title: Combining Health Data Uses to Ignite Health System Learning.
abstract: OBJECTIVE
  In this paper we aim to characterise the critical mass of linked data, methods and expertise required for health systems to adapt to the needs of the populations they serve - more recently known as learning health systems. The objectives are to: 1) identify opportunities to combine separate uses of common data sources in order to reduce duplication of data processing and improve information quality; 2) identify challenges in scaling-up the reuse of health data sufficiently to support health system learning.
  
  
  METHODS
  The challenges and opportunities were identified through a series of e-health stakeholder consultations and workshops in Northern England from 2011 to 2014. From 2013 the concepts presented here have been refined through feedback to collaborators, including patient/citizen representatives, in a regional health informatics research network (www.herc.ac.uk).
  
  
  RESULTS
  Health systems typically have separate information pipelines for: 1) commissioning services; 2) auditing service performance; 3) managing finances; 4) monitoring public health; and 5) research. These pipelines share common data sources but usually duplicate data extraction, aggregation, cleaning/preparation and analytics. Suboptimal analyses may be performed due to a lack of expertise, which may exist elsewhere in the health system but is fully committed to a different pipeline. Contextual knowledge that is essential for proper data analysis and interpretation may be needed in one pipeline but accessible only in another. The lack of capable health and care intelligence systems for populations can be attributed to a legacy of three flawed assumptions: 1) universality: the generalizability of evidence across populations; 2) time-invariance: the stability of evidence over time; and 3) reducibility: the reduction of evidence into specialised sub-systems that may be recombined.
  
  
  CONCLUSIONS
  We conceptualize a population health and care intelligence system capable of supporting health system learning and we put forward a set of maturity tests of progress toward such a system. A factor common to each test is data-action latency; a mature system spawns timely actions proportionate to the information that can be derived from the data, and in doing so creates meaningful measurement about system learning. We illustrate, using future scenarios, some major opportunities to improve health systems by exchanging conventional intelligence pipelines for networked critical masses of data, methods and expertise that minimise data-action latency and ignite system-learning.
authors.affiliation: John Ainsworth, Centre for Health Informatics, University of Manchester, Manchester, M13 9PL, UK, E-mail: john.ainsworth@manchester.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Ainsworth
authors.forename: I
authors.initials: I
authors.lastname: Buchan
mesh_terms: D066289:Data Curation / Q000379:methods*; D066264:Datasets as Topic; D057286:Electronic Health Records / Q000458:organization & administration*; D063005:Health Information Systems / Q000458:organization & administration*; D033181:Information Dissemination / Q000379:methods*; D016247:Information Storage and Retrieval / Q000379:methods*; D062527:Meaningful Use; D008498:Medical Record Linkage / Q000379:methods*; D017146:Models, Organizational; D018511:Systems Integration
keywords: Health data reuse; adaptive health systems; healthcare evidence; intelligence pipelines; learning health systems; meaningful use; population health; secondary uses