Improvement and leadership

Learning healthcare systems and data-driven quality improvement

A learning healthcare system is defined by the Institute of Medicine as a system in which, ‘science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.’

Learning health systems can be based on any of the cyclical improvement approaches, such as ‘Plan, Do, Study, Act’, but they explicitly use technical and social approaches to learn and improve with every patient who is treated. 

There is no single learning healthcare system. Rather there are many manifestations, at different scales. It could be a department that tracks its patients’ outcomes in order to learn and improve its practice. It could be a provider that builds predictive models from elements of its EHR, which allow it to forecast demand and reallocate resources more effectively. It could be a national distributed network drawing tens of millions of patient records from multiple providers, to assess the effectiveness of particular treatment. The Learning Healthcare Project has more information.

Critical to the success of learning healthcare systems is collecting the right data in the right way at the point of care, and using that data to drive quality improvement. The HIU has produced a Hospital Episode Statistics guide to assist physicians in using this information. It was developed through a clinical coding project conducted across England, Wales and Scotland to examine the potential use of hospital activity data to support consultant appraisal.


Clinical leadership and professional development

Health informatics has growing importance in clinical practice, research and the application of ‘big data’ and technology in healthcare. Despite being recognised in successive recommendations from the General Medical Council, UK undergraduate medical education largely neglects health informatics. In North America, there are core health informatics requirements across medical specialties and a separate subspecialty in postgraduate training. In the UK, there are currently no equivalent opportunities for junior doctors.

The HIU is working with other stakeholders to establish a Faculty of Clinical Informatics. This will develop a core competency framework for all trainee physicians across specialties, a career pathway and a UK subspecialty curriculum in health informatics. In due course, this will establish clinical informatics as a professional, respected and attractive discipline in health and social care in the UK. The HIU is happy to give advice and mentorship to those seeking a career in this domain.