By its nature, a Learning Health System will change during its implementation and beyond. To succeed, it must be able to adapt. Likewise, the organisation must have the resilience to respond to critical events and maintain a flexible approach.
HealthTracker required knowledgeable staff and was hard to sustain when staff turnover was high. There were challenges in updating the software in response to bugs and competing systems emerged over time. Eventually, the regulatory system caught up, and created opportunities to align with reimbursements and broader digital strategy.
PatientsLikeMe grew and adapted over time, moving from start-up to mature business, expanding its user base and generating revenue and investment. It was subject to an unforeseen international event (outlined above) that came close to destroying the business. It continues to operate at a different scale, and it remains to be seen how it will develop in future.
CYPHP technology and organisational structures have evolved as the network of organisations has grown and funding has become available. The involvement of university partners has ensured flexible learning capability. Being part of this organisational landscape has helped CYPHP to adapt to changes like new EHRs and new patient administration systems.
TRANSFoRm has found that maintaining interfaces with a range of EHRs as they change has been a huge challenge and threatens sustainability [37].