EHRs critical to 'learning health system' model

Electronic health records can help create network-based learning health systems to integrate chronic care management, quality improvement and research, according to a study published in the August edition of eGEMS (Generating Evidence and Methods to Improve Patient Outcomes).

The researchers, from the Cincinnati Children's' Hospital Medical Center and elsewhere, wanted to create a "proof of concept" architecture for a leaning health system. The goal was that every patient interaction with the healthcare system would provide an opportunity to generate data used both to treat the patient and to create new evidence, as well as knowledge to improve clinical practice and support research efforts.

The researchers designed a technology architecture to support all of these activities, in collaboration with the ImproveCareNow network, which works to boost the quality of life for children and adolescents with Crohn's disease and ulcerative colitis (inflammatory bowel syndrome). They wanted to transform the network's Web-based multicenter registry, which was cumbersome to use, into an "enhanced" version that would serve as a network-based learning health system.

With funding from the Agency for Healthcare Research and Quality, the researchers worked with three leading EHR vendors to collect registry data directly from the centers' systems and electronically transfer it to the registry, deploy automated reports and identify patients for research purposes.

It worked; 31 of the centers have adopted the EHR based forms to collect the data directly from the EHR, and 21 were electronically uploading the data to the registry, which created "significant" time savings over manual data entry. The increased and improved data in the registry also enabled them to more quickly identify potential patients for clinical trials.  

Lack of standards is a major obstacle, according to the study's authors.

"Networks provide the community, expertise, and motivation to do this," they said. "But to be feasible, there must be standardized approaches to allow forms, decision support, and reports to be deployed across vendors. ... Our hope is that this provides a roadmap for others interested in following a similar path and serves as a call for policymakers and sponsors to accelerate the process of defining the necessary standards and methods as well as the best practices on how to adopt them."

EHRs continue to demonstrate their value and potential in supporting research and improving patient care. Lack of interoperability and other standards among EHRs, however, continues to plague the industry.  

To learn more:
- read the study (.pdf)