Table 2

Steps That May Support a Learning Health Care System

Knowledge translation
Develop meaningful use of the EHR to support diagnostic and therapeutic support based on evidence
Develop a computable representation of research evidence and make that available to EHR systems as a Web service
Develop a means of providing diagnostic or therapeutic prompts within an EHR that works across a variety of EHR systems
Turning data into knowledge
Develop a standardized means of using archetypes based on CEN/ISO 13606 within EHR systems
Maintain up-to-date terminology services that can be used by both clinical and research systems
Promote the wide reuse and archiving of defined research data elements via CEN/ISO 11179
Start to link well-defined clinical concepts with well-defined research concepts by mapping archetypes to defined data elements
Create domain specific data models, linking together via BRIDG to enable sharing of archetypes and data elements between domains
Create open-source middleware capable of brokering data exchange and clinical research activities (recruitment, follow-up, etc) between clinical systems
Extend clinical research standards to enable sharing computable representations of clinical study protocols between systems
  • BRIDG = Biomedical Research Integrated Domain Group; EHR = electronic health record; CEN = European Committee for Standardization; ISO = International Organization for Standardization.