understand exactly when we have arrived at a credible and an appropriate lesson in the learning process to apply it to patient care? It is also important to structure the data-gathering process to anticipate, plan for, and execute the collection of data in a systematic fashion to capture the lessons learned and feed those lessons back into the learning enterprise to improve the system’s performance, he said.

However this endeavor has numerous challenges, Dr. McGinnis pointed out, including legal, regulatory, fiscal, and professional. He reiterated the potential of regulatory agencies, such as Medicare and the FDA, to spur the development of a cancer RLHS. Medicare has the ability to “transform our mind-set about the way in which every clinical encounter ought to add to the learning process,” he said, and added that it is encouraging that the FDA, which has traditionally limited itself to the premarket domain, “is now working hard to engage the postmarket domain. So we have the right perspectives, insights, and inclinations on the part of the leadership to act on some of the exciting activities that we heard about in the course of the meeting.”

He then described six basic elements of the continuous learning process:

1. Capturing the experiences of every clinical encounter

2. Developing consensus and guidelines based on the experiences that have been captured

3. Validating the various guidelines that have been developed

4. Delivering care based on those guidelines

5. Ensuring that care is standardized and harmonized, while controlling variation that allows for innovation and the generation of new information

6. Creating natural feedback loops so the results captured are evaluated and fed back into the system for learning and improvement purposes

Because the modern network approach to learning is nonlinear, as opposed to the more traditional linear approach, “one of our biggest challenges is to force ourselves to look specifically at those intersecting dynamics, at each of those points in the feedback process and ensure that the elements necessary for the success of the activities at each of those points are given consideration,” Dr. McGinnis said.

Dr. McGinnis provided some take-home messages, noting that we