University moves forward with plans to further integrate data into health system improvements

As health systems look for ways to better integrate data to improve care, there is growing enthusiasm for approaches that focus on continuously learning what works – and for whom — and what doesn’t, and using that knowledge to make care better.

That is the idea behind a learning health system (LHS), an approach that uses digital tools to rapidly learn and apply evidence, incorporating research evidence into care delivery more quickly. 

“Health care consumes a large part of our gross domestic product and many have concluded that we don’t maximize the value from the total dollars we spend,” says Dr. Robert Reid, MD, PhD, lead scientist emeritus at Trillium Health Partners (THP) and an LHS expert.

“With Canada facing economic challenges and uncertainties, we need the health-care system to achieve better outcomes and experiences without people falling through the cracks.”

Reid will be in Calgary on Oct. 15 as a keynote speaker at the O’Brien Institute for Public Health’s Fall Forum, Learning together: Building learning health systems through collaboration.

Also delivering a keynote at the Fall forum is Dr. Ibukun Abejirinde, MD, PhD, a scientist at THP’s Institute for Better Health, whose work focuses on advancing health equity across multiple levels of the health system.

Learning while delivering care

An LHS brings research, data and evidence into the day-to-day delivery of health care, creating a continuous cycle of learning and improvement.

Reid led the development of the Learning Health System Action Framework, which identifies the key “gears” needed to make that cycle work. These include data and analytics; evidence synthesis; implementation and knowledge mobilization; evaluation and feedback; and co-design with patients, families, health-care providers and other partners.

The important part, says Reid, is that the gears work together.

“Health care does not magically change overnight,” he says. “We need to learn quickly what works, what doesn’t and for whom, then use that knowledge to improve care. Real-time data and Canadian ingenuity can help us do that.”

A UCalgary priority

The Cumming School of Medicine (CSM) at the University of Calgary has identified transforming health through learning health systems as a strategic plan priority, seeking to become a leading health data analytics centre in Canada.

As part of that work, the O’Brien Institute for Public Health is launching a new Learning Health Systems Accelerator to help connect and support researchers working across the LHS “gears.” The Accelerator will provide funding, opportunities to collaborate and professional development, with the goal of helping move LHS work forward more quickly.

Alberta already has many of the ingredients needed to lead in this area, says Dr. Khara Sauro, PhD’16, associate scientific director, health systems, at the O’Brien Institute.

The province’s electronic medical record and longstanding expertise in health data offer an important foundation. In Calgary, that is coupled with expertise in areas including data and analytics, digital health, implementation science, quality improvement, and co-design with patients, families, health-care providers and decision makers.

“The O’Brien Institute is well positioned to ensure all the gears are turning and in synchrony,” says Sauro.

Reid sees similar potential.

“I am an Albertan by birth and know first-hand the talent and ambition of Calgarians,” he says. “I also admire the comprehensive set of learning assets already in place. In my mind, it’s mostly a matter of bringing people together around a common vision, joining the assets together and making them work in synchrony for the system to relentlessly learn and improve.”

Equity can’t be an afterthought

But a health system that gets better at learning will not necessarily become more equitable on its own and is at risk of perpetuating inequities.

Abejirinde says equity needs to be deliberately built into the system from the beginning.

“If we use the ‘garbage in, garbage out’ logic that a system’s output is only as good as its input, there is no other option but to have equity as an embedded design feature if we want to end up with equitable systems as an outcome,” she says.

“The alternative is the same old thing — maintenance of the status quo.”

Abejirinde acknowledges that embedding equity across a health system can sound daunting. Her advice is to make the challenge smaller and more practical.

“If you can’t boil the ocean, can you bring a pot to boil?” she says.

For a researcher, clinician or health-system partner, that “pot” could be the environment they can influence: a research study, clinic, hospital or team, says Abejirinde. Action could mean changing recruitment practices to make research more inclusive, collecting social determinants of health data in a primary-care clinic or bringing a wider range of perspectives and lived experiences to decision-making tables.

Learning health systems can help connect those individual efforts so others can learn from them and build on them. 

“The work and investments necessary to advance equitable health systems are not as far out of reach as is often imagined,” says Abejirinde. “It does, however, require long-term commitment and enabling environments.”

Building the connections in Calgary

“The concept of a learning health system is a big undertaking and it cannot be tackled alone,” says Sauro. “We are stronger than the sum of our parts, and collaboration is the way to make an impact on the health of Albertans.”

The Oct. 15 event will bring together researchers, patients and families, health-care providers, decision makers and other partners to explore what that collaboration can look like in practice.

For Sauro, the goal is simple: People should leave knowing both that they have a role in advancing a learning health system, and who they need to work with to make it happen.

Learning together: Building learning health systems through collaboration takes place Oct. 15 at the Red & White Club. Admission is free and open to everyone. Learn more and register.