A Learning Health System is a complex system that cannot be lifted and shifted from one organisation to another. Still, many aspects of its infrastructure are common across organisations. Early examples – such as TRANSfoRm [116] or FDA Mini-Sentinel – had to develop a distributed network infrastructure and rules for operation before deploying the Learning Health System, making them very expensive. It is analogous to recreating a new version of the Internet every time a new website is launched.
However, the development of platforms has made it affordable for even small organisations to build Learning Health Systems. A platform is a set of systems that work together to deliver specified functions according to agreed standards. These are functions that are likely to be required by many organisations. It forms a base on which organisations can build more specific functions.
Recent years have seen the emergence of platforms offering IT, data, governance, user interfaces, Application Programming Interfaces, workforce solutions and clinical outsourcing. Platform providers include large IT companies (cloud providers), Electronic Record System vendors, academic groups and even healthcare providers.
A Platforms workshop was held to inform this report and to understand the implications of such developments for Learning Health Systems [41]. The workshop brought together a range of platform providers and users. The Mayo Clinic’s approach to platforms was presented as an exemplar, and its general applicability was discussed.
NHS Digital has developed [32] a national Data Services Platform on AWS Cloud that is capable of landing data from every English healthcare provider. The platform manages and de-identifies the data, before making it available for analysis to anyone with authorisation, all within a secure, web-based Data Access Environment. Because this is cloud-based, NHS Digital can offer the Platform as a Service to other organisations that do not have an in-house capability.
Platform thinking requires a new level of collaboration with industry and other partners; public trust is important and has been damaged by previous ill-conceived initiatives [117]. Ideally, partners would develop long-term relationships.
Platform providers represent another useful group, with the potential to bring cross-sectoral experience to bear on the challenges faced by Learning Health Systems. Often healthcare organisations come to platform providers with a clear project that they have worked up. They might also consider collaborations with industry where they are not entirely sure of their next move, so that they can become “thinking partners” [41]. This clearly requires careful procurement governance.
Mayo Clinic Platform
The Mayo Clinic has a 10-year Platform Strategic and Operating Plan that aims to transform healthcare by 2030 [26]. It involves three building blocks:
- A Data Platform on the Google Cloud. Google does not have access to the data, but provides analytics, metadata characterisation, search etc. Mayo created a de-identification process in collaboration with the Office for Civil Rights. It built FIHR-based interfaces to query the data and created subtenancies on the cloud, where innovators could access but not export de-identified data.
- A Virtual Care Platform enables video consultations for ambulatory care, remote monitoring for acute care at home and asynchronous sharing of pictures, results etc.
- A Remote Diagnostic and Management Platform that can collect data, perform an action and return a result. This has already been used to ingest DICOM objects from other providers and return radiation oncology treatment regimes. Mayo is planning to ingest data from smartphones and wearables, apply algorithms and return actions.
These building blocks allow departments to build their own use cases. Mayo is working with its EHR vendor to bring new search functionality into the record and to allow patients to better navigate their potential care journeys. They have also developed an “AI Factory”, allowing clinicians to develop algorithms by themselves. Platform thinking has involved a cultural transformation, requiring constant engagement with all parts of the organisation.
In future, smaller providers may be able to subscribe to the platform products that larger providers create. They could consume products and contribute data. Some organisations manage the digital implementation but then fail to realise change on the ground. It requires a multimodal change involving workforce, buildings, facilities etc. The Mayo example suggests that business transformation rather than technology is the biggest challenge.