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The Learning Healthcare System: Workshop Summary (2007)

Chapter: Appendix A Workshop Agenda

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Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
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Appendix A
Workshop Agenda

THE LEARNING HEALTHCARE SYSTEM


A WORKSHOP OF THE IOM ROUNDTABLE ON EVIDENCE-BASED MEDICINE

THE KECK CENTER OF THE NATIONAL ACADEMIES

WASHINGTON, DC 20001


JULY 20-21, 2006

MEETING AGENDA


OBJECTIVE: To characterize the key features of the Learning Healthcare System, to identify the most important hindrances to its evolution, and to posit some remedies.

DAY 1: THE LEARNING HEALTHCARE SYSTEM

8:30

WELCOME AND OPENING REMARKS

 

Harvey Fineberg, Institute of Medicine

 

Darrell Kirch, Association of American Medical Colleges

What would be the features of a healthcare system designed not to learn—how might it be corrected?

9:00

SESSION 1: HINTS OF A DIFFERENT WAY—LEARNING FROM EXPERIENCE CASE STUDIES IN PRACTICE-BASED EVIDENCE DEVELOPMENT

 

CHAIR: Carolyn Clancy, Agency for Healthcare Research and Quality (AHRQ) and EBM Roundtable Member

What “best practices” might be spotlighted to illustrate ways to use the health care experience as a practical means of both generating and applying evidence for health care? Are there lessons from certain examples that can help identify the most promising approaches?

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×

 

15-minute presentations followed by discussion session

Peter Bach, Centers for Medicare & Medicaid Services (CMS)

Coverage with evidence development: Lung volume reduction surgery

Jed Weissberg, Permanente Federation

Use of large system databases: Cyclooxygenase-2 (COX-2) inhibitors

Stephen Soumerai, Harvard Pilgrim Health Care

Potential of quasi-experimental designs for evaluating health policy

Sean Tunis, Health Technology Center

Practical clinical trials

Alan Morris, Latter Day Saints Hospital and University of Utah

Computerized protocols to assist clinical research*

10:30

SESSION 2: THE EVOLVING EVIDENCE BASE—METHODOLOGIC AND POLICY CHALLENGES

 

CHAIR: Don Steinwachs, Johns Hopkins University and EBM Roundtable Member

What challenges confront methodologically rigorous learning from experience? How can alternatives to randomized controlled trials (RCTs) and innovative approaches to generating evidence be used to confront emerging challenges: broader post-marketing surveillance; linking Phase III and coverage requirements; increasingly complex patterns of comorbidity; subgroup analysis, and heterogeneity in treatment outcomes? How might learning that is more nimble also foster innovation and discovery?

15-minute presentations followed by discussion session

Robert Califf, Duke Clinical Research Institute

Alternatives to large RCTs

David Goldstein, Duke Institute for Genome Sciences and Policy

Engaging the implications of subgroup heterogeneity— prospects for pharmacogenetics

Harlan Weisman, Johnson & Johnson

Broader post-marketing surveillance for insights on risk and effectiveness

Telba Irony, Food and Drug Administration (FDA)

Evaluating interventions in a rapid state of flux

David Eddy, Archimedes Inc.

Mathematical models to fill the gaps in evidence*

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×

 

Sheldon Greenfield, University of California at Irvine

Heterogeneity of treatment effects: subgroup analysis*

Steve Teutsch, Merck & Co. Inc.

Adjusting evidence generation to the scale of effects*

Janlori Goldman, Health Privacy Project

Protecting privacy while linking patient records*

12:00

Lunch

1:00

SESSION 3: NARROWING THE RESEARCH-PRACTICE DIVIDE—SYSTEM CONSIDERATIONS

 

CHAIR: Cato Laurencin, University of Virginia and EBM Roundtable Member

What system changes are needed for the healthcare delivery environment to facilitate the generation and application of better evidence? What are the needs and implications for structuring “built-in” study designs, managing the data burden, and defining appropriate levels of evidence needed? What is needed to turn clinical data into an “epidemiologic utility,” a public good?

15-minute presentations followed by discussion session

Brent James, Intermountain Healthcare

Feedback loops to expedite study timeliness and relevance

Walter Stewart, Geisinger Health System

Clinical data system structure and management for better learning

Steven Pearson, America’s Health Insurance Plans

Implications for standards of evidence

Robert Galvin, General Electric

Implications for innovation acceleration

2:30

SESSION 4: PANEL DISCUSSION—KEY BARRIERS AND PRIORITIES FOR ACTION

 

CHAIR: Denis Cortese, Mayo Clinic and EBM Roundtable Member

Members of the Roundtable on Evidence-Based Medicine

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×

DAY 2: ACCELERATING THE PROGRESS

8:30

OPENING REMARKS

 

Denis Cortese, Mayo Clinic and EBM Roundtable Chair

What are some of the key challenges and opportunities if the development of a sustainable capacity for real-time learning is to be accelerated?

9:00

SESSION 5: HINTS OF A DIFFERENT WAY—LEARNING SYSTEMS IN PROGRESS

 

CHAIR: Jonathan Perlin, Department of Veterans Affairs and EBM Roundtable Member

What experiences of healthcare systems highlight the opportunities and challenges in integrating the generation and application of evidence for improved care? What’s needed to take to scale?

15-minute presentations followed by discussion session

Joel Kupersmith, Veterans Health Administration

Implementation of evidence-based practice in the Veterans Administration

George Isham, HealthPartners

AQA (Ambulatory Care Quality Alliance)

Robert Phillips, Robert Graham Center

Practice-Based Research Networks

Lynn Etheredge, George Washington University

A rapid learning health system

10:30

SESSION 6: DEVELOPING THE TEST BED: LINKING INTEGRATED DELIVERY SYSTEMS

 

CHAIR: Helen Darling, National Business Group on Health and EBM Roundtable Member

How can integrated healthcare delivery systems be better engaged for structured real-time learning? How can the organizational, logistical, data system, reimbursement and regulatory issues be addressed?

15-minute presentations followed by discussion session

Stephen Katz, National Institutes of Health (NIH)

NIH Roadmap initiatives use of integrated delivery systems

Cynthia Palmer, Agency for Healthcare Research and Quality

Turning research to ACTION through delivery systems

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×

 

Eric Larson, Group Health Cooperative

Health Maintenance Organization Research Network (HMORN)

Michael Mustille, Permanente Federation

Council of Accountable Physician Practices

12:00

LUNCH

12:30

SESSION 7: THE PATIENT AS A CATALYST FOR CHANGE

 

CHAIR: Andrew Stern, Service Employees International Union and EBM Roundtable Member

What is the changing role of the patient in an age of the Internet and the personal health record? Reengineering a system focused on patient needs and built around best care requires improved communication of evidence. How does patient preference fit into evidence development?

15-minute presentations followed by discussion session

Janet Marchibroda, eHealth Initiative

The Internet, eHealth, and patient empowerment

Andrew Barbash, Apractis Solutions

Joint patient-provider management of the electronic health record (EHR)

James Weinstein, Dartmouth-Hitchcock Medical Center

Evidence and shared decision making

1:35

SESSION 8: TRAINING THE LEARNING HEALTH PROFESSIONAL

 

CHAIR: Nancy Nielsen, American Medical Association and EBM Roundtable Member

What are the educational needs for the health professional in the Learning Healthcare System? How must qualification exams and continuing education be adjusted? What approaches can bring the processes of learning and application into seamless alignment?

15-minute presentations followed by discussion session

Mary Mundinger, Columbia University School of Nursing

Health professions education and teaching about evidence

William Stead, Vanderbilt University

Providers and the electronic health record as a learning tool

Mark Williams, Emory University School of Medicine

Redefining continuing education around evolving evidence

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×

2:40

SESSION 9: STRUCTURING THE INCENTIVES FOR CHANGE

 

CHAIR: John Rother, AARP and EBM Roundtable Member

What policies can provide the incentives for the developments necessary to build learning—evidence development and application—into every healthcare encounter?

15-minute presentations followed by discussion session

Alan Rosenberg, WellPoint

Opportunities for private insurers

Steve Phurrough, Centers for Medicare and Medicaid Services

Opportunities for CMS

Wayne Rosencrans, Jr., AstraZeneca

Opportunities for manufacturers

Margaret O’Kane, National Care Quality Alliance

Opportunities for standards organizations

4:00

CONCLUDING SUMMARY REMARKS

 

Denis Cortese, Mayo Clinic and EBM Roundtable Chair J. Michael McGinnis, Institute of Medicine

4:30

ADJOURN

*Presentation included in workshop materials, but not delivered.

Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 315
Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 316
Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 317
Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 318
Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 319
Suggested Citation:"Appendix A Workshop Agenda." Institute of Medicine. 2007. The Learning Healthcare System: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11903.
×
Page 320
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As our nation enters a new era of medical science that offers the real prospect of personalized health care, we will be confronted by an increasingly complex array of health care options and decisions. The Learning Healthcare System considers how health care is structured to develop and to apply evidence--from health profession training and infrastructure development to advances in research methodology, patient engagement, payment schemes, and measurement--and highlights opportunities for the creation of a sustainable learning health care system that gets the right care to people when they need it and then captures the results for improvement. This book will be of primary interest to hospital and insurance industry administrators, health care providers, those who train and educate health workers, researchers, and policymakers.

The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in health care decision making. The Roundtable on Evidence-Based Medicine serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care.

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