Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway.
Int J Med Inform. 2024 Dec;192:105652. doi: 10.1016/j.ijmedinf.2024.105652. Epub 2024 Oct 12.
The healthcare sector is a complex domain that faces challenges in effectively learning from practices and outcome data. The Learning Health System (LHS) has emerged as a potential framework to improve healthcare by promoting continuous learning. However, its adoption remains limited, often involving only a single clinical department or a part of the LHS cycle. There is a need to gain a better understanding of implementing LHS on a larger scale.
To identify complete implementations of the LHS for providing recommendations into their implementation strategies, success factors, barriers, and outcomes.
A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Scopus databases. Data from the included papers were thematically categorized into four primary areas: (1) Scale of LHS Implementation; (2) Implementation strategies and the factors that facilitated the implementation of LHS; (3) LHS outcomes; and (4) Barriers /challenges related to the LHS implementation.
We identified 1,279 papers, of which 37 were included in the final analysis. Barriers to implementing LHS included interoperability, data integration, electronic health records (EHRs) challenges, organizational culture, leadership, and regulatory hurdles. Most LHS initiatives lacked discussion on long-term economic sustainability models, and only 16 papers provided objective measurements of performance changes. Drawing from the findings of the included studies, this paper offers recommendations for the effective implementation of the LHS.
The establishment of sustainable LHS necessitates several key components. First, there is a need to develop long-term economic sustainability models. Secondly, governance at the national level should promote common Application Programming Interfaces (APIs) across LHS implementations, communication channels to share tacit knowledge, efficient Institutional Review Board, ethical approval processes, and connect various initiatives currently operating independently. Lastly, the success of LHS relies not only on technological infrastructure but also on the active participation of multidisciplinary teams in decision-making and sharing of tacit knowledge.
医疗保健领域是一个复杂的领域，在有效学习实践和结果数据方面面临挑战。学习型医疗保健系统（LHS）作为一种通过促进持续学习来改善医疗保健的潜在框架已经出现。然而，其采用仍然有限，通常只涉及单个临床科室或 LHS 周期的一部分。需要更好地了解在更大范围内实施 LHS。
确定 LHS 的完整实施情况，为其实施策略、成功因素、障碍和结果提供建议。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用 PubMed 和 Scopus 数据库进行了系统评价。从纳入的论文中提取的数据被主题分为四个主要领域：（1）LHS 实施的规模；（2）实施策略和促进 LHS 实施的因素；（3）LHS 结果；（4）与 LHS 实施相关的障碍/挑战。
我们确定了 1279 篇论文，其中 37 篇论文被纳入最终分析。实施 LHS 的障碍包括互操作性、数据集成、电子健康记录（EHR）挑战、组织文化、领导力和监管障碍。大多数 LHS 计划缺乏关于长期经济可持续性模型的讨论，只有 16 篇论文提供了对绩效变化的客观衡量。本研究从纳入研究的结果中提出了有效实施 LHS 的建议。
建立可持续的 LHS 需要几个关键组成部分。首先，需要制定长期经济可持续性模型。其次，国家层面的治理应该促进 LHS 实施中通用的应用程序编程接口（API）、共享隐性知识的沟通渠道、高效的机构审查委员会、伦理审批流程，并将目前独立运作的各种举措联系起来。最后，LHS 的成功不仅依赖于技术基础设施，还依赖于多学科团队在决策和隐性知识共享方面的积极参与。
