I’ve heard it said that the U.S. “healthcare system” is really not a system at all but rather a tangled web of siloed organizations. As we reflect on the past year, I think most would agree that COVID-19 highlighted its inefficiencies. The only silver lining of the pandemic is the tremendous amount of progress we have made toward making healthcare more interoperable and efficient. With COVID-19 cases dropping dramatically, and vaccine availability continuing to rise, there is hope that we will soon be on the other side of the virus. Yet, as we look to the future, we know COVID-19 is not the last of its kind. Not acting on the lessons learned from COVID-19 would be a grave mistake. Globally, we can turn necessary innovation into an opportunity to finally make the Learning Health System a reality.
In the late 90s and early 2000s, two famous research studies were published. One study, To Err is Human, found an estimated 44,000 to 98,000 Americans die annually due to medical errors, ranking them as a top ten leading killer. The second study, Crossing the Quality Chasm, found there is a 17-year lag between when a health scientist learns of a new healthcare best practice and when that practice is implemented by practitioners. These studies highlighted major inefficiencies in our healthcare system with the chief problem being the lack of timely integration of healthcare best practices. This deficit of continuous learning has grave consequences on health outcomes. Amongst wealthy countries, The U.S. healthcare system ranks highest in spending and lowest in health outcomes. Sadly, the U.S. performs well below other countries in common metrics such as life expectancy, infant mortality and unmanaged diabetes.
As a follow-up to their studies in the early 2000s, the Institute of Medicine developed the concept of the Learning Health System (LHS). The LHS provides a framework for incentivizing the shift of the U.S. healthcare system into one that provides the best healthcare choices for every patient and provider.
Around the same time of the development of the Learning Health System framework, rates of obesity in the U.S. were steadily increasing. In 2008, the estimated annual medical cost of obesity in the U.S. was $147 billion; and the medical cost was found to be $1,429 higher for people who have obesity than those with a normal weight. Public health professionals quickly found an association between obesity and socioeconomic status with poor health outcomes. But then why hasn't the healthcare industry found a way to affect meaningful change when treating obesity? The answer might very well lie in the need to incentivize the doctors to care for those with obesity, diabetes and those who are at-risk for developing those comorbidities. If we had implemented the LHS in the early 2000s, our response to COVID-19 as well as the prevalence of those most at-risk for severe complications for COVID-19 may have looked very different.
When the LHS is fully deployed, our national healthcare system will incentivize value-based care, apply and develop care best practices as a natural product of care delivery and leverage interoperable data streams. The LHS will put timely and actionable knowledge, based on the real-world experiences of millions of patients, in the hands of clinicians, patients, and all healthcare stakeholders. This will allow for better- informed decisions that lead to saving lives, improving health, and transforming our healthcare system into one that rapidly learns and continuously improves. The LHS is what is necessary to prepare for the next life-threatening novel virus (yes, there will be one). If we implement the LHS, disease surveillance, health system preparedness and accountability for value-based care will increase, and administrative burden will organically decrease. All of these capabilities build on each other, ultimately providing us with an actual system that can more adequately prevent, detect and respond to public health crises and more equitably protect our most vulnerable.
As we begin to make plans for the future, I encourage every patient, doctor, administrator, payer and vendor to find ways to enable learning and share knowledge to make our healthcare system more transparent and collaborative. This continuous, collective approach to learning will help create a true "system." In order to realize the LHS at a national level, we must have commitment from all stakeholders to incentivize value-based care, to collaborate and commit to interoperable systems, to measure quality using standardized methods and to provide first-time quality using the best evidence available at the point of care, for every patient. As the famous philosopher George Santayana said, “Those who cannot remember the past are condemned to repeat it." Let’s not forget the lessons learned from COVID-19. Let's commit to making the Learning Health System a reality.
Watch our on-demand webinar to learn how an LHS impacts healthcare quality.