Creating a Learning Health
System in Michigan
Wednesday, June 4, 2014
Joshua C. Rubin, JD, MBA, MPH, MPP
Executive Program Officer for Learning Health System Initiatives
University of Michigan School of Information
[email protected]
Preliminary Acknowledgement
Some portions of this presentation were
adapted from the work of my colleague,
Dr. Charles P. Friedman.
Michigan: A Learning Health State
Pharma
State Public Health
Patientcentered
Groups
Government
Agencies
Beacon
Community
Governance
Patient Engagement
Trust
Analysis
Dissemination
Integrated
Delivery
System
Health Information Organization
3
Health Center
Network
3
Today’s Menu
Primi
• Prelude to the vision and its promise
• The plight of our nation’s health system – the urgent need to learn
• Widespread calls for the Learning Health System (LHS)
• The vision of a nationwide LHS
• Early progress toward a “first system”
• Building a grassroots national (global) movement
Secondi
• Michigan’s charge to transcend HIE and realize the LHS vision
• A summit to launch the movement: creating a LHS in Michigan
• Our collective call to action: working together to transform
healthcare in our state
Envisioning a Learning Health System for
Michigan – Draft Vision Statement Excerpt
“We must take advantage of this
opportunity to build a viable
structure while developing
statewide policies that support a
continuous learning environment.
It seems fitting for the state that
transformed our nation’s
transportation, production, and
distribution systems by inventing
the mass-produced automobile a
century ago to now lead with a
model of transforming healthcare
and health in the 21st century.”
Leading Off with Some Guidance from
JAMA, Circa 1906
The Mass-Produced Automobile:
Invented One Century Ago in Michigan
• Impacts of the invention itself on its domain
• Impacts of the infrastructure created
• Impacts of the frameworks for collaboration created
• Impacts of the lessons learned to realize the invention
What About the Internet?
• What the “galactic network” concept of the 1960s grew into…
• How a foundation for continuous innovation unleashed the
imaginations of billions of people…
A National-Scale Health System That Learns
A System of Health Learners Across Our Nation
Pharma
State Public Health
Patientcentered
Groups
Federal
Agencies
Beacon
Community
Governance
Patient Engagement
Trust
Analysis
Dissemination
Integrated
Delivery
System
Health Information Organization
9
Health Center
Network
9
The LHS Vision: An Opportunity for
Michigan to Lead Our Nation…
• Impacts of the LHS on the health of individuals, communities, and
populations (and the fiscal health of the system itself)
• Impacts of the infrastructure created – empowering continuous
learning, improvement, and innovation
• Impacts from the multi-stakeholder collaborative community
(communities) of interest, social capital, and movement catalyzed
• Impacts of the new cross-disciplinary science of learning
systems/cyber-social ecosystems in innovatively addressing societal
challenges beyond the health domain
An (Unhealthy) Inconvenient Truth:
Our Healthcare System’s Failure to
Learn Routinely and at Scale is a Crisis!
• A number of the challenges that continue to plague healthcare are
symptoms of its failure to learn systemically
• Clinicians (and other stakeholders) are smart…
– But the system is not…
• Much of the learning that is occurring:
– Is not from most experiences
– Is not at scale
– Is not routine or systemic
– Is not shared and translated into practice rapidly
• The impacts connected with these failures constitute a crisis affecting
individual and population health, as well as the fiscal health of our
healthcare system and our nation
• “In the long run the only sustainable competitive advantage is your
organization’s ability to learn faster than the competition.” – Dr. Peter Senge
The Impact of NOT Learning – If Our
Healthcare System Were a Company…
• CEO – We spend way more than our peers and rank next to last on key
indicators of being “high-functioning” (and we’re comparatively inefficient).
• CFO – We waste 30 cents of every dollar we spend (totaling $750 billion per
year – larger than all but 18 countries’ GDPs).
• CIO – We throw away 97% of the experience data needed to address our #2
killer (our #1 killer would give you a heart attack).
• Diversity – Not even close to representative…
• Customer Relations – Over 45% of our customers do not get the service
(care) recommended; when they do get what is recommended, in certain
cases, it works only 20%-30% of the time.
• Safety Officer – We used to believe preventable mistakes killed 98,000
consumers (patients in hospitals) per year, but new studies suggest that figure
could be as high as 400,000.
• Quality Control – Quality improves at around 2% annually (*2 in 35 years).
• Mail Room – It takes about 17 years; lethally slow.
• PR – Infant mortality (compare with other nations).
• Human Resources – We have extraordinary people, but difficulty organizing
and getting them the resources and information they need and desire.
• Child Care – Has a solution…
The Plight in Figures
A Health Equity Issue?
A Civil Rights Issue?
“Unsustainable” – We Can’t Afford NOT
to Do This!
“The price of doing the same
old thing is far higher than the
price of change.”
– Former President Bill Clinton
LHS Fever: Words
“Hard ‘a Port!”
We Need a Hefty Rudder, Now…
The Rudder: A National-Scale
Learning Health System (LHS)
Pharma
State Public Health
Patientcentered
Groups
Federal
Agencies
Beacon
Community
Governance
Patient Engagement
Trust
Analysis
Dissemination
Integrated
Delivery
System
Health Information Organization
18
Health Center
Network
18
The LHS Enables “Virtuous Cycles” of
Study, Learning, and Improvement
LHS: A Platform that Supports Multiple
“Virtuous Cycles”
A High Functioning LHS Will Make These (and
Other) Things Possible
“17 years to 17 months, or maybe 17 weeks or even 17
hours…”
• Over time, the best “personalized” dosage of a new drug is
learned based on patient experience. The current optimal
dosage algorithm is automatically implemented nationwide in
EHR systems.
• During an epidemic, new cases are reported directly from
EHRs and the spread of the disease is predicted. Clinicians
are alerted as the epidemic approaches their practice areas.
• A patient facing a difficult medical decision describes her
case. She discovers the experiences of other patients like her.
The LHS: One Infrastructure that
Supports
• Research
– Clinical
– Comparative effectiveness
– Translational
• Public Health
– Surveillance
– Situational awareness
• Quality Improvement
– Health process and outcomes research
– Best practice dissemination
• Consumer Engagement
– Knowledge-driven decision making
The LHS as Currently Envisioned
• A federation
– NOT a centralized database
• Grounded in public trust and patient
engagement
• Participatory governance
• An “Ultra Large Scale” System
– “Just enough” standardization
– Supports innovation around standards
The LHS as a Fractal
• At every level of scale, it looks pretty much the same
• Local, state, regional, national, global
• A system of like sub-systems
24
LHS Fever in Action
• Learning “islands”
• Data federations and networks
• Grant programs
The Birth of a Grassroots Movement…
• National “Summit” convened in May, 2012 to envision LHS as set of
shared beliefs
• A Dumbarton Oaks conference for the LHS
• ~ 70 organizations represented at The National Press Club
• Resulted in 10 consensus LHS Core Values
• 60 organizations have formally endorsed, hundreds of individuals are
participating in the movement
• Giving rise to a Learning Health Community
“I Have a Dream…”
(Not “I Have a Roadmap”)
Anchoring a Multi-Stakeholder Grassroots
Movement in a Shared Vision for the Future
LHS Core Values
• Person-Focused
• Privacy
• Inclusiveness
• Transparency
• Accessibility
• Adaptability
• Governance
• Cooperative and Participatory Leadership
• Scientific Integrity
• Value
60 Endorsements of the LHS Core Values*
(As of 5/2/2014)
The Center for Learning Health Care
SecureHealthHub, LLC
Siemens Health Services
GE Healthcare IT
Department of Primary Care
and Public Health
*To be included on a Learning Health Community public website that
will list all organizations that have endorsed the LHS Core Values.
Transcending HIE – The Michigan
Imperative
“Enable harmonization with other HIT/HIE work underway that
will provide the foundation to the development of a personcentered learning health system to efficiently serve current and
future learning needs of all stakeholders.”
Realizing MiHIN’s Mission…
Transcending HIE – Anchored in
National Strategic Goals
“The meaningful use space is almost endless in the ways we need to
use it today, whether for public health, disaster or improving
populations, but also to create a learning system, one that is able to
enhance the knowledge base so that nobody gets left behind… By
2024, we are very hopeful that’s the kind of environment we’re going to
have.” – National Coordinator Karen DeSalvo, 4/10/2014
Creating a Learning Health State in Michigan:
Working Together to Transform Health Care in
our State (Excerpt from Draft of 5/14/2014)
Creating a Learning Health State in Michigan: A
Multi-Stakeholder Summit, July, 2014
• Overarching charge: to bring together a critical mass of key (multiple
and diverse) stakeholders to collaboratively create an action plan to
innovatively and collaboratively tackle challenges affecting the health
of the people of Michigan by continuous learning and improvement
• Stakeholder types participating (preliminary list):
– Patients/consumers/caregivers/families
– Clinicians
– Researchers
– Public health professionals
– Payers
– Other stakeholders
Creating a Learning Health State in Michigan:
Preliminary Key Goals and Desired Outcomes
(Excerpt from Draft of 5/14/2014)
• Foster a common understanding of the LHS concept, the foundation for
continuous improvement and innovation it would provide, and the urgency
surrounding its development
• Begin to construct a shared vision of the ways a LHS can empower Summit
participants to innovatively tackle challenges affecting the health of the people
of Michigan at the individual, community, population, and state levels
• Develop a preliminary understanding of Michigan’s current initiatives,
resources, and capabilities related to realizing a LHS
• Collaboratively tailor the vision of the LHS to Michigan’s characteristics and
needs as well as to the interests and needs of the stakeholders
• Collaboratively identify three or more actionable themes to advance this work
in Michigan and form interest groups based on those themes with high-level
strategic work plans with assigned leaders
• Identify stakeholders not present whose participation will be critical to the
success of this work and develop a plan for involving them
• Begin to identify the resources needed to develop a sustainable LHS
including infrastructure, technology, funding, and human and social capital
Creating a Learning Health State in Michigan:
Summit Planning Group
• Gina Buccalo, St. John Providence Health System
• Jim Collins, Michigan Department of Community Health
• Charles Friedman, University of Michigan
• Babette Levy, Center for Healthcare Research & Transformation
• Patrick O’Hare, Spectrum Health System
• Tim Pletcher, Michigan Health Information Network
• Andrew Rosenberg, University of Michigan Health System
• Joshua Rubin, University of Michigan
• Dennis Smith, Upper Peninsula Health Plan
• Tom Simmer, Blue Cross Blue Shield of Michigan
• Marianne Udow-Phillips, Center for Healthcare Research & Transformation
• Meghan Vanderstelt, Michigan Department of Community Health
Creating a Learning Health State in Michigan: A
First Step Toward Catalyzing a Movement…
• Next steps
• Actionable themes
• Working groups
• Self-organizing initiatives
• Grassroots collaboration
• Communities of interest
• A movement
• A model for our nation
Two Questions to Consider*
1. What can a LHS
do for me?
2. What can I do
for a LHS?
*In your role as a healthcare professional, as a
patient/caregiver, as a citizen, and in other roles.
“Let’s all work together to give the gift of health
to current and future generations...”
• Envisioning the future; what is right?
• How do we all work collaboratively to realize this vision?
• Why is doing so (together) urgent?
Questions?
Thank You!
Joshua C. Rubin, JD, MBA, MPH, MPP
Executive Program Officer for Learning Health System Initiatives
University of Michigan School of Information
[email protected]