Guest post by Philip Walker, MLIS, MSHI, Director of the Annette & Irwin Eskind Biomedical Library, Vanderbilt University.
I was introduced to the concept of the learning health system or learning health care system last year, but when the topic came up again at a recent lecture, I felt compelled to know more. My basic search across Medline (PubMed), CINAHL, Embase, and Engineering Village yielded over 10,000 results [before deduplication], including both conceptual and research articles from various clinical specialties and informatics. However, a quick scan of the titles and abstracts uncovered little to no mention of the role of the health sciences or (bio)medical library in the learning health system (LHS).
That got me thinking: what might that role be?
I don’t have all the answers, but given the major part the LHS occupies in the culture of today’s academic medical center, I’m hoping this post can spark a conversation among health sciences librarians about ways we can help our institutions achieve the goals of the LHS.
Generally speaking, the learning health system can be described as a fusion of clinical and basic sciences, informatics/data sciences, and workplace culture, with the goal of continually improving the quality, safety, efficiency, and effectiveness of health care. Or, as one colleague eloquently stated, “The learning health system helps us improve how we care for patients while we are taking care of them.”
It dawned on me that this could be a key step in the evolution of evidence-based medicine/evidence-based practice.
In the LHS, we are not using the biomedical literature to change practice, but instead identifying real-time data signals (via pragmatic clinical trials) within the electronic medical record to generate new knowledge, change clinical practice, and refine institutional policies and procedures. The literature’s influence remains—as the basis for determining which research projects to pursue—but it becomes secondary to real-time data. Then, once the findings are in hand, the literature helps validate and supplement those findings prior to their dissemination and adoption.
Could this be the beginning of real-time evidence-based medicine or evidence-based practice? If so, then there is definitely a place for libraries, information scientists, and knowledge management practitioners in the learning health system.
Of course, libraries have their collections of knowledge-based information resources, literature searching (and filtering) services, and collaboration spaces to offer, but I’m thinking we can do more than that. By identifying the local LHS information architecture, i.e., the flow of information in the research, clinical, or educational context, we can discover potential roles for the library. Understanding the flow of information allows us to identify how it enters the system, interacts with users, and is packaged for adoption. That understanding can also help us—in conjunction with the published literature—pinpoint and address the information needs and gaps within the LHS. That, to me, is where the opportunities for libraries reside.
This novel use of the literature will require knowledge management and knowledge extraction practices such as filtering, summarizing, synthesizing, or curating information. These contributions go beyond the saved searches or static bibliographies libraries traditionally offer, but they fall well within the librarian skillset. While the next steps of translating and integrating the literature and newly generated data into the electronic medical record will likely fall outside the library’s purview, the overall potential for collaboration will ultimately depend upon the relationship between the library, LHS leadership, and the medical center’s informatics and/or clinical decision support unit(s).
Depending on the organization and skills of library staff, we can position ourselves as the central information hub, collaboration space, literature searchers, and, in some cases, consultants in text mining, data mining, data visualization, or data management. By partnering with our institutions to achieve the goals of the LHS, we can strengthen relationships with our constituents and help them educate current and future health care practitioners, generate new knowledge from research, and improve health delivery and outcomes.
Philip Walker, MLIS, MSHI, is the Director of Vanderbilt University’s Annette and Irwin Eskind Biomedical Library. He has been a librarian at Eskind since 2012 and served as Interim Director from 2017-2018. Walker previously worked at Tulane University’s Rudolph Matas Library of the Health Sciences, the Texas Medical Center Library, and the Meharry Medical College Library.