Like individual clinicians, many healthcare organisations are already working at capacity and are focused on relatively short-term financial, process and regulatory targets. Elements of a Learning Healthcare System that are not aligned with these targets or that require upfront investment for long-term payback, may achieve limited uptake. Elements of a Learning Healthcare System that are viewed as a public good, such as the contribution of data to publicly funded research with open access to results, may be seen as a luxury that is only affordable for organisations who trade on their national reputation or who are dominant in their market (Foley and Fairmichael 2015, Simpson 2015). Other organisations may require additional incentives to participate.
As discussed in the Workforce section, clinicians can be powerful advocates for the Learning Healthcare System within an organisation. If they do not engage with a system, then it will struggle to succeed. Even when clinicians are supportive, they may not be able to achieve implementation without management buy in (Akerman 2015). This depends on alignment with the organisations aims.
Ultimately, support from the organisation’s board is crucial in providing the philosophical commitment required to implement a Learning Healthcare System (Simpson 2015). In recognition of this, in the US, the IoM are forming a national network of CEOs to help advocate for Learning Healthcare Systems (McGinnis 2015).
Learning Healthcare Systems are not simply digital networks, they are networks of real world healthcare commissioners and providers, supported by a digital infrastructure. They will reflect the organisational structures within which they exist. In many countries, that means that they are currently fragmented systems. In the UK for example, there is a traditional divide between primary care, community services and hospitals and between social care, physical and mental health (NHS England 2014). There is also a divide between the organisations that pay for care and those who provide it.
These divisions increase the complexity of data sharing and create perverse incentives within the Learning Healthcare System. Development can be slowed because the benefits accrue to organisations other than those that have made the investment (Foley and Fairmichael 2015). The lack of common standards has resulted in a proliferation of incompatible systems (Foley and Fairmichael 2015).
New models of care have been proposed and are beginning to be implemented in the UK and elsewhere (NHS England 2014). There is recognition that services need to be integrated and coordinated around the patient (NHS England 2014). Learning Healthcare Systems will make it easier to evaluate different models of care in a timely way. It should be possible to identify components that are not working and to allow the rapid reconfiguration of services around the needs of patients, using virtual organisations, rather than regular costly top-down structural reorganisations. Both contractual frameworks and transparency around outcomes may be required to facilitate cooperation within potentially competitive health economies (Department of Health 2012)(Foley and Fairmichael 2015).