Many thanks to those who attended our inaugural workshop, held at the Keck Center of the National Academies on July 20-21, 2006. This workshop was the first in a series focusing on ways to better incorporate evidence into healthcare decision-making and took a broad view of the issues, characterizing the key features of a Learning Healthcare System, identifying barriers to its evolution and possible remedies.
Meeting Agenda
The Learning Healthcare System
A Workshop of the IOM Roundtable on Evidence-Based Medicine
Keck Center of the National Academies
Room 100
Washington, DC 20001
July 20-21, 2006
Objective: To characterize the key features of the Learning Healthcare System, to identify the most important hindrances to its evolution, and to posit some remedies.
Day 1: The Learning Healthcare System
8:30 am | Welcome & Opening Remarks
What would be the features of a healthcare system designed not to learn—how might it be corrected?
- Harvey Fineberg, Institute of Medicine
- Darrell Kirch, Association of American Medical Colleges
9:00am | Session 1: Hints of a Different Way— Learning from Experience
What “best practices” might be spotlighted to illustrate ways to use the health care experience as a practical means of both generating and applying evidence for health care? Are there lessons from certain examples that can help identify the most promising approaches?
Case Studies in Practice-Based Evidence Development
Chair: Carolyn Clancy, Agency for Healthcare Research & Quality & EBM Roundtable Member
15-minute presentations followed by discussion session
- Peter Bach, Centers for Medicare & Medicaid Services
Coverage with evidence development: Lung volume reduction surgery - Jed Weissberg, Permanente Federation
Use of large system databases: Cox-2 inhibitors - Stephen Soumerai, Harvard Pilgrim Health Care
Potential of quasi-experimental designs for evaluating health policy - Sean Tunis, Health Technology Center
Practical clinical trials
10:30am | Session 2: The Evolving Evidence Base—Methodologic and Policy Challenges
What challenges confront methodologically rigorous learning from experience? How can alternatives to RCTs and innovative approaches to generating evidence be used to confront emerging challenges: broader post marketing surveillance; linking phase 3 and coverage requirements; increasingly complex patterns of co-morbidity; subgroup analysis and heterogeneity in treatment outcomes? How might learning that is more nimble also foster innovation and discovery?
Chair: Don Steinwachs, Johns Hopkins University & EBM Roundtable Member
15-minute presentations followed by discussion session
- Robert Califf, Duke Clinical Research Institute
Alternatives to large RCTs - David Goldstein, Duke Institute for Genome Sciences & Policy
Engaging the implications of subgroup heterogeneity-prospects for pharmacogenetics - Harlan Weisman, Johnson & Johnson
Broader post marketing surveillance for insights on risk and effectiveness - Telba Irony, Food and Drug Administration
Evaluating interventions in a rapid state of flux
12:00pm | Lunch
1:00pm | Session 3: Narrowing the Research-Practice Divide—System Considerations
What system changes are needed for the healthcare delivery environment to facilitate the generation and application of better evidence? What are the needs and implications for structuring “built-in” study designs, managing the data burden, and defining appropriate levels of evidence needed? What is needed to turn clinical data into an “epidemiologic utility”, a public good?
Chair: Cato Laurencin, University of Virginia & EBM Roundtable Member
15-minute presentations followed by discussion session
- Brent James, Intermountain Healthcare
Feedback loops to expedite study timeliness and relevance - Walter Stewart, Geisinger Health System
Clinical data system structure and management for better learning - Steven Pearson, America’s Health Insurance Plans
Implications for standards of evidence - Robert Galvin, General Electric
Implications for innovation acceleration
2:30pm | Session 4: Panel Discussion—Key Barriers and Priorities for Action
Chair: Denis Cortese, Mayo Clinic & EBM Roundtable Member
Members of IOM Roundtable on Evidence-Based Medicine
DAY 2: Accelerating The Progress
8:30am | Opening Remarks
What are some of the key challenges and opportunities if the development of a sustainable capacity for real-time learning is to be accelerated?
Denis Cortese, Mayo Clinic & EBM Roundtable Chair
9:00am | Session 5: Hints of a Different Way—Learning Systems in Progress
What experiences of healthcare systems highlight the opportunities and challenges in integrating the generation and application evidence for improved care? What’s needed to take to scale?
Chair: Jonathan Perlin, Department of Veterans Affairs & EBM Roundtable Member
15 minute presentations followed by discussion session
- Joel Kupersmith, Veterans Health Administration
Implementation of evidence-based practice in the VA - George Isham, HealthPartners
AQA (Ambulatory Care Quality Alliance) - Robert Phillips, Robert Graham Center
Practice-Based Research Networks - Lynn Etheredge, George Washington University
A rapid learning health system
10:30am | Session 6: Developing the Test-Bed: Linking Integrated Delivery Systems
How can integrated healthcare delivery systems be better engaged for structured real-time learning? How can the organizational, logistical, data system, reimbursement and regulatory issues be addressed?
Chair: Helen Darling, National Business Group on Health & EBM Roundtable Member
15-minute presentations followed by discussion session
- Stephen Katz, National Institutes of Health
NIH Roadmap initiatives use of integrated delivery systems - Cynthia Palmer, Agency for Healthcare Research & Quality
Turning research to ACTION through delivery systems - Eric Larson, Group Health Cooperative
HMO Research Network-developing the T(B)EST bed - Michael Mustille, Permanente Federation
Council of Accountable Physician Practices
12:00pm | Lunch
12:30pm | Session 7: The Patient as a Catalyst for Change
What is the changing role of the patient in an age of the Internet and the personal health record? Reengineering a system focused on patient needs and built around best care requires improved communication of evidence. How does patient preference fit into evidence development?
Chair: Andrew Stern, Service Employees International Union & EBM Roundtable Member
15 minute presentations followed by discussion session
- Janet Marchibroda, eHealth Initiative
The Internet, eHealth and patient empowerment - Andrew Barbash, Apractis Solutions
Joint patient-provider management of the electronic health record - James Weinstein, Dartmouth-Hitchcock Medical Center
Evidence and shared decision making
1:35pm | Session 8: Training the Learning Health Professional
What are the educational needs for the health professional in the Learning Healthcare System? How must qualification exams and CE be adjusted? What approaches can bring the processes of learning and application into seamless alignment?
Chair: Nancy Nielsen, American Medical Association & EBM Roundtable Member
15 minute presentations followed by discussion session
- Mary Mundinger, Columbia University School of Nursing
Health professions education and teaching about evidence - William Stead, Vanderbilt University
Providers and the electronic health record as a learning tool - Mark Williams, Emory University School of Medicine
Redefining continuing education around evolving evidence
2:40pm | Session 9: Structuring the Incentives for Change
What policies can provide the incentives for the developments necessary to build learning—evidence development and application—into every healthcare encounter?
Chair: John Rother, AARP & EBM Roundtable Member
15 minute presentations followed by discussion session
- Alan Rosenberg, Wellpoint
Opportunities for private insurers - Steve Phurrough, Centers for Medicare & Medicaid Services
Opportunities for CMS - Wayne Rosencrans, Jr., AstraZeneca
Opportunities for manufacturers - Margaret O’Kane, National Care Quality Alliance
Opportunities for standards organizations
4:00pm | Concluding Summary Remarks
- Denis Cortese, Mayo Clinic & EBM Roundtable Chair
- Michael McGinnis, Institute of Medicine
4:30pm | Adjourn
