Skip to content
naulon
Get started

No retraction, correction or concern found when last checked on Oct 30, 2026.

Learning health systems using data to drive healthcare improvement and impact: a systematic review

Joanne Enticott, Alison Johnson, Helena Teede

BMC Health Services Research · 2021 · Systematic review · CC BY

doi:10.1186/s12913-021-06215-8

Abstract

Background. The transition to electronic health records offers the potential for big data to drive the next frontier in healthcare improvement. Yet there are multiple barriers to harnessing the power of data. The Learning Health System (LHS) has emerged as a model to overcome these barriers, yet there remains limited evidence of impact on delivery or outcomes of healthcare.

Objective. To gather evidence on the effects of LHS data hubs or aligned models that use data to deliver healthcare improvement and impact. Any reported impact on the process, delivery or outcomes of healthcare was captured.

Methods. Systematic review from CINAHL, EMBASE, MEDLINE, Medline in-process and Web of Science PubMed databases, using learning health system, data hub, data-driven, ehealth, informatics, collaborations, partnerships, and translation terms. English-language, peer-reviewed literature published between January 2014 and Sept 2019 was captured, supplemented by a grey literature search. Eligibility criteria included studies of LHS data hubs that reported research translation leading to health impact.

Results. Overall, 1076 titles were identified, with 43 eligible studies, across 23 LHS environments. Most LHS environments were in the United States (n = 18) with others in Canada, UK, Sweden and Australia/NZ. Five (21.7%) produced medium-high level of evidence, which were peer-reviewed publications.

Conclusions. LHS environments are producing impact across multiple continents and settings.

Supplementary Information. The online version contains supplementary material available at 10.1186/s12913-021-06215-8.

References 68

  1. 1.

    Medicine., I.o. Roundtable on Value and Science-Driven Health Care: The Learning Health System and its Innovation Collaboratives: Update Report. 2011.

    Not in our library

  2. 2.

    Medicine., I.o. Making a Difference: Roundtable Charter, Strategy, Tactics, Impact. 2014.

    Not in our library

  3. 3.

    Budrionis A, Bellika JG. The learning healthcare system: where are we now? A systematic review. J Biomed Inform. 2016;64:87-92.

    Not in our library10.1016/j.jbi.2016.09.018

  4. 4.

    McLachlan S, et al. The Heimdall framework for supporting characterisation of learning health systems. J Innov Health Inform. 2018;25(2):77-87.

    Not in our library10.14236/jhi.v25i2.996

  5. 5.
    A framework for value-creating learning health systems · 2019
    No notice
  6. 6.

    Scobie S, Castle-Clarke S. Implementing learning health systems in the UK NHS: policy actions to improve collaboration and transparency and support innovation and better use of analytics. Learn Health Syst. 2020;4(1):e10209.

    Not in our library10.1002/lrh2.10209

  7. 7.

    Teede H, et al. Australian Health Research Alliance: national priorities in data driven healthcare improvement. Med J Aust. 2019;211(11):494-497.

    Not in our library10.5694/mja2.50409

  8. 8.

    Agency for Healthcare Research and Quality (AHRQ), AHRQ Pub No. 19–0052-2. 2019.

    Not in our library

  9. 9.

    Friedman C, et al. Toward a science of learning systems: a research agenda for the high-functioning learning health system. J Am Med Inform Assoc. 2015;22(1):43-50.

    Not in our library10.1136/amiajnl-2014-002977

  10. 10.

    Flynn A. Informatics and technology enable us to learn from every patient: Pharmacists' many roles in learning health systems. Am J Health Syst Pharm. 2019;76(15):1095-1096.

    Not in our library10.1093/ajhp/zxz118

  11. 11.

    Coury J, et al. Applying the plan-do-study-act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC Health Serv Res. 2017;17(1):411.

    Not in our library10.1186/s12913-017-2364-3

  12. 12.

    Harvard Business Review Analytic Services. Leading a new era in health care. 2019.

    Not in our library

  13. 13.

    Foley JF, Vale L. What role for learning health systems in quality improvementwithin healthcare providers? Learn Health Syst. 2017;1(4):e10025.

    Not in our library10.1002/lrh2.10025

  14. 14.
    Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement · 2009
    No notice
  15. 15.

    World Bank Group. World Bank Country and Lending Groups Country Classification. 2020.

    Not in our library

  16. 16.

    Aoki NJ, Enticott JC, Phillips LE. Searching the literature: four simple steps. Transfusion. 2013;53(1):14-17.

    Not in our library10.1111/j.1537-2995.2012.03790.x

  17. 17.

    Enticott J, Braaf S, Johnson A. et al. Leaders’ perspectives on learning health systems: a qualitative study. BMC Health Serv Res. 2020;20:1087. 10.1186/s12913-020-05924-w.

    Not in our library10.1186/s12913-020-05924-w

  18. 18.

    Schünemann 2013, Schünemann HBJ, Guyatt G, Oxman A. The GRADE Working Group. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. 2013.

    Not in our library

  19. 19.

    Smith SK, Rowe K, Abernethy AP. Use of an electronic patient-reported outcome measurement system to improve distress management in oncology. Palliat Support Care. 2014;12(1):69-73.

    Not in our library10.1017/s1478951513000345

  20. 20.

    Simianu VV, Kumar AS. Surgical care and outcomes assessment program (SCOAP): a nuanced, flexible platform for colorectal surgical research. Clin Colon Rectal Surg. 2019;32(1):25-32.

    Not in our library10.1055/s-0038-1673351

  21. 21.

    Marsolo K, et al. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2015;3(1):1168.

    Not in our library10.13063/2327-9214.1168

  22. 22.

    McLinden D, et al. The learning exchange, a community knowledge commons for learning networks: qualitative evaluation to test acceptability, feasibility, and utility. JMIR Form Res. 2019;3(1):e9858.

    Not in our library10.2196/formative.9858

  23. 23.

    Pitt B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.

    Not in our library10.1056/nejmoa1313731

  24. 24.

    Starren JB, Winter AQ, Lloyd-Jones DM. Enabling a learning health system through a unified Enterprise data warehouse: the experience of the Northwestern University clinical and translational sciences (NUCATS) institute. Clin Transl Sci. 2015;8(4):269-271.

    Not in our library10.1111/cts.12294

  25. 25.

    Wagner LI, et al. Bringing PROMIS to practice: brief and precise symptom screening in ambulatory cancer care. Cancer. 2015;121(6):927-934.

    Not in our library10.1002/cncr.29104

  26. 26.

    Shah SJ, et al. Phenomapping for novel classification of heart failure with preserved ejection fraction. Circulation. 2015;131(3):269-279.

    Not in our library10.1161/circulationaha.114.010637

  27. 27.

    Fung-Kee-Fung M, et al. Piloting a regional collaborative in cancer surgery using a "community of practice" model. Curr Oncol. 2014;21(1):27-34.

    Not in our library10.3747/co.21.1663

  28. 28.

    Fung-Kee-Fung M, et al. Regional process redesign of lung cancer care: a learning health system pilot project. Curr Oncol. 2018;25(1):59-66.

    Not in our library10.3747/co.25.3719

  29. 29.

    Bhandari RP, et al. Pediatric-collaborative health outcomes information registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain. 2016;157(9):2033-2044.

    Not in our library10.1097/j.pain.0000000000000609

  30. 30.

    Briscoe MB, Carlisle B, Cerfolio RJ. Data-driven collaboration: how physicians and administration can team up to improve outcomes. Healthc Financ Manage. 2016;70(7):42-49.

    Not in our library

  31. 31.

    Tardif H, et al. Establishment of the Australasian electronic persistent pain outcomes collaboration. Pain Med. 2017;18(6):1007-1018.

    Not in our library10.1093/pm/pnw201

  32. 32.

    Laws R, et al. The Community Health Applied Research Network (CHARN) Data Warehouse: a Resource for Patient-Centered Outcomes Research and Quality Improvement in Underserved, Safety Net Populations. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2014;2(3):1097.

    Not in our library10.13063/2327-9214.1097

  33. 33.

    Vargas N, et al. Qualitative perspective on the learning health system: how the community health applied research network paved the way for research in safety-net settings. Prog Community Health Partnersh. 2018;12(3):329-339.

    Not in our library10.1353/cpr.2018.0057

  34. 34.

    Vo MT, et al. Prompting patients with poorly controlled diabetes to identify visit priorities before primary care visits: a pragmatic cluster randomized trial. J Gen Intern Med. 2019;34(6):831-838.

    Not in our library10.1007/s11606-018-4756-4

  35. 35.

    Ransom C, et al. Correspondance: Understanding cognitive barriers to safer prescribing for frail patients. Clinical Pharmacist, CP, May 2018, Vol 10, No 5;10(5):10.1211/PJ.2018.20204794

    Not in our library

  36. 36.

    Wade SL, et al. Long-term behavioral outcomes after a randomized, clinical trial of counselor-assisted problem solving for adolescents with complicated mild-to-severe traumatic brain injury. J Neurotrauma. 2015;32(13):967-975.

    Not in our library10.1089/neu.2014.3684

  37. 37.

    Lowenstein LM, et al. Randomized trial of a patient-centered decision aid for promoting informed decisions about lung cancer screening: implementation of a PCORI study protocol and lessons learned. Contemp Clin Trials. 2018;72:26-34.

    Not in our library10.1016/j.cct.2018.07.007

  38. 38.

    Arterburn D, et al. Comparative effectiveness and safety of bariatric procedures for weight loss: a PCORnet cohort study. Ann Intern Med. 2018;169(11):741-750.

    Not in our library10.7326/m17-2786

  39. 39.

    Toh S, et al. The National Patient-Centered Clinical Research Network (PCORnet) bariatric study cohort: rationale, methods, and baseline characteristics. JMIR Res Protoc. 2017;6(12):e222.

    Not in our library10.2196/resprot.8323

  40. 40.

    Eriksson JK, Askling J, Arkema EV. The Swedish Rheumatology Quality Register: optimisation of rheumatic disease assessments using register-enriched data. Clin Exp Rheumatol. 2014;32(5 Suppl 85):S-147-9.

    Not in our library

  41. 41.

    Neovius M, et al. Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab. Ann Rheum Dis. 2015;74(2):354-360.

    Not in our library10.1136/annrheumdis-2013-204128

  42. 42.

    Ovretveit J, Nelson E, James B. Building a learning health system using clinical registers: a non-technical introduction. J Health Organ Manag. 2016;30(7):1105-1118.

    Not in our library10.1108/jhom-06-2016-0110

  43. 43.

    Cox ED, et al. A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial. Pediatrics. 2017 May;139(5):e20161688. 10.1542/peds.2016-1688.

    Not in our library10.1542/peds.2016-1688

  44. 44.

    Bartels CM, et al. Connecting rheumatology patients to primary Care for High Blood Pressure: specialty clinic protocol improves follow-up and population blood pressures. Arthritis Care Res. 2019;71(4):461-470.

    Not in our library10.1002/acr.23612

  45. 45.

    Koslov S, et al. Across the divide: "primary care departments working together to redesign care to achieve the triple aim". Healthc (Amst). 2016;4(3):200-206.

    Not in our library10.1016/j.hjdsi.2015.12.003

  46. 46.

    Kraft S, et al. Building the learning health system: describing an organizational structure to support continuous learning. Learn Health Syst. 2017;1:e10034.

    Not in our library10.1002/lrh2.10034

  47. 47.

    Fife CE. How Should Outpatient Wound Clinics Honestly Measure Success? Todays Wound Clin. 2018;12(4). https://www.todayswoundclinic.com/articles/how-should-outpatient-wound-clinics-honestly-measure-success.

    Not in our library

  48. 48.

    Serena TE, et al. A new approach to clinical research: integrating clinical care, quality reporting, and research using a wound care network-based learning healthcare system. Wound Repair Regen. 2017;25(3):354-365.

    Not in our library10.1111/wrr.12538

  49. 49.
    Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system · 2017
    No notice
  50. 50.

    Noseworthy T, Wasylak T, O'Neill B. Strategic clinical networks in Alberta: structures, processes, and early outcomes. Healthc Manage Forum. 2015;28(6):262-264.

    Not in our library10.1177/0840470415600130

  51. 51.

    Psek WA, et al. Operationalizing the learning health care system in an integrated delivery system. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2015;3(1):1122.

    Not in our library10.13063/2327-9214.1122

  52. 52.

    Schechter MS, et al. The Cystic Fibrosis Foundation patient registry as a tool for use in quality improvement. BMJ Qual Saf. 2014;23(Suppl 1):i9-14.

    Not in our library10.1136/bmjqs-2013-002378

  53. 53.

    Liu VX, et al. Data that drive: closing the loop in the learning hospital system. J Hosp Med. 2016;11(Suppl 1):S11-S17.

    Not in our library10.1002/jhm.2651

  54. 54.

    Liu VX, et al. Multicenter implementation of a treatment bundle for patients with Sepsis and intermediate lactate values. Am J Respir Crit Care Med. 2016;193(11):1264-1270.

    Not in our library10.1164/rccm.201507-1489oc

  55. 55.

    Pace WD, et al. The DARTNet Institute: Seeking a Sustainable Support Mechanism for Electronic Data Enabled Research Networks. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2014;2(2):1063

    Not in our library10.13063/2327-9214.1063

  56. 56.

    Wallace PJ, et al. Optum labs: building a novel node in the learning health care system. Health Aff (Millwood). 2014;33(7):1187-1194.

    Not in our library10.1377/hlthaff.2014.0038

  57. 57.

    Lowes LP, et al. 'Learn from every Patient': implementation and early results of a learning health system. Dev Med Child Neurol. 2017;59(2):183-191.

    Not in our library10.1111/dmcn.13227

  58. 58.

    Noritz G, et al. "Learn From Every Patient": How a Learning Health System Can Improve Patient Care. Pediatr Qual Saf. 2018;3(5):e100.

    Not in our library10.1097/pq9.0000000000000100

  59. 59.

    Moffatt-Bruce S, et al. IDEA4PS: the development of a research-oriented learning healthcare system. Am J Med Qual. 2018;33(4):420-425.

    Not in our library10.1177/1062860617751044

  60. 60.

    Rayo MF, et al. Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods retrospective data analysis and direct observation study. BMJ Qual Saf. 2016;25(10):796-802.

    Not in our library10.1136/bmjqs-2015-004137

  61. 61.

    Griffiths and Kapacee. Enabling data flows in Greater Manchester Connected Health City: Connected Health Cities UK; 2019.

    Not in our library

  62. 62.

    Wade SL, Kurowski BG. Behavioral clinical trials in moderate to severe pediatric traumatic brain injury: challenges, potential solutions, and lessons learned. J Head Trauma Rehabil. 2017;32(6):433-437.

    Not in our library10.1097/htr.0000000000000323

  63. 63.

    Noseworthy T, Wasylak T, O'Neill BJ. Strategic clinical networks: Alberta's response to triple aim. Healthc Pap. 2016;15(3):49-54.

    Not in our library

  64. 64.

    Hvitfeldt H, et al. Feed forward systems for patient participation and provider support: adoption results from the original US context to Sweden and beyond. Qual Manag Health Care. 2009;18(4):247-256.

    Not in our library10.1097/qmh.0b013e3181bee32e

  65. 65.

    Zurynski Y, et al. White paper - Mapping the Learning Health System: A Scoping Review of Current Evidence, vol. 2020. Sydney, Australia: 2020: Australian Institute of Health Innovation, and the NHRMC partnership Centre for health system sustainability.

    Not in our library

  66. 66.

    Blog, P. Funding the Next Generation of Learning-Health-System Researchers. 2017 [cited 18th Sep 2019]; Available from: https://www.pcori.org/blog/funding-next-generation-learning-health-system-researchers.

    Not in our library

  67. 67.

    Melder A, et al. An overview of healthcare improvement: unpacking the complexity for clinicians and managers in a learning health system. IMJ. 2020;50(10):1174-1184.

    Not in our library10.1111/imj.14876

  68. 68.

    Lessard L, et al. Type and use of digital technology in learning health systems: a scoping review protocol. BMJ Open. 2019;9(5):e026204.

    Not in our library10.1136/bmjopen-2018-026204

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.