Learning Health Sciences Slides for MIDAS October 2015

LHS.medicine.umich.edu @umichDLHS

The Department of

Learning Health Sciences, University of Michigan

Medical School: A First-of-Its Kind Department

Chaired by Charles P. Friedman, PhD

Prepared for the MIDAS Symposium, October 6, 2015

Content Title A New Basic Science Department The Department of Learning Health Sciences is a new basic science department dedicated to the learning sciences in health, from individuals up to ultra large scale systems that span states and nations. The Department was created in May 2014 as an evolution of the Department of Medical Education.

A New Perspective on Learning Learning is a continuous process of study, reflection, and change leading to improvement. This learning can happen at multiple levels, by: •  Individuals •  Teams •  Organizations •  Regional, national, and international

systems.

Individual  

Team  

Organization  

Large Scale System  

A New Perspective on Learning

A Learning Health System is an organization or network of organizations that can continuously study and improve itself. Fundamental to the concept, which was pioneered by the Institute of Medicine in 2007, is the capacity and commitment to reshape every healthcare interaction to rapidly study and adapt the system.

Creating a Scalable and Sustainable Learning Health System

A Learning Health System is based on learning cycles that include data and analytics to generate knowledge and feedback of knowledge to stakeholders, with the goal to change behavior and transform practice.

Creating a Scalable and Sustainable Learning Health System

“A LHS works through the implementation of virtual cycles of studying, learning and improvement. The key to where we eventually want to go, very importantly, needs to be understood as not only including establishing a number of learning cycles going on, but also creating a platform that sits underneath all of them, supports all of them, and makes them efficient.” 

Charles P. Friedman

Creating a Scalable and Sustainable Learning Health System

1.  Every consenting patient’s characteristics and experience are available for study

2.  Best practice knowledge is immediately available to support decisions

3.  Improvement is continuous through ongoing study

4.  This happens routinely, economically and almost invisibly

5.  All of this is part of the culture

Creating a Scalable and Sustainable Learning Health System, where:

Healthcare delivery systems & research networks must run many complete learning cycles simultaneously, each addressing a different problem.

High functioning learning health systems raise many deep scientific challenges.

Enabling learning that is effective, continuous, sustainable, routine, and at any level of scale requires multiple disciplines.

Creating a Scalable and Sustainable Learning Health System

Through its Learning Health System initiatives, the department has research and service partnerships that reach across clinical areas across the medical school, across disciplines across 10 schools and colleges at the University of Michigan, and around the world through partnerships with other health organizations.

Bringing Together Diverse, World-Class Expertise

•  Data Science •  Machine Learning •  Semantics •  Knowledge

Representation •  Knowledge

Management •  Decision Science •  Communication •  Human Factors

•  Organizational Psychology

•  Behavior Change •  Implementation

Science •  Economics •  Policy Analysis &

Design •  Complexity & System

Science

Bringing Together Diverse, World-Class Expertise in:

The Division of Learning and Knowledge Systems primarily focuses on learning at the organizational and system levels.

The Division of Professional Education primarily addresses learning by individuals and teams in preparation for careers as health educator-leaders.

The Clinical Simulation Center focuses on learning by individuals and teams in environments with advanced simulation technology that model the real world of clinical practice.

Bringing Together Diverse, World-Class Expertise

The department aims to generate and communicate new knowledge that advances the sciences of learning applied to health.

Future Direction: Research

On October 1, 2015, University of Michigan began a three-year contract with PCORI to create a new Clinical Data Research Network called LHSnet with 9 partner organizations across U.S.

Future Direction: Research

A national scale Learning Health System, with meaningful use of electronic medical records, widespread participation by multiple diverse entities, and an appropriate technical architecture can spur the construction of a highly participatory rapid learning system that stretches from coast to coast.

Source: Charles P. Friedman et al., Sci Transl Med 2010;2:57cm29 Published by AAAS

Future Direction: Research

The  department  aims  to  prepare  a  next  genera1on  of  educators  and  learning  scien1sts  by  developing  new  graduate  level  programs  and  by  integra1ng  learning  sciences  into  health  professional  curricula.  

Future Direction: Education

The  department  promotes  learning  and  learning  systems  at  all  levels  of  scale.    

Locally,  together  with  the  Brehm  Center  for  Diabetes  Research,  we  are  engaging  individuals  across  the  university  to  create  a  scalable  and  replicable  diabetes-­‐focused  Learning  Health  System  within  the  University  of  Michigan  Health  System.  Several  clinicians  have  joined  as  faculty  champions.  Topics  for  learning  cycles  are  in  discussion.    

Future Direction: Service

Across  the  state,  the  department  ac1vely  supports  an  ini1a1ve  called  Learning  Health  for  Michigan,  first  convened  by  the  Center  for  Healthcare  Research  in  July  2014.  Learning  Health  for  Michigan  is  a  collabora1ve  grassroots  effort  among  mul1ple  and  diverse  stakeholders  statewide  aimed  at  realizing  a  state-­‐level  Learning  Health  System  across  Michigan.    

Future Direction: Service

“As we were talking to some of our leading authorities [in University of Michigan] on quality-related research [in Diabetes], they expressed frustration at the challenge of getting their findings adopted even at their own institution because there’s no system in place to do that. A learning health system bridges that gap between research and clinical care. We’ll do things that aren’t quite formalized research but will allow our system to learn from patients and enhance our care.”

Dorene Markel

Bridging Research and Clinical Care

Beyond Precision Medicine

“[In our envisioned Learning Health System approach for Diabetes], as more and more patients are tracked, [our app] would discover – based on the last 100 patients like you who had similar levels of activity, blood sugar, and diet – this is the way the correction factor should be modified. Over time the phrase ‘like you’ would become more and more refined… We want to create an interaction where this app is like a trusted friend who delivers messages in way that reinforces a patient’s values and goals for her health.”

Larry An

Learning Systems Beyond Health

“The Learning Health System (LHS) requires a new and significant crossing of capabilities that today are present only in largely disconnected communities… There will be important lessons for how to leverage large amounts of real-world data, mechanisms for learning from such data, feedback components aimed at mobilizing lessons learned to inform decisions and actions, and cyber-social ecosystems - entailing networks of computers, machines, people, and organizations - to improve performance and bring about transformation in many other sectors outside of health.”

Friedman et al. Toward a Science of Learning Systems. JAMIA, Nov. 2014