tell it like it seems: challenges identifying requirements of a learning health system
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Tell It Like It Seems: Challenges Iden4fying Requirements of a Learning Health System Allen Flynn, PharmD
Johmarx PaDon, MD Jodyn PlaD, PhD
Images: Ennead Architects “building”. Bluedarkat “psychedelic elephant pop art design”.
The health system is like an elephant
Images: Bluedarkat “psychedelic elephant pop art design”.
Truths about the health system come from various viewpoints
Clinical Prac4ce and
Research
Engineering
Informa4cs
Biosciences
Consumers
Computer science
Individuals “tell it like it seems” to them
Collabora4vely realizing a LHS will require…
(1) A transdisciplinary community of researchers, (2) funded by various sources, (3) anchored in a common overarching vision, (4) driven by a set of deep and enduring research
ques4ons. -‐ Charles P. Friedman, December 28, 2014
Images: Ennead Architects “building” Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”. .
Disclosures
• None
Images: Ennead Architects “building”. Bluedarkat “psychedelic elephant pop art design”.
• Mo4va4on and background • Problem of gathering requirements • Research ques4ons • Methods • Results • Conclusions
Outline
Images: Ennead Architects “building”. Bluedarkat “psychedelic elephant pop art design”.
High cost care of mediocre quality
Davis, K., Squires, D. Stremikis, K. & Schoen C. (2014). “Mirror, mirror on the wall: how the performance of the U.S. health care system compares internationally, 2014 update.” Commonwealth Report.
The United States health care system is the most expensive in the world, but data show it consistently underperforms rela4ve to other
countries on most dimensions of performance.
$8,500 in U.S.
$4,400 average
2014
Per capita expenditure 2011
Images: UCL.AC.UK (Post PCR Laboratory) – modified photo. Pilgrim Medical Center (exam room) – modified image.
The divide
Images: Mallow “Document” Lewis “Microscope” Warslab “ICU”.
Health Care Prac4ce & Health Behavior
Scien4fic Analysis Evidence
Con4nuous rapid systema4c learning
Images: “Analysis”, “User” from The Noun Project.. Warslab “ICU” Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”.
Disseminate Evidence as
Advice
Inform Care & Behavior
Scien4fic Analysis
Share Data
Problem: Generate a minimum set of requirements to support a common LHS vision
Images: Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”.
“A massive system of systems.” or
an “ultra-‐large system.”
Friedman C, et al, J Am Med Inform Assoc, 2014, “Toward a science of learning systems: a research agenda for the high-‐func4oning Learning Health System”.
• No individual person can ar4culate them all
• Many scien4fic and other perspec4ves
• Iden4fica4on & reconcilia4on of various LHS concepts and related requirements are needed to achieve a common overarching vision
Research ques4ons
1 What learning health system requirements can be found already in the literature? 2 What new requirements can be generated by using narra4ve ar4facts to tell stories about a LHS? 3 What are some challenges of
using story-‐telling techniques to to elicit LHS requirements?
Images: Ennead Architects “building” Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”.
Methods
Search Literature
Write LHS Narra4ves
Create LHS Diagrams
Make LHS Storyboards
Images: Ennead Architects “building” Bluedarkat “psychedelic elephant pop art design”. Logos by MisterPixel, N. Eul, G. Dolce-‐Merda, A. Gajdosik
Literature search
• “Seed ar4cles” with LHS defini4ons • References from “seed ar4cles” examined • IOM 2012 “Best Care at Lower Cost” Report analyzed for LHS concepts and requirements
Images: Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”.
Narra4ve stories • Select domain • Write a problem statement • Tell of how it seems the LHS might “work” • Gather feedback about LHS concepts
Development of diagrams
• Develop diagrams to explain how it seems the LHS might “work”
• Gather feedback about LHS concepts
Iden4fy a problem of interest
Iden4fy par4cipa4ng stakeholders
Iden4fy needed experience data Standardize representa4on
Aggregate experience data
Analyze experience data
Generate findings
Human interpreta4on of findings
Generate and package knowledge for dissemina4on (DKOs)
Iden4fy message recipients
Generate and send “message”
Collect and record experience data (modify data to be collected?)
Afferent Efferent
Respond to message
hDp://healthinforma4cs.umich.edu/research/lhs-‐ini4a4ves/tci/storyboards
Design and share story boards
LHS requirements repeated in the literature
• Integrates with exis4ng health IT systems • Accumulates data automa4cally in analyzable form • Is pa4ent oriented & supports consumers directly • Is query-‐able by end users with health ques4ons • Relies on federated data
Images: Ennead Architects “building” Bluedarkat “psychedelic elephant pop art design . .
LHS requirements generated using ar4facts • Indicates varying levels of analy4cal rigor and reliability of evidence
• Interprets, vets, and validates new knowledge • Formulates, tailors and makes advice available • Supports shigs between individual level and popula4on level views and decision-‐making
• Automa4cally begins capturing new data at the moment when knowledge is applied to a decision related to a problem of interest
Images: Ennead Architects “building” Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”. .
• As a form, short narra4ve stories were too simple • Prose tended to hide the LHS infrastructure • Feedback focused on content and not concepts • We struggled to communicate these things:
– Itera4on – Timeframes – Scope of the problems of interest – What’s new and different in an LHS – Areas of system science inquiry
Challenges genera4ng requirements
Images: Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”. .
Conclusion – “Tell it Like it Seems”
Some new shared concepts moving us towards
a “common overarching vision” of a Learning Health System
• Understanding came from repeated sharing • Several “new to us” LHS requirements emerged • Transdisciplinary scien4fic team-‐building
Images: Bluedarkat “psychedelic elephant pop art design . Pixgood “circuit board wall art”. .