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Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, Zurynski Y, Braithwaite J. Learning health systems: A review of key topic areas and bibliometric trends. Learn Health Syst 2022; 6:e10265. [PMID: 35036549 PMCID: PMC8753300 DOI: 10.1002/lrh2.10265] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research. METHODS We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full-texts to identify: type of study (empirical, non-empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs. RESULTS A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non-empirical and over two-thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for example: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging; however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities. CONCLUSIONS The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Zeyad Mahmoud
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Alex Vedovi
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Louise A. Ellis
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Gilbert Knaggs
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Carolynn L. Smith
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Yvonne Zurynski
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Jeffrey Braithwaite
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
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Piasecki J, Walkiewicz-Żarek E, Figas-Skrzypulec J, Kordecka A, Dranseika V. Ethical issues in biomedical research using electronic health records: a systematic review. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:633-658. [PMID: 34146228 PMCID: PMC8214390 DOI: 10.1007/s11019-021-10031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 05/14/2023]
Abstract
Digitization of a health record changes its accessibility. An electronic health record (EHR) can be accessed by multiple authorized users. Health information from EHRs contributes to learning healthcare systems' development. The objective of this systematic review is to answer a question: What are ethical issues concerning research using EHRs in the literature? We searched Medline Ovid, Embase and Scopus for publications concerning ethical issues of research use of EHRs. We employed the constant comparative method to retrieve common ethical themes. We descriptively summarized empirical studies. The study reveals the breadth, depth, and complexity of ethical problems associated with research use of EHRs. The central ethical question that emerges from the review is how to manage access to EHRs. Managing accessibility consists of interconnected and overlapping issues: streamlining research access to EHRs, minimizing risk, engaging and educating patients, as well as ensuring trustworthy governance of EHR data. Most of the ethical problems concerning EHR-based research arise from rapid cultural change. The framing of concepts of privacy, as well as individual and public dimensions of beneficence, are changing. We are currently living in the middle of this transition period. Human emotions and mental habits, as well as laws, are lagging behind technological developments. In the medical tradition, individual patient's health has always been in the center. Transformation of healthcare care, its digitalization, seems to have some impacts on our perspective of health care ethics, research ethics and public health ethics.
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Affiliation(s)
- Jan Piasecki
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Medical College, Jagiellonian University, Michalowskiego 12, 31-126, Krakow, Poland.
| | | | | | - Anna Kordecka
- HTA Registry Sp. z o.o. Sp. K, Herzoga 15, 30-252, Krakow, Poland
| | - Vilius Dranseika
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Medical College, Jagiellonian University, Michalowskiego 12, 31-126, Krakow, Poland
- Institute of Philosophy, Vilnius University, 9/1 Universiteto, 01513, Vilnius, Lithuania
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Battineni G, Nittari G, Sirignano A, Amenta F. Are telemedicine systems effective healthcare solutions during the COVID-19 pandemic? J Taibah Univ Med Sci 2021; 16:305-306. [PMID: 33753981 PMCID: PMC7969856 DOI: 10.1016/j.jtumed.2021.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gopi Battineni
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Giulio Nittari
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Ascanio Sirignano
- Legal Medicine Division, School of Law, University of Camerino, Camerino, Italy
| | - Francesco Amenta
- Telemedicine and TelePharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
- Research Department, International Radio Medical Centre (C.I.R.M.), Rome, Italy
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McAuliffe S, Unwin D, Bradfield J, Ray S, Martyn K. Bridging the gap between science-led research and evaluation of clinical practice: the role of service innovation audits and case studies. BMJ Nutr Prev Health 2021; 4:350-351. [PMID: 34308144 PMCID: PMC8258076 DOI: 10.1136/bmjnph-2020-000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shane McAuliffe
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - David Unwin
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Norwood Surgery, Southport, Merseyside, UK
| | - James Bradfield
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Biomedical Sciences, Ulster University at Coleraine, Coleraine, Northern Ireland.,School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK
| | - Kathy Martyn
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Health Sciences, University of Brighton, Brighton, UK
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Schork NJ, Goetz LH, Lowey J, Trent J. Strategies for Testing Intervention Matching Schemes in Cancer. Clin Pharmacol Ther 2020; 108:542-552. [PMID: 32535886 DOI: 10.1002/cpt.1947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/04/2020] [Indexed: 01/02/2023]
Abstract
Personalized medicine, or the tailoring of health interventions to an individual's nuanced and often unique genetic, biochemical, physiological, behavioral, and/or exposure profile, is seen by many as a biological necessity given the great heterogeneity of pathogenic processes underlying most diseases. However, testing and ultimately proving the benefit of strategies or algorithms connecting the mechanisms of action of specific interventions to patient pathophysiological profiles (referred to here as "intervention matching schemes" (IMS)) is complex for many reasons. We argue that IMS are likely to be pervasive, if not ubiquitous, in future health care, but raise important questions about their broad deployment and the contexts within which their utility can be proven. For example, one could question the need to, the efficiency associated with, and the reliability of, strategies for comparing competing or perhaps complementary IMS. We briefly summarize some of the more salient issues surrounding the vetting of IMS in cancer contexts and argue that IMS are at the foundation of many modern clinical trials and intervention strategies, such as basket, umbrella, and adaptive trials. In addition, IMS are at the heart of proposed "rapid learning systems" in hospitals, and implicit in cell replacement strategies, such as cytotoxic T-cell therapies targeting patient-specific neo-antigen profiles. We also consider the need for sensitivity to issues surrounding the deployment of IMS and comment on directions for future research.
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Affiliation(s)
- Nicholas J Schork
- The Translational Genomics Research Institute (TGen), Phoenix, Arizona, USA.,Department of Population Sciences, The City of Hope National Medical Center, Duarte, California, USA.,Department of Molecular and Cell Biology, The City of Hope National Medical Center, Duarte, California, USA
| | - Laura H Goetz
- The Translational Genomics Research Institute (TGen), Phoenix, Arizona, USA.,Department of Medical Oncology, The City of Hope National Medical Center, Duarte, California, USA
| | - James Lowey
- The Translational Genomics Research Institute (TGen), Phoenix, Arizona, USA
| | - Jeffrey Trent
- The Translational Genomics Research Institute (TGen), Phoenix, Arizona, USA.,Department of Medical Oncology, The City of Hope National Medical Center, Duarte, California, USA
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Abstract
BACKGROUND Sharing de-identified individual-level health research data is widely promoted and has many potential benefits. However there are also some potential harms, such as misuse of data and breach of participant confidentiality. One way to promote the benefits of sharing while ameliorating its potential harms is through the adoption of a managed access approach where data requests are channeled through a Data Access Committee (DAC), rather than making data openly available without restrictions. A DAC, whether a formal or informal group of individuals, has the responsibility of reviewing and assessing data access requests. Many individual groups, consortiums, institutional and independent DACs have been established but there is currently no widely accepted framework for their organization and function. MAIN TEXT We propose that DACs, should have the role of both promotion of data sharing and protection of data subjects, their communities, data producers, their institutions and the scientific enterprise. We suggest that data access should be granted by DACs as long as the data reuse has potential social value and provided there is low risk of foreseeable harms. To promote data sharing and to motivate data producers, DACs should encourage secondary uses that are consistent with the interests of data producers and their own institutions. Given the suggested roles of DACs, there should be transparent, simple and clear application procedures for data access. The approach to review of applications should be proportionate to the potential risks involved. DACs should be established within institutional and legal frameworks with clear lines of accountability, terms of reference and membership. We suggest that DACs should not be modelled after research ethics committees (RECs) because their functions and goals of review are different from those of RECs. DAC reviews should be guided by the principles of public health ethics instead of research ethics. CONCLUSIONS In this paper we have suggested a framework under which DACs should operate, how they should be organised, and how to constitute them.
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Affiliation(s)
- Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, UK
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jan Piasecki
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Jagiellonian University Medical College, ul. Michalowskiego 12, Krakow, Poland
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