McLachlan Scott, Dube Kudakwashe, Johnson Owen, Buchanan Derek, Potts Henry W W, Gallagher Thomas, Fenton Norman
Electrical Engineering and Computer Science Queen Mary University of London London UK.
Fundamental Sciences Massey University Palmerston North New Zealand.
Learn Health Syst. 2019 Mar 21;3(4):e10189. doi: 10.1002/lrh2.10189. eCollection 2019 Oct.
Learning health systems (LHS) are one of the major computing advances in health care. However, no prior research has systematically analysed barriers and facilitators for LHS. This paper presents an investigation into the barriers, benefits, and facilitating factors for LHS in order to create a basis for their successful implementation and adoption.
First, the ITPOSMO-BBF framework was developed based on the established ITPOSMO (information, technology, processes, objectives, staffing, management, and other factors) framework, extending it for analysing barriers, benefits, and facilitators. Second, the new framework was applied to LHS.
We found that LHS shares similar barriers and facilitators with electronic health records (EHR); in particular, most facilitator effort in implementing EHR and LHS goes towards barriers categorised as , even though they were seen to carry fewer benefits. Barriers whose resolution would bring significant benefits in safety, quality, and health outcomes remain.LHS envisage constant generation of new clinical knowledge and practice based on the central role of collections of EHR. Once LHS are constructed and operational, they trigger new data streams into the EHR. So LHS and EHR have a symbiotic relationship. The implementation and adoption of EHRs have proved and continues to prove challenging, and there are many lessons for LHS arising from these challenges.
Successful adoption of LHS should take account of the framework proposed in this paper, especially with respect to its focus on removing barriers that have the most impact.
学习型健康系统（LHS）是医疗保健领域主要的计算技术进步之一。然而，此前尚无研究系统分析过LHS的障碍和促进因素。本文对LHS的障碍、益处和促进因素进行了调查，以便为其成功实施和采用奠定基础。
首先，在已有的ITPOSMO（信息、技术、流程、目标、人员配备、管理及其他因素）框架基础上开发了ITPOSMO-BBF框架，并对其进行扩展以分析障碍、益处和促进因素。其次，将新框架应用于LHS。
我们发现LHS与电子健康记录（EHR）存在相似的障碍和促进因素；特别是，在实施EHR和LHS时，大多数促进因素的努力都用于归类为 的障碍，尽管这些障碍带来的益处较少。那些解决后将在安全性、质量和健康结果方面带来显著益处的障碍仍然存在。LHS设想基于EHR集合的核心作用不断产生新的临床知识和实践。一旦LHS构建并运行，它们会触发新的数据流进入EHR。因此，LHS和EHR存在共生关系。EHR的实施和采用已被证明且仍在证明具有挑战性，从这些挑战中可以为LHS汲取许多经验教训。
成功采用LHS应考虑本文提出的框架，特别是其侧重于消除影响最大的障碍。
