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                                <h1 style="font-weight:bold;color:#fff;margin-bottom:25px;letter-spacing:.8px;">LHS Phase 1 ProposalPlan </h1>

                                <p style="font-size:17px; line-height:1.6em;margin-bottom:20px;">This draft proposal is a stakeholder-driven plan for how ACTS Collaborative participants and other stakeholders can take specific actions to build on the <a href="https://covid-acts.ahrq.gov/display/PUB/ACTS+LHS+Concept+Demonstration" style="color:#17d0ea;">ACTS LHS Concept Demonstration</a> and drive progress toward a shared learning health system (LHS) future vision.</p>

                                <p style="font-size:17px; line-height:1.6em;">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. </p>

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<h2 class="title" style="color:#041944;margin-bottom: 0;margin-top:0;">Proposed Concept Demonstration Use Cases</h2>
<p style="font-size:17px; line-height:1.6em;color:#041944;">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: </p><p style="font-size:17px;color:#041944; line-height:1.6em;margin-top:5px;margin-bottom:10px;font-weight:bold;"><ul class="no-list-style"><li><span style="font-weight:bold;">Care Improvements</span> Use cases represent significant opportunities to improve public health and reduce morbidity and mortality</li><li><span style="font-weight:bold;">Leverage Federal Initiatives </span>Activities and deliverables build on pertinent Federal programs, guidance, and tools for the use cases </li><li><span style="font-weight:bold;">Stakeholder Participation</span> Use cases are based on improvement targets prioritized by stakeholders and work to address them will be driven by their strategic initiatives</li></ul></p></div>

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	<h3 style="margin-bottom:20px;margin-top:15px;">Proposed Use Cases</h3>
	<ol><li>Pandemic Response</li>
		<li>Preventative Care</li>
		<li>Hypertension Control</li>
		<li>Pain Management / Opioid Use</li>
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                            <h2 class="title" style="margin: 0 .5% 1.5%;">ACTS Stakeholder-Based Approach to Success</h2>
              <div class="flex-row"> <div class="flex-bucket flex-one no-style" style="margin: 0 .5% .5%;"><p>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.</p><p>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). </p><p>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 <a href="https://covid-acts.ahrq.gov/display/PUB/ACTS+Support+Letters">37 ACTS support letters</a> indicating interest from key stakeholder organizations in aligning their efforts and investments in this way.</p>
              <p style="font-weight: bold;margin: 20px 0 10px;">The proposal recommends conducting scalable pilots for the initial four use cases that successfully: </p></div>
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                            <div class="flex-wrap" style="padding:20px;"><h3><span>Use best available tools and strategies</span> (including existing resources from AHRQ/HHS/federal agencies) to develop living, evidence-based guidance</h3></div></div> 
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                            <div class="flex-wrap" style="padding:20px;"><h3><span>Implement guidance</span> through care process reengineering for several care delivery organizations (CDOs)</h3></div></div> 
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                            <div class="flex-wrap" style="padding:20px;"><h3><span>Evaluate results</span> from care, learning, and progress toward <a target="_blank" href="https://www.ahrq.gov/ncepcr/tools/workforce-financing/white-paper.html#tab2">Quintuple Aim</a> outcomes</h3></div></div> 
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                            <div class="flex-wrap" style="padding:20px;"><h3><span>Apply the results</span> from this analysis to build working concept demonstrations for four use cases and promote scaling to more CDOs and targets</h3></div></div>   
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                            <h2 class="title" style="margin: 0 .5% 1%;">The “How” and the “Who”</h2>
              <div class="flex-row"> <div class="flex-bucket flex-two no-style m-border right-padding-3"><p>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.</p><p>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.</p>
              </div><div class="flex-bucket flex-two no-style right-padding-3"><p>ACTS participants are beginning to fill out a <a href="https://covid-acts.ahrq.gov/download/attachments/70484024/Phase%201%20LHS%20Project%20-%20Stakeholder%20Organization%20Activities%20Template%20v9.23.21.docx?api=v2" class="confluence-link">"Phase 1 LHS Project Stakeholder Organization Activities Template"</a> 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.</p><p>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</p>               </div>
              </div> <h3 style="font-size: 22px;" class="center-align">Elements of an Effective Learning Health System Cycle</h3><img style="display: block;max-width: 900px;text-align: center;margin: 0 auto;width:100%;" class="confluence-embedded-image image-center" src="https://covid-acts.ahrq.gov/download/attachments/71139343/health-system-cycle.png" data-image-src="https://covid-acts.ahrq.gov/download/attachments/71139343/health-system-cycle.png" data-unresolved-comment-count="0" data-linked-resource-id="68387045" data-linked-resource-version="1" data-linked-resource-type="attachment" data-linked-resource-default-alias="large-AHRQ_ACTS_4 Pager_Graphics_2.1_Lifecycle 2_Lifecycle 2.png" data-base-url="https://covid-acts.ahrq.gov" data-linked-resource-content-type="image/png" data-linked-resource-container-id="68388200" data-linked-resource-container-version="110"><p style="padding-left: 20px;border-left: 4px solid #8244d3; margin-top: 30px;max-width: 780px;margin: 35px auto 0;font-size: 20px;"></p></div></div>  
              
              
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                            <h2 class="title" style="margin: 0 .5% .5%;">Proposed Phase 1 Activities</h2>
              <div class="flex-row"> <div class="flex-bucket flex-one no-style" style="margin: 0 .5% .5%;"><p>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.</p><p>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 <a href="https://covid-acts.ahrq.gov/display/PUB/LHS+Case+Study">University of Minnesota LHS case study</a> as an example). Proposed activities will build on the experiences/insights derived from such previous work as illustrated in the <a href="https://covid-acts.ahrq.gov/display/PUB">LHS Concept Demo</a> that lays a strong foundation for each of the proposed tasks. </p>
<p>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.</p>
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    <button class="nav-link" id="nav-infastructure-tab" data-bs-toggle="tab" data-bs-target="#nav-infastructure" type="button" role="tab" aria-controls="nav-infastructure" aria-selected="false">Enhance/Leverage Infrastructure</button>
    <button class="nav-link" id="nav-computable-tab" data-bs-toggle="tab" data-bs-target="#nav-computable" type="button" role="tab" aria-controls="nav-computable" aria-selected="false">Enhance/Develop Living, Computable Guidance</button>
    <button class="nav-link" id="nav-implementation-tab" data-bs-toggle="tab" data-bs-target="#nav-implementation" type="button" role="tab" aria-controls="nav-implementation" aria-selected="false">Enhance Guidance Implementation & Assessment</button>
    <button class="nav-link" id="nav-roadmap-tab" data-bs-toggle="tab" data-bs-target="#nav-roadmap" type="button" role="tab" aria-controls="nav-roadmap" aria-selected="false">Evaluate/Plan Roadmap Execution</button>
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<div class="tab-nested-content"><h3>Form Phase 1 LHS Project Steering Committee</h3><p>Build on <a target="_blank" href="https://digital.ahrq.gov/acts/stakeholder-community">ACTS Stakeholder Community</a> and COVID Collaborative participants.</p>
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<h3>Establish Collaboration Infrastructure </h3>
<p>Build on experience with <a href="https://covid-acts.ahrq.gov/display/ACLC/ACTS+COVID-19+Evidence+to+Guidance+to+Action+Collaborative">ACTS COVID Collaborative site</a> and AHRQ/HL7/other collaborative sites.</p><div class="rule"></div>
<h3>Support LHS Project Steering Committee </h3>
<p>Select/create overarching entity to coordinate efforts on the specific targets and related efforts to build knowledge ecosystem.</p>
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<ul><li>Refine four clinical targets (use cases) for concept demo and consider additional potential targets.</li>
<li>Establish criteria to select tools/resources for Federal Digital Knowledge Portal, other demo tools.</li>
<li>Establish criteria to select clinical sites to participate in guidance implementation (sites will likely need to have sophisticated health IT capabilities).</li>
<li>Support requirements development for concept demo components.</li>
<li>Support agile development for concept demos.</li>
<li>Support concept demo feedback evaluation and project plan for Phase 2.</li>
<li>Institute project management for Phase 1 activities. </li>
<li>Cultivate opportunities for public and private organizations participation in Phase 1.
<ul><span style="font-weight: bold;display: block;margin: 15px 0 10px;">Leverage existing national initiatives, including: </span><li>Hypertension: <a target="_blank" href="https://millionhearts.hhs.gov/">Million Hearts</a>, <a target="_blank" href="https://targetbp.org/">AMA/AHA TargetBP</a>, <a target="_blank" href="https://www.ahrq.gov/evidencenow/tools/index.html">EvidenceNOW</a></li>
<li>Pain/Opioids: <a target="_blank" href="https://www.pccds-ln.org/sites/default/files/2019-04/LearningNetwork_OpioidActionPlan.pdf">PCCDS Stakeholder-driven Opioid Action Plan</a>, <a target="_blank" href="https://addiction.surgeongeneral.gov/">Surgeon General's Opioid Efforts</a>, <a target="_blank" href="https://www.cdc.gov/opioids/index.html">CDC Opioid efforts</a>, <a target="_blank" href="https://www.cms.gov/About-CMS/Story-Page/Reducing-Opioid-Misuse">CMS Opioid Efforts</a>,  <a target="_blank" href="https://covid-acts.ahrq.gov/display/PUB/References#67.">(67)</a><a taget="_blank" href="https://covid-acts.ahrq.gov/display/PUB/References#56.">(56)</a> </li>
<li>COVID-19/Pandemic Response: <a target="_blank" href="https://www.hhs.gov/coronavirus/index.html">HHS Activities</a>, <a target="_blank" href="https://www.publichealth.va.gov/n-coronavirus/">VA Activities</a>, <a href="https://www.defense.gov/Explore/Spotlight/Coronavirus-DOD-Response/" target="_blank">DOD Activities</a>, <a href="https://www.mcmasterforum.org/networks/covid-end" target="_blank">International Activities</a></li>
<li>Preventative Care: <a target="_blank" href="https://health.gov/healthypeople/objectives-and-data/browse-objectives/preventive-care">Healthy People 2030</a>, <a target="_blank" href="https://www.uspreventiveservicestaskforce.org/uspstf/">USPSTF</a> </li></ul>
<li>Build on collaboration process and results from <a href="https://covid-acts.ahrq.gov/display/PUB" target="_blank">ACTS LHS Concept Demo</a></li>
<li>Coordinate Phase 1 project requirements gathering, development, evaluation, and Phase 2 planning. </li>
<li>Hold an annual meeting for stakeholders.</li>
<li>Plan to form/selecta public/private partnership to manage LHS execution efforts/phases.</li></ul>
</div><div class="tab-meta"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/gov-collab.png"></div></div>
  <div class="tab-pane fade" id="nav-infastructure" role="tabpanel" aria-labelledby="nav-infastructure-tab"><div class="tab-nested-content"><h3>Develop an AHRQ Digital Knowledge Portal concept demo</h3><p>Potentially seed a federal digital knowledge portal.</p><ul><li>Produce a directory of AHRQ (and HHS) tools/resources pertinent to targets. Ensure inclusion of <a href="https://digital.ahrq.gov/ahrq-funded-projects/search" target="_blank" digital health research</a> from AHRQ and others. </li>
<li>Augment the directory with authoritative, select non-HHS tools and resources (leverage and enhance guideline repositories such as <a target="_blank" href="https://guidelines.ecri.org/">ECRI</a>, <a target="_blank" href="https://g-i-n.net/international-guidelines-library/">GIN</a>, <a target="_blank" href="https://www.ahrq.gov/gam/updates/index.html">NGC</a>.</li>
<li>Define requirements for an AHRQ Digital Knowledge Portal concept demo website. Build on <a href="https://covid-acts.ahrq.gov/display/PUB/Knowledge+Portal" target="_blank">knowledge portal component</a> of ACTS LHS Concept Demo and leverage/expand capabilities in AHRQ's <a href="https://digital.ahrq.gov/ahrq-funded-projects/cepi-evidence-discovery-and-retrieval-cedar-project" target="_blank">CEDAR project</a>.</li>
<li>Produce the AHRQ Digital Knowledge Portal concept demo website. </li>
<li>Determine requirements to expand the AHRQ Digital Knowledge Portal concept demo website.</li>
<li>Produce the full Federal Digital Knowledge Portal concept demo. </li></ul><div class="rule"></div><h3>Develop concept demos for integrated tools that support the knowledge ecosystem cycle </h3><ul><li>Determine requirements for ecosystem cycle support tools for concept demo.</li>
<li>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+.</li>
<li>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.</li>
<li>Produce an open, unified, integrated federal marketplace concept demo. See marketplace components of ACTS LHS Concept Demo. Includes building on the CDS Connect Repository.</li>
<li>Produce/adapt concept demo registry of care processes and results data. See Gathering and Analyzing Care Data components of ACTS LHS Concept Demo.</li>
</ul></div><div class="tab-meta"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/disseminate.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/reference-architecture.png"></div></div>

  <div class="tab-pane fade" id="nav-computable" role="tabpanel" aria-labelledby="nav-computable-tab"><div class="tab-nested-content"><h3>Produce/enhance a living directory of high-impact studies</h3>
<p>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.</p>
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	  <h3>Produce/enhance living systematic reviews</h3>
<p>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.</p>
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	  <h3>Produce/enhance living clinical guidelines</h3>
<p>Build on Recommendation Summary Browser component of ACTS LHS Concept.</p>
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<h3>Produce/adapt at least one high-impact, living CDS intervention and corresponding eCQMs</h3>
<ul><li>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.</li></ul><div class="rule"></div>
<h3>Produce a living guidance development playbook </h3>
<p>Leverage and build on insights and resources outlined in the  CPG Authoring and Recommendation Summary Browser.</p>
</div><div class="tab-meta"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/aggregate.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/product-guidance.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/create-tools.png"></div></div>
  <div class="tab-pane fade" id="nav-implementation" role="tabpanel" aria-labelledby="nav-implementation-tab"><div class="tab-nested-content"><h3>Integrate the living CDS/eCQM and Federal Digital Knowledge Portal concept demo into information systems and clinical workflows at five CDOs</h3>
<ul><li>Select care delivery organization (CDO) sites, providers, and patients for guidance implementation and assessment.</li>
<li>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.</li>
<li>Deploy tools and workflow into care delivery activities. See Guidance Implementation/QI Support components of ACTS LHS Concept Demo.</li></ul>
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<h3>Produce an Implementation Playbook</h3>
<ul><li>Optimize how AHRQ offerings (e.g., Knowledge Portal) can be deployed to add value. See ACTS Guidance Implementation/QI Support components.</li></ul>

</div><div class="tab-meta"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/integrate-tools.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/use-tools.png"></div></div>
  <div class="tab-pane fade" id="nav-roadmap" role="tabpanel" aria-labelledby="nav-roadmap-tab"><div class="tab-nested-content"><h3>Gather and analyze feedback on concept demos</h3><ul><li>Develop a plan to evaluate Phase 1 (assess activities and results related to the knowledge portal, computable guidance, and CDS tools for targets).</li>
<li>Implement evaluation plan and develop requirements and project plans for Phase 2 pilots.
<ul><li>Evaluate Phase 1 concept demo processes and outcomes</li>
<li>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
<li>Provide Phase 2 project plan and requirements to build demos and production-grade tools related to:
<ul><li>Literature surveillance </li>
<li>Evidence synthesis</li>
<li>Living computable guidance</li>
<li>Authoring tool and scalable CDS/eCQM development</li>
<li>Public marketplace</li>
<li>Care process/results registry</li>
<li>CDS/eCQM implementations for additional sites and clinical targets</li></ul></li></ul></li>
<li>Produce Phase 1 LHS Project report</li></ul><div class="rule"></div>
<h3>Develop and execute research plan</h3>
<ul><li>Identify critical research questions to be addressed during concept demo phase.</li>
<li>Execute the research plan. </li></ul>
</div><div class="tab-meta"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/conduct-research.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/gather-analyze.png"><img src="https://covid-acts.ahrq.gov/download/thumbnails/71139343/supporting-functions.png"></div></div>
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<div class="concept-section" id="deliverables" style="padding-top:0;"><h2 class="title center-align">Proposed Phase 1 Deliverables</h2><nav>
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	  <button class="nav-link active" id="nav-coordination-tab" data-bs-toggle="tab" data-bs-target="#nav-coordination" type="button" role="tab" aria-controls="nav-coordination" aria-selected="true"> Collaboration/Coordination</button>
	   <button class="nav-link" id="nav-infrastructure-tab" data-bs-toggle="tab" data-bs-target="#nav-infrastructure" type="button" role="tab" aria-controls="nav-infrastructure" aria-selected="false"> Infrastructure</button>
	   <button class="nav-link" id="nav-living-tab" data-bs-toggle="tab" data-bs-target="#nav-living" type="button" role="tab" aria-controls="nav-living" aria-selected="false">Living Evidence/Guidance</button>
	    <button class="nav-link" id="nav-guidance-tab" data-bs-toggle="tab" data-bs-target="#nav-guidance" type="button" role="tab" aria-controls="nav-guidance" aria-selected="false">Guidance Implementation</button>
	     <button class="nav-link" id="nav-eval-tab" data-bs-toggle="tab" data-bs-target="#nav-eval" type="button" role="tab" aria-controls="nav-eval" aria-selected="false">Evaluation/Next Steps</button>
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		 <h3>Collaboration/Coordination</h3>
<ul><li>Collaboration network and infrastructure </li>
<li>Refined, expanded, and further vetted shared future vision</li>
<li>Phase 1 LHS Concept Demonstration steering committee</li>
<li>Coordinating center to ensure concept demonstration execution leverages and supports the many other initiatives working to enhance the knowledge ecosystem </li>
<li>Public/private partnership to drive coordinated LHS execution efforts </li></ul>

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		 <h3>Infrastructure</h3> 
<ul><li>Defined requirements for AHRQ/Federal Digital Healthcare Knowledge Portal and other knowledge ecosystem components and enablers</li>
<li>AHRQ/Federal Digital Knowledge Portal prototype </li>
<li>Concept demonstration and requirements for production AHRQ/Federal Digital Knowledge Portal Pilot that: 
<ul style="margin-top:10px;"><li>Makes all AHRQ/HHS/federal tools and resources more FAIR and useful</li>
<li>Makes evidence, guidance, tools, and data for proposed use cases more computable and interoperable</li>
<li>Demonstrates tooling to support computable processing for the knowledge ecosystem </li></ul></li>
<li>Concept demonstrations and requirements for tools that make information processing more computable and useful, and that improve information transfer between systems and organizations </li>
<li>National/international reference architecture that supports interoperable digital knowledge platforms </li>
<li>An open, public-sector marketplace</li></ul>

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	 <div class="tab-pane fade" id="nav-living" role="tabpanel" aria-labelledby="nav-living-tab"><h3>Living Evidence/Guidance</h3><ul><li>Living evidence, guidance, and CDS interventions/eCQMs for the four Phase 1 clinical targets (use cases) to demonstrate more seamless flow from studies and systematic reviews, to CDS/eCQMs guidance and implementation</li></ul></div>
	 <div class="tab-pane fade" id="nav-guidance" role="tabpanel" aria-labelledby="nav-guidance-tab"><h3>Guidance Implementation</h3>
<ul><li>Living guidance development playbook for creating and maintaining living, computable evidence, guidance, and CDS/eCQMs</li>  
<li>Results from implementing the production Federal Digital Knowledge portal pilot and living CDS interventions and eCQMs for the four Phase 1 use cases (spanning at least five different care development organizations and affecting care for at least 50,000 patients)</li>
<li>Playbook for successfully implementing CDS interventions and eCQMs for the four Phase 1 clinical use cases (applicable to other targets as well). Playbook is coordinated with investments from other stakeholder organizations to generate supporting educational materials (e.g., courses, learning communities) </li></ul>
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	 <div class="tab-pane fade" id="nav-eval" role="tabpanel" aria-labelledby="nav-eval-tab"><h3>Evaluation/Next Steps</h3>
<ul><li>Requirements and project plans for full production versions of the Federal Digital Knowledge Portal and other knowledge ecosystem components (includes testing and tooling)</li>
<li>Project report outlining successes, challenges, lessons learned, and proposed next steps to build on this project to achieve fuller and more widespread realization of LHS/Quintuple Aim goals</li></ul>
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