‘Learning Health System’ Requires Interoperable EHR, PHR Data

To achieve a national-scale “learning health system” for identifying and sharing best care practices, the industry must reach a level of data access, integration, and scalability that goes well beyond interoperability of electronic health record systems.

That is the conclusion of an independent group of scientists called JASON, published in a just-released report funded by the Agency for Healthcare Research and Quality. In addition to EHR data, the report argues it will be necessary to assimilate data from personal health records, personal health devices, patient collaborative networks, social media, environmental and demographic data, and “the burgeoning data streams that will soon become available through progress in genomics and other ‘omics.’”

According to JASON, the data layer for a learning health system “must also encompass these highly diverse forms of personal health information.” And, ostensibly, such a learning health system “would connect the medical system with broader societal inputs, creating important links between health and wellness and healthcare.”

However, the report concludes that currently there is “an inadequate feedback loop between healthcare outcomes and clinical research, reducing opportunities for further learning in this system” and that “population health research and community engagement are not adequately connected.”

The report provides the following finding and recommendation:

* The learning health system needs to be “closed loop” to ensure a continuous and transparent cycle of research, analysis, development, and adoption of improvements relevant to health and wellness and to the delivery of healthcare.

* Establishment of publicly available APIs to “bridge from existing systems to a future software ecosystem that can ingest, protect, integrate, and share the knowledge gained from the vast stores of data.”

Toward that end, the report notes the establishment of data interchange APIs for mobile health which are making the installed base of 140 million smartphones a “natural platform for collection, assimilation, and exchange of EHR and PHR data.”

Nonetheless, the independent group of scientists asserts that there remains a “critical need for open APIs for EHR systems to further open the entrepreneurial space” and in their view “any API that is exposed to EHR customers should also be exposed to the general application development ecosystem,” enabling increased partnerships among providers and empowering individuals to “increase their meaningful participation in their own health and wellness.”