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The Learning Healthcare System: Workshop Summary
amount of information needed for clinical decisions—far exceeding the capacity of the human mind. The electronic health record (EHR) will help health professionals accommodate this overload and deliver evidence-based, individualized care. In such a system, EHRs would change the practice ecosystem by making learning continuous, with clinical practice augmented by “just-in-time” access to information and curricula. In addition, when paired with clinical informatics tools, EHRs can support a number of learning strategies ranging from identification of variation in care, to hypothesis generation, to phenotype-genotype hypothesis testing. Achieving this potential will require a completely new approach, entailing discontinuous changes in how we define the roles of health professionals and how we learn.
Mary Mundinger of the Columbia School of Nursing then outlines some of the challenges in health professions education with regard to orienting training around an evolving evidence base. Grounding the teaching approach in evidence and adopting translational research as a guiding principle can lead to a continuous cycle in which students and faculty engage in research, implementation, dissemination, and inquiry. Yet most institutions find considerable variance in the level of integration of evidence into education across health professions. While intellectual engagement with evidence-based practice is evident in faculty publications, it often has not yet found its way substantially into the curriculum as a framework for training. In part, educational efforts always lag behind academic practice, but changes in the culture of medical practice are needed to ensure that educating health professionals about the benefits and methods of bringing evidence to their daily practice actually produces a skill that is recognized and utilized in the healthcare setting.
In the chapter’s final paper, Mark Williams discusses the shortfalls of current continuing medical education (CME) efforts and urges a shift to a knowledge translation approach that is integrated with practice and occurs on a daily basis. He notes that change is needed not only in the content and approach of CME but also in the culture of medical practice, advocating for a shift toward collaborative teamwork and increased cross-departmental collaboration, coupled with incentives for change and the provision of tools to facilitate such change.
CLINICIANS AND THE ELECTRONIC HEALTH RECORDAS A LEARNING TOOL
William W. Stead, M.D.
The electronic health record is one key to a shift to systems approaches to evidence-based care that is nonetheless individualized. EHRs enable