Next Steps
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LHS Phase 1 Plan
This draft proposal is a stakeholder-driven plan for how ACTS Collaborative participants and other stakeholders can take specific actions to build on the ACTS LHS Concept Demonstration and drive progress toward a shared learning health system (LHS) future vision. The proposed plan is under review and advisement by AHRQ.
The proposal outlines a three-year Phase 1 effort to create a series of concept demonstrations around specific use cases. The goal is to demonstrate a strong digital knowledge ecosystem where information flows seamlessly around the LHS cycle in ways that improve care processes – and ultimately outcomes – for selected high priority clinical targets.
Proposed Concept Demonstration Use Cases
To prove the value of the ACTS framework for real-world scenarios, the proposal focuses on creating four initial use cases with broad value to the extended healthcare community. These use cases share specific traits, including:
- Care Improvements Use cases represent significant opportunities to improve public health and reduce morbidity and mortality
- Leverage Federal Initiatives Activities and deliverables build on pertinent Federal programs, guidance, and tools for the use cases
- Stakeholder Participation Use cases are based on improvement targets prioritized by stakeholders and work to address them will be driven by their strategic initiatives
Proposed Use Cases
- Pandemic Response
- Preventative Care
- Hypertension Control
- Pain Management / Opioid Use
ACTS Stakeholder-Based Approach to Success
The public and private sectors are already investing massive resources into improving information flow to build a true health knowledge ecosystem. But current investments and activities are fraught with waste and redundancy, and valuable health information and evidence is not used nearly to its true potential. This is occurring in a large part because most of the work underway is happening in siloes.
Numerous organizations play a role in delivering on the vision of a tightly integrated, interactive learning health system. The ACTS Phase 1 proposal aims to drive collaboration and consensus. Continuous improvement within learning health systems is driven by smooth flow of information - within and between many different sources – throughout the cycle (see figure below).
The ACTS Phase 1 proposal calls on AHRQ and other participants to work together to identify projects currently underway, leverage existing efforts and tools, and when needed, enhance or create new solutions. Participating organizations will identify tasks and deliverables they can work on (based on their business drivers) to contribute to a broader, federated LHS whole. The viability of this approach is reinforced by the 41 ACTS support letters indicating interest from key stakeholder organizations in aligning their efforts and investments in this way.
The proposal recommends conducting scalable pilots for the initial four use cases that successfully:
Use best available tools and strategies (including existing resources from AHRQ/HHS/federal agencies) to develop living, evidence-based guidance
Implement guidance through care process reengineering for several care delivery organizations (CDOs)
Evaluate results from care, learning, and progress toward Quintuple Aim outcomes
Apply the results from this analysis to build working concept demonstrations for four use cases and promote scaling to more CDOs and targets
The “How” and the “Who”
The image below depicts how the various elements of the learning health cycle should interoperate. We’re not there yet, but initiatives such as ACTS are driving real progress.
The ACTS Phase 1 proposal focuses on convening the individuals and organizations (the who) already working independently and in small groups to address discrete parts of the larger challenge. By promoting understanding of who is doing what to enable the knowledge ecosystem, the ACTS initiative can help organizations share ideas, best practices, and even resources and tools on a broader scale.
ACTS participants are beginning to fill out a "Phase 1 LHS Project Stakeholder Organization Activities Template" to document their LHS-related efforts pertinent to the Phase 1 proposal. Once completed and shared on via this Proposal page, stakeholders will be able to see others doing similar work, get ideas about promising practices and collaborations, and cultivate synergies.
The ACTS initiative has been a valuable forum to understand and begin addressing gaps in technology, standards, and processes that hind progress. We have the opportunity to further advance collaborations and coordination around disjointed projects to more quickly make progress toward an effective learning health system cycle that fully realizes stakeholder goals
Elements of an Effective Learning Health System Cycle
Phase 1 Activities
Information under the the following five tabs detail specific activities AHRQ and others could undertake to transform independent, separate activities, into an integrated learning health system cycle. The proposed activities address the broad spectrum of requirements needed to create and sustain an effective learning health system cycle, initially focusing on the four identified use cases and expanding over time to additional targets.
This work will focus on accessing and using the best of available tools and information, as well as designing and piloting better future approaches (view the University of Minnesota LHS case study as an example). Proposed activities will build on the experiences/insights derived from such previous work as illustrated in the LHS Concept Demo that lays a strong foundation for each of the proposed tasks.
The proposed timeline for activities is located following the list of proposed activities. Click on one of the five buttons below to see the corresponding activities/tasks.
Form Phase 1 LHS Project Steering Committee
Build on ACTS Stakeholder Community and COVID Collaborative participants.
Establish Collaboration Infrastructure
Build on experience with ACTS COVID Collaborative site and AHRQ/HL7/other collaborative sites.
Support LHS Project Steering Committee
Select/create overarching entity to coordinate efforts on the specific targets and related efforts to build knowledge ecosystem.
- Refine four clinical targets (use cases) for concept demo and consider additional potential targets.
- Establish criteria to select tools/resources for Federal Digital Knowledge Portal, other demo tools.
- Establish criteria to select clinical sites to participate in guidance implementation (sites will likely need to have sophisticated health IT capabilities).
- Support requirements development for concept demo components.
- Support agile development for concept demos.
- Support concept demo feedback evaluation and project plan for Phase 2.
- Institute project management for Phase 1 activities.
- Cultivate opportunities for public and private organizations participation in Phase 1.
- Leverage existing national initiatives, including:
- Hypertension: Million Hearts, AMA/AHA TargetBP, EvidenceNOW
- Pain/Opioids: PCCDS Stakeholder-driven Opioid Action Plan, Surgeon General's Opioid Efforts, CDC Opioid efforts, CMS Opioid Efforts, (67)(56)
- COVID-19/Pandemic Response: HHS Activities, VA Activities, DOD Activities, International Activities
- Preventative Care: Healthy People 2030, USPSTF
- Build on collaboration process and results from ACTS LHS Concept Demo
- Coordinate Phase 1 project requirements gathering, development, evaluation, and Phase 2 planning.
- Hold an annual meeting for stakeholders.
- Plan to form/selecta public/private partnership to manage LHS execution efforts/phases.
Develop an AHRQ Digital Knowledge Portal concept demo
Potentially seed a federal digital knowledge portal.
- Produce a directory of AHRQ (and HHS) tools/resources pertinent to targets. Ensure inclusion of from AHRQ and others.
- Augment the directory with authoritative, select non-HHS tools and resources (leverage and enhance guideline repositories such as ECRI, GIN, NGC.
- Define requirements for an AHRQ Digital Knowledge Portal concept demo website. Build on knowledge portal component of ACTS LHS Concept Demo and leverage/expand capabilities in AHRQ's CEDAR project.
- Produce the AHRQ Digital Knowledge Portal concept demo website.
- Determine requirements to expand the AHRQ Digital Knowledge Portal concept demo website.
- Produce the full Federal Digital Knowledge Portal concept demo.
Develop concept demos for integrated tools that support the knowledge ecosystem cycle
- Determine requirements for ecosystem cycle support tools for concept demo.
- Produce/adapt a computable literature management/systematic review tool concept demo. Build on the Recommendation Summary Browser component of ACTS LHS Concept Demo and leverage/enhance AHRQ's SRDR+.
- Produce/adapt living guideline authoring tools concept demo. Include tooling to design, author, and validate computable clinical practice guidelines (CPGs) and their derivatives, clinical decision support (CDS), electronic clinical quality measures (eCQMs), and eCaseReports. See CPG Authoring components of ACTS LHS Concept Demo.
- Produce an open, unified, integrated federal marketplace concept demo. See marketplace components of ACTS LHS Concept Demo. Includes building on the CDS Connect Repository.
- Produce/adapt concept demo registry of care processes and results data. See Gathering and Analyzing Care Data components of ACTS LHS Concept Demo.
Produce/enhance a living directory of high-impact studies
Continue work to make evidence and guidance computable. Explore using/enhancing directories produced by ACTS Collaborators including SRDR+, McMaster (Evidence Alerts, RecMap), Epistemonikos Foundation, MAGIC, GIN, etc.
Produce/enhance living systematic reviews
Build on content, processes, and tools in AHRQ's Effective Health Care Program. Build on work from Recommendation Summary Browser component of ACTS LHS Concept.
Produce/enhance living clinical guidelines
Build on Recommendation Summary Browser component of ACTS LHS Concept.
Produce/adapt at least one high-impact, living CDS intervention and corresponding eCQMs
- Produce initial living CDS/eCQMs. Build on work outlined in CPG Authoring components of ACTS LHS Concept Demo, including potential extensions to the CDS Connect Authoring Tool.
Produce a living guidance development playbook
Leverage and build on insights and resources outlined in the CPG Authoring and Recommendation Summary Browser.
Integrate the living CDS/eCQM and Federal Digital Knowledge Portal concept demo into information systems and clinical workflows at five CDOs
- Select care delivery organization (CDO) sites, providers, and patients for guidance implementation and assessment.
- Integrate interventions into systems, reengineer workflows, and train staff. Leverage VA-led Patient Journey and Service Blueprint templates, as well as the Comprehensive Shared Care Plans and Guidance Implementation/QI Support components of ACTS LHS Concept Demo.
- Deploy tools and workflow into care delivery activities. See Guidance Implementation/QI Support components of ACTS LHS Concept Demo.
Produce an Implementation Playbook
- Optimize how AHRQ offerings (e.g., Knowledge Portal) can be deployed to add value. See ACTS Guidance Implementation/QI Support components.
Gather and analyze feedback on concept demos
- Develop a plan to evaluate Phase 1 (assess activities and results related to the knowledge portal, computable guidance, and CDS tools for targets).
- Implement evaluation plan and develop requirements and project plans for Phase 2 pilots.
- Evaluate Phase 1 concept demo processes and outcomes
- Provide requirements and a Phase 2 project plan to convert the Federal Digital Knowledge Portal concept demo into a fully functional Federal Digital Knowledge Portal
- Provide Phase 2 project plan and requirements to build demos and production-grade tools related to:
- Literature surveillance
- Evidence synthesis
- Living computable guidance
- Authoring tool and scalable CDS/eCQM development
- Public marketplace
- Care process/results registry
- CDS/eCQM implementations for additional sites and clinical targets
- Produce Phase 1 LHS Project report
Develop and execute research plan
- Identify critical research questions to be addressed during concept demo phase.
- Execute the research plan.
