The Alliance and its members are uniquely successful, not only in comparison to others in Ontario, but also in Canada and Internationally, as being the largest, most deeply rooted, most successful learning health system that I’ve ever seen.
– Dr. Merrick Zwarenstein, Professor in the Centre for Studies in Family Medicine and Department of Epidemiology & Biostatistics at Western University
# What is the EPIC Learning Health System?
A Learning Health System (LHS) is characterized by continuous learning and growth. It brings together information from practice and research and feeds it back to teams in ways that are meaningful and useable to them. This in turn leads to practice change that improves care. The participants in a learning health system collect, share, and use information in real time to guide care and improve decision-making. This cycle of continuous improvement results in better client experiences; better health and wellbeing for individuals, communities, and populations; more satisfaction and joy in work for health care teams; and a more effective and sustainable health system. Around the world, this approach to learning and improvement has been increasingly recognized as a key enabler of better health care.
In 2015, the Alliance began a journey towards becoming a learning health system. This journey passed a major milestone in October 2020, when our LHS was formally adopted by the Executive Leaders’ Network. Thus our learning health system, EPIC – which stands for Equity, Performance, Improvement, and Change – was born.
We will no longer provide data that isn't meaningful or actionable.
Another key aspect of our Learning Health System is a commitment to ensure that data shared is meaningful and actionable. This means we are committed to compiling and presenting practice and administrative data in accessible ways that Alliance members can use do drive local improvements and that our sector can use to advocate for changes to the health system.
We are also committed to collecting, sharing, and using data in ways that are culturally safe and advance health equity. This means a commitment to working with Black and Indigenous health leaders to ensure we are adhering to principles of data sovereignty, including the EGAP (Engagement Governance, Access and Protection) and OCAP (Ownership, Control, Access and Possession) frameworks.
The EPIC Learning Health system brings together many different Alliance programs and projects, including:
- TeamCare
- Social Prescribing
- Research
- Information Management
- Learning Events
- Practice-Based Learning Network
- Communities of Practice
- Learning Collaboratives
- Updated and streamlined practice profiles and benchmarking reports.
All learning health systems follow a similar learning cycle: relevant data is assembled and analyzed; results are interpreted and delivered with tailored feedback; and action is taken to change or improve practice. This generates new data, and the cycle continues. This is illustrated in Figure 1.
Despite these common elements, there is no single LHS framework. Rather, there are many different manifestations at different scales. What is unique about Alliance member organizations will also be unique to the LHS we build together: it will be grounded in our common commitment to health equity and the principles and attributes of the Model of Health and Wellbeing.
We communicate about EPIC activities and research through our weekly Alliance eBulletin, EPIC News, and our Research Library.
# There are many ways to participate in our Learning Health System! Here are a few of them.
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# Elements of our Learning Health System
To complete the continuous cycle of learning, we must commit to using the knowledge we generate through tailored feedback and meaningful quality improvement. We will achieve this by employing a number of new tools and by modifying and repurposing existing ones. The tools and people below are the drivers of our learning health system.
# Information Management Strategy
The Alliance LHS will be built on a foundation we have already established: our Information Management Strategy (IMS). IMS is a program created and directed by Alliance members and supported by Alliance staff. It provides tools and supports to help each organization to collect, manage, analyze, and share their data. Our members collect high-quality, individual-level data through our common electronic medical records system (EMR). This data is compiled in our Business Intelligence Reporting Tool (BIRT), a data warehouse that allows high-quality, practice-based data from Alliance member organizations across Ontario to be aggregated and analyzed without added burden to providers or teams. Through BIRT, our members share sector-wide, practice-based information with research partners such as ICES and CIHI. The IMS protects clients’ personal information by providing tools and training for privacy and security.
Both collectively and at the individual team level, the Alliance and our member organizations analyze the information gathered in BIRT to generate new insights into the quality and effectiveness of the care our sector provides. Data Management Coordinators, clinicians, and managers in each team analyze and interpret their local practice information to identify strengths and opportunities. This comprises the first three segments of the circle in Figure 1: Assemble relevant data. Analyze data. Interpret results. To complete the continuous cycle of learning, our sector must commit to using the knowledge we generate through tailored feedback and meaningful quality improvement.
# Strategic Guidance
The EPIC Learning Health System Steering Committee was formerly known as the Performance Management Committee (PMC). As part of the shift to a learning health system, this member-led committee is now supported by the Alliance’s Director of Research and Evaluation, Dr. Jennifer Rayner. Dr. Rayner has a PhD in epidemiology from Western University and has a long history of working in the community primary healthcare sector. Prior to working for the Alliance, she was a data analyst at London Intercommunity Health Centre for 13 years and provided decision support to Ontario CHCs for 8 years.
The EPIC committee provides guidance for the work of our Learning Health System. Its primary focus is to support meaningful quality improvement activities. The committee works closely with the Research Advisory Council (RAC) to choose research based on their potential to result in more equitable care. EPIC also supports clinical engagement in learning and quality improvement through a practice-based learning network (PBLN), known as the EPIC PBLN.
Drawing from the Model of Health and Wellbeing and our Evaluation Framework, the EPIC committee will develop strategies, questions, and indicators for measuring the effectiveness of the LHS. EPIC will promote and guide the production of tailored reports and dashboard content, and it will provide high-level guidance for quality improvement work.
The Information Management Committee (IMC) will continue to oversee the development and maintenance of the Information Management Strategy to meet the needs of the Alliance members and support the LHS. IMC will monitor and support BIRT, the EMR, privacy, data standards, data quality, technical specifications, and IT development.
# Primary Care Teams
A learning health system cannot be driven from the top. It requires committed and engaged front-line staff who will participate in learning and knowledge-sharing as well as staff who will implement and evaluate tools and processes. Primary care teams, clinicians, and other healthcare providers will tell us what matters to them. They will identify questions the LHS can help answer, and in return, they will receive feedback and improvement ideas they may incorporate into the care they provide.
# Health Promotion and Community Teams
Staff who work in community development, health promotion, or outreach have essential community knowledge and connections. They can support client participation in research, help identify client and community research priorities, and share research findings back to the community in accessible ways. Like their peers in the primary care teams, they can participate in quality improvement activities based on practice-based, sociodemographic, and population health data, and they can enrich the team’s understanding of the data through their knowledge of people’s lived experience.
# Executive Leaders
Executive leaders can participate by fostering curiosity and encouraging continuous learning and growth. As leaders within their teams, they need to adopt and live this vision. This will include freeing up time and space for staff to participate in LHS activities such as research and quality improvement. It will also involve collaborating with their teams, RDSSs, DMCs, clinical managers, clients, and system partners to identify needs and opportunities and to measure the effectiveness of each change. These changes might require doing things differently, but the result will be higher-quality, safer, and more efficient care, and our member organizations will become better places to work.
# Clients, Caregivers, and Community Members
To advance equity, research must be relevant to the needs and interests of the community. Clients, caregivers, and community members will be engaged throughout the learning cycle to help us understand their experiences, both within and beyond the health system, and how the care they receive should be responsive to those experiences. Clients may help us identify ways to measure what matters to them and to communicate research and improvement stories in clear and accessible ways.
# Practice-Based Learning Networks (PBLNs)
There are multiple ways for clinicians and other providers to participate in the learning health system. For example, they may also wish to participate in a practice-based learning network (PBLN), a group of primary healthcare clinicians and other providers who work together to answer community-based healthcare questions and translate research into practice. In the fall of 2020, the Alliance launched a new PBLN, developed through EPIC, to be a source of rapid learning and improvement for Alliance member agencies and Ontario Health Teams. The EPIC PBLN is one of seven in the province; together they comprise the POPLAR Network, a “network of networks” that supports province-wide and inter-sectoral primary care data linkage and research partnerships.
The Ontario PLBNs use client data to identify needs, measure the impact of interventions, and share these insights with Ontario Health Team (OHT) partners and at other decision-making tables. The Alliance PBLN will also advocate for OHTs to use data in their decision-making that includes people who are marginalized or experience social and clinical complexity, and for data to be collected that sheds light on the determinants of health. This will mean that equity is at the forefront when needs are being identified or interventions are being evaluated.