development of the digital infrastructure for the learning health system. Major elements of those discussions are summarized in this publication, Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care.


In 2001, the IOM report Crossing the Quality Chasm called national attention to untenable deficiencies in health care, noting that every patient should expect care that is safe, effective, patient-centered, timely, efficient, and equitable (IOM, 2001). Based on the determination that health care is a complex adaptive system—one in which progress on its central purpose is shaped by tenets that are few, simple, and basic—the report identified several rules to guide health care. In particular, these rules underscore the importance of issues related to the locus of decisions, patient perspectives, evidence, transparency, and waste reduction. The report envisioned, in effect, engaging patients, providers, and policy makers alike to ensure that every healthcare decision is guided by timely, accurate, and comprehensive health information provided in real time to ensure constantly improving delivery of the right care to the right person for the right price.

The release of the IOM Chasm report stimulated broad activities related to clinical quality improvement and the effectiveness of health care, including the creation by the IOM of the Roundtable on Value & Science-Driven Health Care. Begun in 2006 as the IOM Roundtable on Evidence-Based Medicine, it has explored ways to improve the evidence base for medical decisions and sought the development of a learning health system “designed to generate and apply the best evidence for collaborative health choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.” From its inception, the Roundtable has conducted The Learning Health System Series of public meetings in an effort to outline components of the conceptual foundation of the learning health system. Since 2006 the IOM has conducted 15 workshops in the Learning Health System Series, with 10 reports published and in production:

  • The Learning Healthcare System
  • Leadership Commitments to Improve Value in Health Care: Finding Common Ground
  • Evidence-Based Medicine and the Changing Nature of Health Care
  • Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches
  • Clinical Data as the Basic Staple of Healthcare Learning: Creating and Protecting a Public Good

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