Learning Healthcare Systems will have significant implications for many of the professionals currently associated with the health service (Foley and Fairmichael 2015).
Researchers
To realise the potential of the Learning Healthcare System, the health services research community will have to upgrade their skills and change the way that they work (Simpson 2015). The majority of the health services research community have relied on administrative data, for example from national surveys, to generate retrospective studies that have been clinically valuable. Doing research with complex, clinically rich data, from a broad representation of the population will require new training (Simpson 2015). Researchers will also have to work more closely with clinicians and health care managers.
Clinicians
Bold claims have been made, in the media (Meltzer 2014), that computers and big data analytics could eventually replace doctors and other clinicians. This view was not supported by any of the participants in this study. It was felt that such developments should complement and extend the capabilities of the healthcare professionals:
“People do not want to see “Dr Watson”, they want to see a doctor who is backed up by the knowledge of Watson. It is important not to forget the unique qualities a doctor brings to the relationship with the patient that cannot be offloaded to the IT side, such as empathy, intuition, autonomy as a doctor, and accountability to the patient. “ (Wallace 2015)
While Learning Healthcare Systems will not eliminate the need for clinicians, they may alter the number and type of clinicians that are required, in ways that are difficult to predict.
There was agreement that Learning Healthcare Systems will change the role of clinicians, but also that it will not succeed without the support of a majority of clinicians. For example, any system that increases their workload, without demonstrating significant benefit for them or their patients will not be accepted (Foley and Fairmichael 2015).
While the implementation of Electronic Health Records has been often been associated with increased clinical time spent on administrative tasks (Payne, Corley et al. 2015), the most innovative providers have been using automation to reduce the time that clinicians spend on administrative tasks. This could increase their productivity and reduce errors. It is hoped that a greater range of tasks can be automated (Foley and Fairmichael 2015).
In future, the ability to harness routine data to make judgements about comparative effectiveness, that are specific to individual patients, will be a powerful tool for clinicians, but will require a new set of competencies. Namely the (Friedman 2015):
1. Ability to know when you are right or wrong
2. Ability to ask a good question
3. Ability to deal with fuzzy information
“The knowledge cloud will not provide clear answers. Doctors will become organisers and question askers. They will provide the scaffold for patients and carers.” (Friedman 2015) IT systems are unlikely to replace this role in the foreseeable future.
In the development of modern medicine, the role of clinician has become disassociated from the role of researcher. Researchers are there to ask questions and supply knowledge that subsequently trickles down to the clinicians. The development of a Learning Healthcare System means that the skills mix in the system will have to change (Wallace 2015).
There is a sense that as the clinician role changes, it will incorporate more research activity (McGinnis 2015). Clinicians will be generating data and will have access to much more information than they have been used to. Extra training will be required for them to be productive in this scenario (Simpson 2015). What this training will involve has not yet been clearly defined and in the US, AcademyHealth has just established an education council to think about these issues (Simpson 2015).
Clinicians will no longer need to remember a vast number of facts (Manning 2015), but they may need to be:
• More aware of how the information that they record might be used by the system (Foley and Fairmichael 2015)
• Able to interpret results of routine data analytics (Foley and Fairmichael 2015, Friedman 2015, Wallace 2015) (Simpson 2015)
• Able to leverage data from non-healthcare system sources (Foley and Fairmichael 2015)
• Able to interpret and act upon feedback on their practice (Munro 2015)
• Able to live with continual change (Foley and Fairmichael 2015)
This may require a fundamentally different system of clinical education and training that would be more responsive to the needs of the service (Manning 2015).
IT and Informatics Professionals
There is often a lack of appreciation of the difference between Health IT and Health Informatics. The priority for IT is the maintenance of clinical systems with a high level of reliability. Informatics is concerned with deriving insight from data (Foley and Fairmichael 2015). While most reasonably sized healthcare organisations employ IT staff and infrastructure, there is more variation in their informatics investment.
Some organisations have begun to invest heavily in informatics. University Hospitals Birmingham has employed a data analytics team, including professionals from other data intensive industries. This has allowed them to gather greater insights from routinely collected data. For example, doctors with abnormal prescribing behaviour can be identified and offered targeted training (Foley and Fairmichael 2015). In the US, health systems like Geisinger are also investing heavily in these skills, in the belief that they will improve outcomes and reduce costs (Foley and Fairmichael 2015). There is a wide range of clinical informatics related roles that do not yet exist in sufficient numbers (Foley and Fairmichael 2015).
There is potentially a role for a new type of professional that works between the clinician, researcher and informatician, the “new medical librarians” (Platt 2015). These professionals would help clinicians to ask the right questions and to understand the implications and limitations of the answers produced by the system.
Conclusion
Learning Healthcare Systems seem unlikely to remove the need for clinicians, but the skills required by those clinicians and the researchers and informaticians who support them, will certainly continue to change. There is a need to train people to handle the change that seems certain to arise in the future (Foley and Fairmichael 2015).
Evidence