sheikh

Published in: BMC Medicine | Issue 1/2017

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Abstract

There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Although reliant on similar policies, informatics tools, and data science and implementation research capabilities, these two major initiatives have thus far largely progressed in parallel. In this opinion piece, we argue that they should be considered as complementary, synergistic initiatives whereby the creation of learning health systems infrastructure can support and catalyse the delivery of precision medicine that maximises the benefits and minimises the risks associated with treatments for individual patients. We illustrate this synergy by considering the example of treatments for asthma, which is now recognised as an umbrella term for a heterogeneous group of related conditions.
Literature
1.
Auffray C, Caulfield T, Griffin JL, Khoury MJ, Lupski JR, Schwab M. From genomic medicine to precision medicine: highlights of 2015. Genome Med. 2016;8:12.CrossRefPubMedPubMedCentral
2.
Green ED, Guyer MS. Charting a course for genomic medicine from base pairs to bedside. Nature. 2011;470:204–13.CrossRefPubMed
3.
International HapMap Consortium. The international HapMap project. Nature. 2003;426:789–96.CrossRef
4.
Mogensen J, van Tintelen JP, Fokstuen S, Elliot P, van Langen IM, Meder B, et al. The current role of next-generation DNA sequencing in routine care of patients with hereditary cardiovascular conditions: a viewpoint paper of the European Society of Cardiology working group on myocardial and pericardial diseases and members of the European Society of Human Genetics. Eur Heart J. 2015;36:1367–70.CrossRefPubMed
5.
6.
7.
Khoury MJ, Evans JE. A public health perspective on a national precision medicine cohort: balancing long-term knowledge generation with early health benefit. JAMA. 2015;313:2117–8.CrossRefPubMedPubMedCentral
8.
Jameson JL, Longo DL. Precision medicine — personalized, problematic, and promising. N Engl J Med. 2015;372:2229–34.CrossRefPubMed
9.
Brewington JJ, McPhail GL, Clancy JP. Lumacaftor alone and combined with ivacaftor: preclinical and clinical trial experience of F508del CFTR correction. Expert Rev Respir Med. 2016;10:5–17.CrossRefPubMed
10.
Rehman A, Baloch NU, Janahi IA. Lumacaftor-ivacaftor in patients with cystic fibrosis homoqygous for Phe508del CFTR. N Engl J Med. 2015;373:1783.CrossRefPubMed
11.
Lindeman NI, Cagle PT, Beasley MB, Chitale DA, Dacic S, Giaccone G, et al. Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Canceer, and Association for Molecular Pathology. J Thorac Oncol. 2013;8:823–59.CrossRefPubMedPubMedCentral
12.
Blumenthal G. Next-generation sequencing in oncology in the era of precision medicine. JAMA Oncol. 2015;2:13–4.CrossRef
13.
Antman EM, Loscalzo J. Precision medicine in cardiology. Nature Rev Cardiol. 2016;13:591–602.CrossRef
14.
15.
Darcy AM, Louie AK, Roberts LW. Machine learning and the profession of medicine. JAMA. 2016;315:551–2.CrossRefPubMed
16.
Parikh RB, Kakad M, Bates DW. Integrating predictive analytics into high-value care: the dawn of precision delivery. JAMA. 2016;315:651–2.CrossRefPubMed
17.
18.
19.
Dzau VJ, Ginsburg GS. Realizing the full potential of precision medicine in health and health care. JAMA. 2016;316:1659–60.CrossRefPubMed
20.
Chambers DA, Feero WG, Khoury MJ. Convergence of implementation science, precision medicine, and the learning health care system: a new model for biomedical research. JAMA. 2016;315:1941–2.CrossRefPubMed
21.
Friedman CP, Wong AK, Blumenthal D. Achieving a nationwide learning health system. Sci Transl Med. 2010;2:57cm29.CrossRefPubMed
22.
Friedman C, Rigby M. Conceptualising and creating a global learning health system. Int J Med Inform. 2013;82:e63–71.CrossRefPubMed
23.
Bernstein JA, Friendman C, Jacobson P, Rubin JC. Ensuring public health’s future in a national-scale learning health system. Am J Prev Med. 2015;48:480–7.CrossRefPubMed
24.
Friedman C, Rubin J, Brown J, Buntin M, Corn M, Eheredge L, et al. Toward a science of learning systems: a research agenda for the high-functioning Learning Health System. J Am Med Inform Assoc. 2015;22:43–50.PubMed
25.
van Staa TP, Dyson L, McCann G, Padmanabhan S, Belatri R, Goldacre B, et al. The opportunities and challenges of pragmatic point-of-care randomized trials using routinely collected electronic records: evaluations of two exemplar trials. Health Technol Assess. 2014;18(43):1–146.PubMedPubMedCentral
26.
Williams JG, Cheung WY, Cohen DR, Hutchings HA, Longo MF, Russell IT. Can randomised trials rely on existing electronic data? A feasibility study to explore the value of routine data in health technology assessment. Health Technol Assess. 2003;7:1–117.CrossRef
27.
Grant A, Ure J, Nicolson DJ, Hanley J, Sheikh A, McKinstry B, et al. Acceptability and perceived barriers and facilitators to creating a national research register to enable ‘direct to patient’ enrolment into research: the Scottish Health Research Register (SHARE). BMC Health Serv Res. 2013;13:422.CrossRefPubMedPubMedCentral
28.
Nwaru BI, Soyiri IN, Simpson CR, Griffiths C, Sheikh A. Building a recruitment database for asthma trials: a conceptual framework for the creation of the UK Database of Asthma Research Volunteers. Trials. 2016;17:264.CrossRefPubMedPubMedCentral
29.
Pronovost PJ, Mathews SC, Chute CG, Rosen A. Creating a purpose-driven learning and improving health system: the Johns Hopkins Medicine quality and safety experience. Learn Health Sys. 2017;1:e10018.CrossRef
30.
Cleghorn GD, Headrick LA. The PDSA cycle at the core of learning in health professions education. Jt Comm J Qual Improv. 1996;22:206–12.PubMed
31.
Leis JA, Shojania KG. A primer on PDSA: executing plan-do-study-act cycles in practice, not just in name. BMJ Qual Saf. 2017;26:572–7.CrossRefPubMed
32.
Friedman CP, Rubin JC, Sullivan KJ. Toward an information infrastructure for Global Health Improvement. Yearb Med Inform. 2017;26:16–7.CrossRef
33.
Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379:1310–9.CrossRefPubMed
34.
British Thoracic Society and Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma: a national clinical guideline. Edinburgh: Healthcare Improvement Scotland; 2016.
35.
Hood L, Friend SH. Predictive, personalized, preventive, participatory (P4) cancer medicine. Nat Rev Clin Oncol. 2011;8:184–1.87.CrossRefPubMed
36.
Flores M, Glusman G, Brogaard K, Price ND, Hood L. P4 medicine: how systems medicine will transform the healthcare sector and society. Per Med. 2013;10:565–76.CrossRefPubMedPubMedCentral
37.
Hood L, Flores M. A personal view on systems medicine and the emergence of proactive P4 medicine: predictive, preventive, personalized and participatory. N Biotechnol. 2012;29:613–24.CrossRefPubMed
38.
39.
40.
Muraro A, Lemanske RF, Hellings PW, Akdis CA, Bieder T, Casale TB, et al. Precision medicine in patients with allergic diseases: airway diseases and atopic dermatitis — PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2016;137:1347–58.CrossRefPubMed
41.
King HY, DeKrfuyff RH, Umetsu DT. The many paths to asthma: phenotype shaped by innate adaptive immunity. Nat Immunol. 2010;11:557–84.
42.
Borish L, Culp JA. Asthma: a syndrome composed of heterogeneous diseases. Ann Allergy Asthma Immunol. 2008;101:1–8.CrossRefPubMed
43.
Bonfield TL, Ross KR. Asthma heterogeneity and therapeutic options from the clinic to bench. Curr Opin Allergy Clin Immunol. 2012;12:60–7.CrossRefPubMed
44.
Steilling K, Christenson SA. Targeting ‘types: precision medicine in pulmonary disease. Am J Respir Crit Care Med. 2015;191:1093–4.CrossRef
45.
Kersten ETG, Koppelman GH. Pharmacogenetics of asthma: toward precision medicine. Curr Opin Pulm Med. 2017;23:12–20.CrossRefPubMed
46.
47.
48.
Fisher ES, Shortell SM, Savitz LA. Implementation science: a potential catalyst for delivery system reform. JAMA. 2016;315:339–40.CrossRefPubMed
49.
Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43:337–50.CrossRefPubMedPubMedCentral
50.
Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Bunger AC, Glass JE, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69:123–57.CrossRefPubMed
51.
Ginsburg G. Medicial genomics: gather and use genetic data in healthcare. Nature. 2014;508:451–3.CrossRefPubMed
52.
Taitsman JK, Grimm CM, Agrawal S. Protecting patient privacy and data security. N Engl J Med. 2013;368:977–9.CrossRefPubMed
53.
Harvey A, Brand A, Holgate ST, Kristiansen LV, Lehrach H, Palotie A, et al. The future of technologies for personalized medicine. N Biotechnol. 2012;29:625–33.CrossRefPubMed
54.
Gostin LO, Turek-Bresina J, Powers M, Kozloff R, Faden R, Steinauer DD. Privacy and security of personal information in a New Health Care System. JAMA. 1993;270(20):2487–93.CrossRefPubMed
55.
Eisenberg JNS, Desai MA, Levy K, Bates SJ, Liang S, Naumoff K, et al. Environmental determinants of infectious disease: a framework for tracking causal links and guiding public health research. Environ Health Perspect. 2007;115:1216–23.CrossRefPubMedPubMedCentral
56.
Gomez GB, Campos PE, Buendia C, Carcamo CP, Garcia PJ, Segura P, et al. Studying complex interactions among determinants of healthcare-seeking behaviours: self-medication for sexually transmitted infection symptoms in female sex workers. Sex Transm Infect. 2010;86:285–91.CrossRefPubMed
57.
Friedman CP, Rubin JC, Sullivan KJ. Toward an information infrastructure for Global Health Improvement. Yearb Med Inform. 2017;26:16–23.
58.
Chambers DA, Feero WG, Khoury MJ. Convergence of Implementation Science, Precision Medicine, and the Learning Health Care System: A New Model for Biomedical Research. JAMA. 2016;315(18):1941–2. doi10.​1001/​jama.​2016.​3867.
Metadata
Title
Can learning health systems help organisations deliver personalised care?
Authors
Bright I. Nwaru
Charles Friedman
John Halamka
Aziz Sheikh
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2017
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-017-0935-0

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