ONC Turns Focus To Developing A "Learning" Health Environment

By Megan Williams, contributing writer

A recent JASON study report, “Data For Individual Health,” outlines the progression of the ONC (Office of the National Coordinator for Health IT) in vision from one based on electronic health records (EHRs) and personal health records (PHRs), to a broader, more health-focused outlook, specifically around the development of a “learning health system.”

The study asks three specific questions in line with achieving that goal:

• “How can EHRs highlight opportunities to engage individuals as they try to achieve health, and to learn from failed efforts to improve treatments for individuals?”
• “How would an EHR of the future help a care team whose goal was health, rather than health care, and who, along with the individual, have access to all the data?”
• “How can data analytics be used to support high quality, patient centered care and offload the large requirements of processing?”

A Weak Loop

The current process of healthcare — a progression from prevention, to diagnosis, to treatment, and then outcomes informed by clinical research, is essentially an inadequate feedback loop that does not provide for learning within the system. It has also left population health research, along with community engagement, disconnected from the process.

The creation of a “learning health system” would involve connecting these factors with more social inputs, connecting healthcare with wellness and health overall. Achieving this environment means an increased role for EHRs and PHRs, along with highlights of data access, scalability, and integration that reaches well beyond what we see in today’s environment.

What It Means For IT

For solutions providers, this means the need for development in a number of areas.

Software architecture that supports an effective health data infrastructure will be essential. JASON has proposed a non-monolithic system — a framework for the development and implementation of the infrastructure.

Apps will also play a key role in achieving interoperability. JASON has already recommended (in 2013) the establishment of publicly accessible APIs (application programming interfaces) as a “bridge from existing systems to a future software ecosystem that can ingest, protect, integrate, and share the knowledge gained from the vast stores of data.” In this report, it restates that recommendation.

The Data Question

The report also indicates that to achieve the goals JASON has laid out, the types of data that can be ingested and analyzed will need to be greatly expanded. That means moving beyond the EHR and into the PHR. That data will come from sources including:

• personal health devices
• patient collaborative networks
• social media
• environmental and demographic data
• genomics and related sources

While these data streams would be new to the healthcare environment, the architecture as proposed would be the same for them as for traditional EHRs.

Going Deeper

The report delves much deeper into the topics of genomics, personal health monitoring, moving diagnostics deeper into point of care environments, social media, analytics and more.

Read “Healthcare IT Driven By The Patient” for more insight into patient health centered IT initiatives.