This document discusses the concept of a learning healthcare system where each patient experience contributes to the evidence base to continuously improve care. It notes that an ideal system provides up-to-date, unbiased, personalized information to patients when and where they want it. However, two cultural challenges remain - acting under uncertainty and improving transparency and trust between providers, health systems, and patients. The document argues that as an integrated, cooperative system, Group Health is well-positioned to help lead the transition to a true learning healthcare system.

1. BIRNBAUM
LECTURE 2013
Prologue: Becoming a learning
healthcare system
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2. What is a learning healthcare system?
“Each patient care experience naturally reflects
the best available evidence, and, in turn, adds
seamlessly to learning what works best in different
circumstances.”
IOM Roundtable on Evidence-Based Medicine, 2008
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3. With the accent on:
“Each patient care experience naturally reflects
the best available evidence, and, in turn, adds
seamlessly to learning what works best in different
circumstances.”
IOM Roundtable on Evidence-Based Medicine, 2008
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4. Seamless integration means:
• No boundary between practice and research.
• Patients and providers are both creators and
consumers of the latest information.
• All experience contributes to evidence.
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5. An example:
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6. An example:
I want information that is:
• Up to the minute
• Unbiased
• Personalized to me
• When & where I want
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7. An example:
I want information that is:
• Up to the minute
• Unbiased
• Personalized to me
• When & where I want
Clinical trials won’t get there,
so we should stop waiting.
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8. The pieces are coming into place
• Systematic assessment of outcomes
• Well-organized data resources
• Sophisticated analytic methods
• Effective health communication
But…technology changes faster than culture.
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9. Two cultural challenges:
• Acting under uncertainty
• Transparency & trust
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10. Two cultural challenges:
• Acting under uncertainty
o Quickly commit to action – knowing we might be wrong
o Change direction – immediately and with no regrets
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11. Two cultural challenges:
• Acting under uncertainty
o Quickly commit to action – knowing we might be wrong
o Change direction – immediately and with no regrets
o Or – learn to play like Mauro
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12. Two cultural challenges
• Acting under uncertainty
o Quickly commit to action – knowing we might be wrong
o Change direction – immediately and with no regrets
• Transparency & trust
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13. Two cultural challenges
• Acting under uncertainty
o Quickly commit to action – knowing we might be wrong
o Change direction – immediately and with no regrets
• Transparency & trust
It’s not really about patient privacy. It’s about our own issues:
o Providers’ fear of scrutiny
o Health systems’ “reputational risk”
o The business model of traditional research
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14. Why Group Health?
• We are an integrated system
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15. Why Group Health?
• We are an integrated system
o So the financial incentives are aligned
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16. Why Group Health?
• We are an integrated system
o So the financial incentives are aligned
• We are a cooperative
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17. Why Group Health?
• We are an integrated system
o So the financial incentives are aligned
• We are a cooperative
o So we know that it’s our members’ data, our
members’ money, and our members’ health
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18. THANK YOU
@GHResearch #Birnbaum13