Academic Medical Centers: Ripe for Rapid-Learning Personalized Health Care

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Science Translational Medicine  21 Sep 2011:
Vol. 3, Issue 101, pp. 101cm27
DOI: 10.1126/scitranslmed.3002386


  • Fig. 1. Fast learner.

    Depicted is the dynamic, iterative nature of a health care learning system for PHC with its diverse inputs (blue) and outputs (red). A PHC learning system requires biorepositories, genome technologies, interoperable databases, predictive models, patient and provider education, and a team approach. At the center of the activity are patients, for whom the ultimate goal is widely available, high-quality effective medical care delivered at a reasonable price.



  • Table 1. Opportunities for AMCs to advance PHC.
    ActivityChallenges to implementing PHCResources and capabilities of AMCsOpportunities for AMCs
    Rapid-learning health careNonuniform data capture

    Integration of research methods into health system workflow
    Information technology

    Electronic data capture

    Clinical-decision support

    Health-services research
    PHC learning laboratories

    Data governance policies

    Comparative effectiveness research

    Knowledge dissemination
    Development of common discovery resourcesLimited awareness of availability of biological samples

    Limited ability to combine data sets

    Paucity of standardized biobanks
    Access to research subjects, biological samples, and annotated clinical data

    Organizational structure capable of centralizing biobanking activities.
    Development of data standards for clinical sample characterization and annotation

    Centralization of biobanking

    Data and sample sharing across labs and institutions

    Value-creating partnerships with industry and payers
    Establishing evidence for initial PHC adoptionHistorical lack of funding for clinical evidence development

    Uncertainty around levels of evidence necessary to achieve adoption, coverage, and regulatory clearance
    Synergistic co-location of research and clinical care

    Established relationships with payers and industry
    Value-creating partnerships with industry and payers to gather evidence of utility

    Development of data standards for PHC usage, outcomes, and costs
    Enabling of clinical effectiveness research and population studiesLimited coordination of PHC implementation and data collection among providers and payersAlong with payers, AMCs have access to treatment-history and health-outcomes dataDevelopment of data standards for electronic health records (EHR) to foster cross-institutional data mining

    Multicenter outcomes research using deidentified clinical data
    Overcoming barriers to implementation of new models of carePerverse microeconomic incentives of providers—focus on “sick care”Culture that promotes innovation

    Flexibility in developing care models
    “Learning laboratories” for new models of care, quality metrics, and accounting
    Modernizing health professional and public educationLimited genomic literacy among providers and publicScholarship and education is a core missionTrain next generation of MDs in genomics and PHC

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