The Learning Health System Series – författare

Over the last decade, advances in artificial intelligence (AI) technologies have created transformational opportunities for health, health care, and biomedical science. While new tools are available to improve effectiveness and efficiency in myriad applications in health and health care, challenges persist, including those related to increasing costs of care, staff burnout and shortages, and the growing disease burden of an aging population. The need for new approaches to address these long-standing challenges is evident and AI offers both new hope and new concerns.An Artificial Intelligence Code of Conduct for Health and Medicine: Essential Guidance for Aligned Action presents a unifying AI Code of Conduct (AICC) framework developed to align the field around responsible development and application of AI and to catalyze collective action to ensure that the transformative potential of AI in health and medicine is realized. Designed to be applied at every level of decision making—from boardroom to bedside and from innovation labs to reimbursement policies—the publication serves as a blueprint for building trust, protecting patients, and ensuring that innovation benefits people.

Since its founding, the Center for Medicare & Medicaid Innovation (CMMI) has tested more than 50 alternative payment models reaching more than 28 million patients across 528,000 health care providers and plans, yielding invaluable insights on the implementation of models to achieve better care, better health, and lower costs. On the other hand, many basic lessons learned are lessons unapplied. U.S. population health outcomes lag behind its highly economically developed peers and our health system is still firmly entrenched in the fee-for-service payment system that rewards service volume.This Special Publication suggests six key priority actions for CMMI centered on signaling, mapping, measuring, modeling, partnering, and demonstrating. These priority actions, coupled with implementation considerations that focus on meaningful and continuous engagement, intersectionality and diversity, and expanding CMMI activities and impact, are intended to assist in aligning, supporting, and informing the implementation of CMMI's Strategic Refresh.

Sharing health data and information across stakeholder groups is the bedrock of a learning health system. As data and information are increasingly combined across various sources, their generative value to transform health, health care, and health equity increases significantly. Health data have proven their centrality in guiding action to change the course of individual and population health, if properly stewarded and used.In the context of the COVID-19 pandemic, both data and a lack of data illuminated profound shortcomings that affected health care and health equity. Yet, a silver lining of the pandemic was a surge in collaboration among data holders in public health, health care, and technology firms, suggesting that an evolution in health data sharing is visible and tangible.This Special Publication features some of these novel data-sharing collaborations, and has been developed to provide practical context and implementation guidance that is critical to advancing the lessons learned identified in its parent NAM Special Publication, Health Data Sharing: Building a Foundation of Stakeholder Trust. The focus of this publication is to identify and describe exemplar groups to dispel the myth that sharing health data more broadly is impossible and illuminate the innovative approaches that are being taken to make progress in the current environment. It also serves as a resource for those waiting in the wings, showing how barriers were addressed and harvesting lessons and insights from those on the front lines.In the meantime, knowledge is already available to foster better health care and health outcomes. The examples described in this volume suggest how intentional attention to health data sharing can enable unparalleled advances, securing a healthier and more equitable future for all.

The emergence of artificial intelligence (AI) in health care offers unprecedented opportunities to improve patient and clinical team outcomes, reduce costs, and impact population health. While there have been a number of promising examples of AI applications in health care, it is imperative to proceed with caution or risk the potential of user disillusionment, another AI winter, or further exacerbation of existing health- and technology-driven disparities.This Special Publication synthesizes current knowledge to offer a reference document for relevant health care stakeholders. It outlines the current and near-term AI solutions; highlights the challenges, limitations, and best practices for AI development, adoption, and maintenance; offers an overview of the legal and regulatory landscape for AI tools designed for health care application; prioritizes the need for equity, inclusion, and a human rights lens for this work; and outlines key considerations for moving forward.AI is poised to make transformative and disruptive advances in health care, but it is prudent to balance the need for thoughtful, inclusive health care AI that plans for and actively manages and reduces potential unintended consequences, while not yielding to marketing hype and profit motives.

Evidence-based medicine arose from a clear need and represents a major advance in the science of clinical decision making. Despite broad acceptance of evidence-based medicine, however, a fundamental issue remains unresolved: evidence is derived from groups of people, yet medical decisions are made by and for individuals. Despite persistent assertions from clinicians that determining the best therapy for each patient is a more complicated endeavor than just picking the best treatment on average, traditional approaches have been overly reliant on the average effects estimated from the outcomes of clinical trials.This Special Publication is based on a workshop, held by the National Academy of Medicine, that considered patient and stakeholder perspectives on the importance of understanding heterogeneous treatment effects (HTE) and best practices for implementing clinical programs that take HTE into account. For evidence to be more applicable to individual patients, we need to combine methods for strong causal inference (first and foremost, randomization) with methods for prediction that permit inferences about which particular patients are likely to benefit and which are not. Better population-based outcomes will only be realized when we understand more completely how to treat patients as the unique individuals they are.

Realizing the promise of digital technology will depend on the ability to share information across time and space from multiple devices, sources, systems, and organizations. The major barrier to progress is not technical; rather, it is in the failure of organizational demand and purchasing requirements. In contrast to many other industries, the purchasers of health care technologies have not marshaled their purchasing power to drive interoperability as a key requirement. Better procurement practices, supported by compatible interoperability platforms and architecture, will allow for better, safer patient care; reduced administrative workload for clinicians; protection from cybersecurity attacks; and significant financial savings across multiple markets.With funding support from the Gordon and Betty Moore Foundation, this National Academy of Medicine Special Publication represents a multi-stakeholder exploration of the path toward achieving large-scale interoperability through strategic acquisition of health information technology solutions and devices. In this publication, data exchanges over three environments are identified as critical to achieving interoperability: facility-to-facility (macro-tier); intra-facility (meso-tier); and at point-of-care (micro-tier). The publication further identifies the key characteristics of information exchange involved in health and health care, the nature of the requirements for functional interoperability in care processes, the mapping of those requirements into prevailing contracting practices, the specification of the steps necessary to achieve system-wide interoperability, and the proposal of a roadmap for using procurement specifications to engage those steps. The publication concludes with a series of checklists to be used by health care organizations and other stakeholders to accelerate progress in achieving system-wide interoperability.

As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS.

In 2016, the National Academy of Medicine (NAM) hosted a series of meetings, which was sponsored by the Patient-Centered Outcomes Research Institute, with support from NAM's Executive Leadership Network. The series underscored the importance of partnerships between researchers and health system leadership and considered opportunities to build institutional capacity, cross-institutional synergy, and system-wide learning. During these meetings, health system executives, researchers, and others discussed building infrastructure that simultaneously facilitates care delivery, care improvement and evidence development. The vision is a digital system-wide progress toward continuous and seamless learning and improvement throughout health and health care. This publication aims to answer the following questions:How can evidence development be accelerated, given current knowledge and resources?What might that mean for better outcomes for patients and greater efficiency in health care?What system and culture changes are required to generate evidence from the care experience?How much progress has been made in preparing the field for the paradigm shift?What are the hallmarks of successful partnerships among care executives and research leaders?What are the priorities in advancing executive leadership to the next level for continuously learning health and health care?

The United States is experiencing a decline in life expectancy despite high health care spending due to a multitude of factors, including the COVID-19 pandemic, opioid epidemic, high burden of chronic disease, and systemic and structural inequities.A response proportional to this crisis is required. Valuing America's Health: Aligning Financing to Reward Better Health and Well-Being explores opportunities to transform the current health and health care system to one that promotes whole person and whole population health. The publication emphasizes the need for a bold vision and sustainable financing strategies to prioritize health and well-being for all. Authors of the publication highlight the importance of building a movement to prioritize health, repairing systemic failures, holding stakeholders accountable, controlling health care costs, incentivizing health promotion, adopting collaborative financing and policy-making approaches, and empowering individuals and communities in health decision-making.The way is clear; what is needed now is the will to move forward. Learn more about how to ensure our nation's health and health care system can support optimal health for all.

The U.S. biomedical research enterprise has played a vital role in advancing science, human health, and the economy. It has contributed significantly to fields such as agriculture, environmental remediation, job creation, and technological innovation. Over the past 80 years, landmark achievements include reducing cancer mortality, developing HIV/AIDS treatments, sequencing the human genome, and creating vaccines that mitigated the impact of the COVID-19 pandemic. The enterprise has grown remarkably in less than a century and holds even greater potential for future success. However, its progress is hindered by a lack of high-level national coordination, a fragmented funding system, and a declining workforce.The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America addresses these challenges in five key areas—strategic vision, funding, health equity, coordination and convergence science, and workforce development—offering a roadmap that could be used to sustain U.S. leadership in global health.