Rapid Learning Systems for Streamlined Care

Tampa—To decrease costs and increase quality of care, the way healthcare providers exchange information and make treatment decisions, must be integrated and provide recommendations. According to Dr. Edward Li, PharmD, BCOP, associate professor, department of pharmacy practice, University of New England College of Pharmacy, Portland, Maine, implementing a rapid learning healthcare system (RLHS) is necessary for capturing results, improving processes, strengthening public health, and generating broader knowledge. Dr. Li presented this information during a session at the AMCP meeting.

A RLHS uses information technology (IT) to gather data from clinical practices, clinical trials, disease registries, and other sources of information on a particular disease state in order to make it readily available to all RLHS users, said Dr. Li. The information in these systems can assist doctors in decision-making by providing rapid data computation to advance evidence creation, formulate analyses, and expedite education on certain diseases. Dr. Li presented oncology as a specific disease state in which a RLHS can assist.

The RLHS is a cycle with 6 stages: (1) hypothesis generation; (2) clinical data collection; (3) data analysis; (4) evidence generation; (5) transformation of care; and (6) evaluation of outcomes. Elements of RLHS include data and informatics, grid computing, clinical practice guidelines, comparative effectiveness research (CER), quality metrics, and decision support tools.

The clinical cancer data collection, for example, uses evidence and informatics from sources such as administrative claims, cancer registries, electronic healthcare records (EHRs), and health information exchanges.

Dr. Li noted that 1 current issue that prevents the RLHS from being successful is the lack of patient data shared among organizations; but there is a solution. There are multiple potential links between organizations. For example, both cancer registries and administrative claims use the Medicare state registry. The information from an all-payers claims database and the Commission on Cancer’s rapid quality reporting system can be compiled and inserted into the Health Information Exchange.

The Health Information Exchange moves patient data among organizations and is a crucial part of the RLHS. From there, the Health Information Exchange distributes EHRs to various institutions. The challenges with the Health Information Exchange include a potential lack of participation and insufficient funds to implement the IT structure that is necessary.

Transformation of care could also be a challenge, as institutions must adopt the same guidelines and decision tools in order to make all conclusions uniform. This can allow managed care to focus more on the paths taken to reach a particular decision, rather than relying on compendiums.

RLHS does have limitations. Insufficient funds can hinder implementation of RLHS. Due to the nature of the system, all records must be electronic, thus potentially forcing organizations to modify their current recording methods. Computing the data into practical guidance for doctors may also be challenging. Ultimately, the RLHS is contingent upon the cooperation and participation of all institutions involved.

Managed care could benefit greatly from the implementation of RLHS; creating data links and exchanges can assist in developing information guidelines, thereby streamlining what is expected of every healthcare institution. Providing access to CER can help doctors make informed decisions. Creating standards and decision tools can promote pathways of thought. Finally, quality metrics can create a standard of care and provide quick reports to providers.

The RLHS can be highly useful in transferring information between institutions and administering treatment to patients using innovative heath IT.

Dr. Li noted that managed care would immensely profit from a RLHS and would considerably improve the efficiency of healthcare.