|Learning Health System Characteristics|
|Data utility: data stewarded and used for the common good||Digital technology: the engine for continuous improvement||Trust fabric: strong, protected, and actively nurtured||Leadership: multifocal, networked, and dynamic|
|Care: starting with the best practice, every time||Health information: a reliable, secure, and reusable resource||Outcomes and costs: transparent and constantly assessed||Knowledge: ongoing, seamless product of services and research|
|Culture: participatory, team-based, transparent, improving||Design and processes: patient-anchored and tested||Patients and public: fully and actively engaged||Decisions: informed, facilitated, shared, and coordinated|
|Meaningful Use Requirementsa|
|Core structured personal data (age, sex, ethnicity)||Core list of active problems||Core structured clinical data (VS, meds, [labs])||Clinical decision support||Care coordination support/interoperability|
|Outpatient medicines electronically prescribed||Automated medication safeguard/econciliation||Visit-specific information to patients||Automated patient reminders||e-Record patient access (copy or patient portal)|
|Embedded clinical quality measures||Security safeguards||[Condition-specific data retrieval capacity]||[Public health reporting (reportable conditions)]||[Advance directives for ages >65]|
|Next-Generation Digital Infrastructure|
|LHS Digital Health Utility Next generation requirements||Strategy Elements Activities that advance:||Stakeholder Responsibilitiesb|
|Technical Progress||Ultra-large-scale system perspective Distributed, local data maintenance Virtual interoperability Reliable use and system security protocols Standards vehicles for setting/revising, metadata, vocabulary, data transport, common core datasets, sentinel indicators, access authorization/authentication, data quality review protocols||Ultra-large-scale system perspective Functionality focus System specifications/interoperability Workflow and usability Security and privacy safeguards System innovation||ONC works with NIST, other agencies and IT community to advance interoperability and security protocols NSF works with ONC/NIH on test beds for digital infrastructure component technologies including ULS system approach Interoperability agreements among delivery systems utilizing EHRs CMS develops test beds for digital infrastructure application in care coordination/delivery model innovation|
|Knowledge Generation/Use||Core clinical data elements available for quality improvement and research Channels and protocols for integrating clinical and public health data Capacity and protocols for query-driven data use in quality and research and monitoring of sentinel indicators Novel statistical and database tools for reliable new insights||Shared learning environment Point of decision support and guidance Research-ready records for data reuse Patient-generated data Integration/use of data across sources Distributed data repositories Sentinel indicators Query capacity Analytical tools and methods innovation||NIH, NSF, AHRQ, and FDA work on innovative approaches to research insights from clinical data CDC develops templates/protocols for integrating population and clinical data Healthcare organizations form research collaboratives|
|Engagement||“New norm” for patient involvement Facilitated personal record interface Clinician–patient electronic partnership Patient information access/control Updated best practices delivered at point of decision Active patient support for data use in care improvement Clinician–public health e-partnership||Value proposition and patient confidence Shared learning culture Patient–clinician outcome partnerships Person-centric, lay-oriented health information Closing the disparity gap Continuous evaluation||AHRQ, FDA, NIH, and ONC use established links with patient community to foster active embracing of the digital health utility Patient and clinician groups mediate public engagement and facilitate dialogue among stakeholders to develop shared learning culture/trust|
|Governance||Progressively evolving requirements, specifications, process protocols for exchange, interoperability, and research Cross-national harmonization to foster the global e-health utility Broad ongoing evaluation capacity||The vision Guiding principles Participant roles and responsibilities Process and protocol stewardship Implementation phasing Continuous evaluation||ONC works with other agencies, the HIT community, and patient/clinician groups to foster development of a governance mechanism that encourages dynamic entrepreneurial growth while safeguarding personal security and the common good|
a Optional elements denoted with [ ]. See Appendix B for details.
b Sample list, neither definitive nor complete. See page xxiii for list of acronyms.