Learning Health Systems: Connecting Research to Practice Worldwide

The practice of medicine and clinician learning have seen constant change over the past century. This change has been driven not only through new scientific discoveries leading to new treatment options for patients, but also through new technologies and the exponential increase in digital data. In A Family of Doctors, Dr. David Hellerstein describes his great‐ great‐grandfather's efforts to track his personal success as an obstetrician with notebooks full of handwritten data about successful deliveries and unfortunate deaths (maternal and fetal), from which he himself learned. Presumably, he passed this learning on to his students, but they were not shared broadly. Dr. Atul Gawande, in Complications, describes how doctors in the 1980s were revered, trusted and not questioned with respect to their knowledge or decisions. Yet, in the 1990s, research was done to assess whether computers or doctors were better at reading EKGs. Dr. Gawande himself made attempts to create decision trees with options and possible outcomes, but hewas frustrated with the lack of information on probabilities associated with one treatment path vs. another. “In the absence of algorithms and evidence about what to do, you learn inmedicine tomake decisions by feel. You count on experience and judgment. And it is hard not to be troubled by this.” An important part of a learning health cycle is devoted to research, which is based upon healthcare information and provides results to inform medical decisions. Research has been defined as “studious inquiry or examination especially investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws.” Clearly, the ability to generate research facts or results relies on data to build evidence. Data has been called the world's most valuable resource. Physician educators are encouraging medical students to include data and data