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This site is a collaborative workspace. Enclosed DRAFT content is not vetted or approved by AHRQ or others.

Introduction to the ACTS Learning Health System (LHS) Concept Demonstration

AHRQ and many other public and private organizations provide invaluable research, evidence, and resources to a broad range of healthcare stakeholders. At AHRQ, this information is currently spread across many different websites and is not computable, making it hard for users and tools to find what they need to support their role in optimizing population health and care outcomes.

Ideally, evidence on a clinical topic from AHRQ and other sources could be seamlessly combined in ways that flow smoothly to support guidance development on the topic. Guidance would be delivered through tools to support decisions and actions throughout the LHS cycle.

To evaluate the opportunity for AHRQ and others to provide offerings in ways that better meet stakeholder needs and accelerate progress toward shared healthcare improvement goals, the agency established the AHRQ evidence-based Care Transformation Support (ACTS) initiative. The core ACTS deliverable is a roadmap to achieve a 10-year shared future vision for evidence-based care delivery. This vision focuses on building a robust knowledge ecosystem and creating and implementing the needed reference architecture (including interoperability standards and specifications).

What should a learning health system look like, and how do we make them commonplace?

ACTS Concept Demonstration Goals

Show care delivery future vision supported by an effective learning health system (LHS) cycle that realizes the quintuple aim and addresses urgent healthcare needs

Highlight elements of future vision already in place (e.g., tools, standards, collaborations, etc.), where the gaps are, and recommended next steps

Encourage stakeholders to leverage concept demonstration materials (e.g., patient journey and service blueprint templates) to advance their care transformation and LHS efforts

Expand Collaboration on high priority improvement imperatives (related to specific acute and chronic diseases and prevention targets) to focus near-term ecosystem development

Foster commitments from key public and private organizations to continue funding and coordination to drive these next steps

Increase stakeholder engagement to accelerate progress toward achieving the future vision (41 ACTS support letters already received)

The Importance of the Vision Detailed in the ACTS Initiative

The lack of access to actionable evidence leads to unnecessary morbidity, mortality, and waste.

  • We don’t put evidence about care into practice efficient or effectively
  • We cannot easily learn from care results to drive continuous improvement
  • We lack computable, interoperable information and tools to solve this issue

A disjointed information ecosystem leads to:

The vision and roadmap created through the ACTS program provides AHRQ and other stakeholders with detailed information to shape the path forward.

The Solution: An Evidence-Driven Learning Health System

A learning health system will be driven by a series of tools and resources that will feed the continuous care improvement loop. These tools and resources will be based upon common standards, reference architectures, and will require governance and collaboration mechanisms to promote industry-wide information sharing.

Care Delivery Future Vision

Patients and care teams will interact with multiple tools that support better care and engagement. In a learning health system, each of these tools will be supported by a constant infusion of new evidence and information.

This proposed structure is based on three guiding principles:

  1. Make it easy to get information/tools to optimize decisions, action, and outcomes
  2. Embed continuous learning to engage the workforce/patients/families
  3. Feed care results seamlessly back to evidence, quality improvement, and guidance.

Once we have a suite of tools infused with the most recent healthcare evidence, then patients, care teams, and populations will experience coordinated, efficient care.

A Framework for Optimizing Health and Care Activities: The Patient Journey & Service Blueprint Template

With support from the VA Human Factors Engineering Team, the ACTS Initiative is building the Patient Journey & Service Blueprint (DRAFT) template as a tool foundational tool for reengineering care processes so they can deliver the quintuple aim.

The template covers the full continuum of care, and illustrates specific ways technology and evidence can be applied to improve key health and care decisions, actions and outcomes. Although still in development, the VA is beginning to explore leveraging this template in its quality improvement efforts, as are other care delivery organizations and other stakeholders. Having multiple organizations using the same template in their care transformation efforts can foster cross-fertilization that accelerates local quality improvement efforts and enhancements to the knowledge ecosystem.

The Patient Journey & Service Blueprint (DRAFT) details each step in an individual's health care journey, and the activities, interactions, and tools to optimize these steps. Beneath these steps are the many behind the scenes activities and technologies that quality improvement teams in care delivery organizations need to address to support the health and care journey.

The following graphic shows the level of detail currently included in the blueprint for each type of care setting.

To view the full Patient Journey and Service Blueprint prototype, click here.

Knowledge Ecosystem Components and Enablers

A continuous learning environment is created by building the infrastructure that allows technologies to commonly access information in computable ways. An effective learning ecosystem roots tools in a common reference architecture and leverages standards as the basis for sharing evidence.

Click here to learn more about the "Computable Knowledge Supply Chain" - from research and systematic reviews to guidelines and dissemination.

 

Key Knowledge Ecosystem Tool Sets

The ACTS team evaluated the following tools to describe their importance for and interaction with the proposed learning health system information ecosystem vision.

A "learning culture" requires collaboration on inputs, outputs, and processes represented in the LHS cycle. It also requires dedicated resources (e.g., leadership, staff, technology, expertise) that apply learning as a value-add in every interaction.

Each tool described below includes information about:

Vision & Approach: A view of how the tool will fit into a LHS and benefit from/feed into an evidence-driven cycle

Work in Progress: Details about the work already in process at AHRQ and other places across industry to achieve a common vision

Knowledge Portal

Demonstrate potential for a single federal knowledge portal (seamlessly interoperable with other public and private knowledge portals) that enables all users (patients, care teams, researchers, CPG authors, etc.) to quickly and easily find and use information and tools specific to their needs. The portal provides access to a diverse body of assets from AHRQ and other federal agencies, as well as other vetted organizations. The recommendation summary browser function is one of the components of the knowledge portal.

Recommendation Summary Browser

This function of a knowledge portal enables users to search on a specific condition and patient demographic, and then view search result recommendations and the evidence, value judgments, currency, and other factors critical to determining recommendation quality and appropriateness for the user's need.

Computable Clinical Practice Guidelines / CDS Authoring Support

Provide authors with the ability to easily create computable/interoperable clinical practice guidelines, pathways, decision support interventions, electronic clinical quality measures (eCQMs), electronic case reports, and other guideline derivatives, and share these items in a timely way. Guidelines and related artifacts can also be kept up to date seamlessly as evidence evolves, and the latest version/recommendations are easy to identify.

Guidance Implementation Playbooks - Guidance on Successful Implementation

Support healthcare organization quality improvement / care transformation efforts and enable faster vetting, implementation, and adoption of the most current clinical guidance, pathways, and decision support to improve care outcomes.

Marketplace

Provide a centerpiece for care transformation by enabling patients and their care teams and caregivers to access all patient data (e.g., health goals, clinical history, medications, social determinants of health, concerns, etc) needed to make decisions that support the patient's health and healthcare goals. Also helps connect patients and care teams to pertinent evidence and guidance needed to achieve these goals.

Comprehensive Shared Care Plans (CSCP)

Demonstrate potential for a single federal knowledge portal (seamlessly interoperable with other public and private knowledge portals) that enables all users (patients, care teams, researchers, CPG authors, etc.) to quickly and easily find and use information and tools specific to their needs. The portal provides access to a diverse body of assets from AHRQ and other federal agencies, as well as other vetted organizations. The recommendation summary browser function is one of the components of the knowledge portal.

Gathering / Using Care Data

Enable care delivery, public health, and other organization types to gather, analyze, and use data (within and across organizations) needed to improve care quality and health for individuals and populations, enhance quality improvement efforts, and meet regulatory and other reporting requirements.

Expressing / Using Research Results as Computable Information

Enables research data to be easily shared across the knowledge ecosystem; timely delivery of the latest evidence feeds into improved decision support and ultimately improved outcomes. This work is directly related to efforts on the recommendation summary browser.

Knowledge Ecosystem Gaps to Close

There are many gaps between current and ideal patient/population health journeys, as well as in the knowledge ecosystem that supports these journeys.

The ACTS Initiative contributors evaluated current activities across the country to detail where progress is being made, where the gaps exist, and what steps could be taken to close them.

A Roadmap to Achieve the Future Vision

The potential Roadmap is divided into four phases over the next decade:

Phase 1:

Concept Demonstrations (2021–2024)

Phase 2:

Pilots (2024–2027)

Phase 3:

Scaling (2027–2030)

Phase 4:

LHS (2031)

Phase 1 delivers stakeholder-driven improvements for each critical activity over a 3-year period on a limited scale. It lays the foundation for next generation tools, resources, and infrastructure to address those targets and others in many settings. See the plan for a Phase 1 LHS project.

Subsequent phases expand and scale to enhance knowledge ecosystem cycle infrastructure and content to achieve improvements and goals for additional clinical targets at additional implementation sites. Robust coordination and governance mechanisms over the four phases ensure this work is responsive to stakeholder needs.

Critical Activities Addressed Throughout Each Roadmap Phase

Each phase includes tasks organized around five critical activities:

*RESC = Roadmap Execution Steering Committee; CC = Coordinating Center; PPP = Public Private Partnership; DKP = Digital Knowledge Platform

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