{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:00:20Z","timestamp":1777640420085,"version":"3.51.4"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2016,10,4]],"date-time":"2016-10-04T00:00:00Z","timestamp":1475539200000},"content-version":"vor","delay-in-days":712,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objective The capability to share data, and harness its potential to generate knowledge rapidly and inform decisions, can have transformative effects that improve health. The infrastructure to achieve this goal at scale\u2014marrying technology, process, and policy\u2014is commonly referred to as the Learning Health System (LHS). Achieving an LHS raises numerous scientific challenges.<\/jats:p>\n               <jats:p>Materials and methods The National Science Foundation convened an invitational workshop to identify the fundamental scientific and engineering research challenges to achieving a national-scale LHS. The workshop was planned by a 12-member committee and ultimately engaged 45 prominent researchers spanning multiple disciplines over 2\u2005days in Washington, DC on 11\u201312 April 2013.<\/jats:p>\n               <jats:p>Results The workshop participants collectively identified 106 research questions organized around four system-level requirements that a high-functioning LHS must satisfy. The workshop participants also identified a new cross-disciplinary integrative science of cyber-social ecosystems that will be required to address these challenges.<\/jats:p>\n               <jats:p>Conclusions The intellectual merit and potential broad impacts of the innovations that will be driven by investments in an LHS are of great potential significance. The specific research questions that emerged from the workshop, alongside the potential for diverse communities to assemble to address them through a \u2018new science of learning systems\u2019, create an important agenda for informatics and related disciplines.<\/jats:p>","DOI":"10.1136\/amiajnl-2014-002977","type":"journal-article","created":{"date-parts":[[2014,10,24]],"date-time":"2014-10-24T01:53:02Z","timestamp":1414115582000},"page":"43-50","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":350,"title":["Toward a science of learning systems: a research agenda for the high-functioning Learning Health System"],"prefix":"10.1093","volume":"22","author":[{"given":"Charles","family":"Friedman","sequence":"first","affiliation":[{"name":"University of Michigan, Ann Arbor, Michigan, USA"}]},{"given":"Joshua","family":"Rubin","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, Michigan, USA"}]},{"given":"Jeffrey","family":"Brown","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA"}]},{"given":"Melinda","family":"Buntin","sequence":"additional","affiliation":[{"name":"Vanderbilt University, Nashville, Tennessee, USA"}]},{"given":"Milton","family":"Corn","sequence":"additional","affiliation":[{"name":"National Library of Medicine, Bethesda, Maryland, USA"}]},{"given":"Lynn","family":"Etheredge","sequence":"additional","affiliation":[{"name":"George Washington University, Washington, District of Columbia, USA"}]},{"given":"Carl","family":"Gunter","sequence":"additional","affiliation":[{"name":"University of Illinois, Urbana-Champaign, Illinois, USA"}]},{"given":"Mark","family":"Musen","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California, USA"}]},{"given":"Richard","family":"Platt","sequence":"additional","affiliation":[{"name":"Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA"}]},{"given":"William","family":"Stead","sequence":"additional","affiliation":[{"name":"Vanderbilt University, Nashville, Tennessee, USA"}]},{"given":"Kevin","family":"Sullivan","sequence":"additional","affiliation":[{"name":"University of Virginia, Charlottesville, Virginia, USA"}]},{"given":"Douglas","family":"Van Houweling","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, Michigan, USA"}]}],"member":"286","published-online":{"date-parts":[[2014,10,23]]},"reference":[{"key":"2020110613004354800_R1","first-page":"1","author":"Ayres","year":"2007"},{"key":"2020110613004354800_R2","first-page":"1","author":"Davenport","year":"2007"},{"key":"2020110613004354800_R3","first-page":"1","author":"Tapscott","year":"2008"},{"key":"2020110613004354800_R4","author":"Northrop","year":"2008"},{"key":"2020110613004354800_R5","year":"2011"},{"key":"2020110613004354800_R6","first-page":"1","author":"Clark","year":"2011"},{"key":"2020110613004354800_R7","first-page":"1","article-title":"Digital infrastructure for the learning health system: the foundation for continuous improvement in health and health care","volume-title":"The foundation for continuous improvement in health and health care workshop series summary","author":"Institute of Medicine (IOM)","year":"2011"},{"key":"2020110613004354800_R8","volume-title":"Best care at lower cost: the path to continuously learning health care in America","author":"Smith","year":"2012"},{"key":"2020110613004354800_R9","author":"Institute of Medicine (IOM)","year":"2012"},{"key":"2020110613004354800_R10","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1056\/NEJMp1006304","volume":"363","author":"Hamburg","year":"2010","journal-title":"N Engl J Med"},{"key":"2020110613004354800_R11","volume-title":"The case for precision medicine","author":"Personalized Medicine Coalition","year":"2014","edition":"4th edn"},{"key":"2020110613004354800_R12","author":"Office of the National Coordinator for Health Information Technology (ONC)","year":"2011"},{"key":"2020110613004354800_R13","author":"Office of the National Coordinator for Health Information Technology (ONC)","year":"2014"},{"key":"2020110613004354800_R14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJMp1211374","article-title":"Code red and blue\u2014safely limiting health care's GDP footprint","volume":"368","author":"Milstein","year":"2012","journal-title":"N Engl J Med"},{"key":"2020110613004354800_R15","volume-title":"The economic case for health reform","author":"Executive Office of the President, Council of Economic Advisers","year":"2009"},{"key":"2020110613004354800_R16","doi-asserted-by":"crossref","DOI":"10.1787\/health_glance-2013-en","volume-title":"Health at a glance 2013: OECD indicators","author":"OECD","year":"2013"},{"key":"2020110613004354800_R17","author":"Mahon","year":"2012"},{"key":"2020110613004354800_R18","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1001\/jama.2012.362","article-title":"Eliminating waste in US health care","volume":"307","author":"Berwick","year":"2012","journal-title":"JAMA"},{"key":"2020110613004354800_R19","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1056\/NEJMsa022615","article-title":"The quality of health care delivered to adults in the United States","volume":"348","author":"McGlynn","year":"2003","journal-title":"N Engl J Med"},{"key":"2020110613004354800_R20","article-title":"National Healthcare Quality Report 2012","year":"2013"},{"key":"2020110613004354800_R21","author":"(IOM) Medicine, I. of","year":"2012"},{"key":"2020110613004354800_R22","author":"Institute of Medicine","year":"2007"},{"key":"2020110613004354800_R23","author":"Rubin","year":"2004"},{"key":"2020110613004354800_R24","article-title":"Creating infrastructure for big data in the public and private sectors","author":"Norton","year":"2013"},{"key":"2020110613004354800_R25","doi-asserted-by":"crossref","first-page":"b81","DOI":"10.1136\/bmj.b81","article-title":"Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings","volume":"338","author":"Tannen","year":"2009","journal-title":"BMJ"},{"key":"2020110613004354800_R26","first-page":"991","article-title":"Transforming academic health centers for an uncertain future","volume-title":"N Engl J Med","author":"Dzau","year":"2013"},{"key":"2020110613004354800_R27","author":"Health Affairs"},{"key":"2020110613004354800_R28","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1377\/hlthaff.2014.0043","article-title":"Rapid learning: a breakthrough agenda","volume":"33","author":"Etheredge","year":"2014","journal-title":"Health Aff"},{"key":"2020110613004354800_R29","author":"Collins","year":"1994"},{"key":"2020110613004354800_R30","author":"Buchanan","year":"2012"},{"key":"2020110613004354800_R31","author":"Halamka","year":"2011"},{"key":"2020110613004354800_R32","author":"O'Harlow","year":"2009"},{"key":"2020110613004354800_R33","author":"Blavin"},{"key":"2020110613004354800_R34","first-page":"1","author":"Technology, P. C. of A. on S. and","year":"2010"},{"key":"2020110613004354800_R35","doi-asserted-by":"crossref","first-page":"w107","DOI":"10.1377\/hlthaff.26.2.w107","article-title":"A rapid-learning health system","volume":"26","author":"Etheredge","year":"2007","journal-title":"Health Aff"},{"key":"2020110613004354800_R36"},{"key":"2020110613004354800_R37","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1377\/hlthaff.2014.0121","article-title":"Four health data networks illustrate the potential for a shared national multipurpose big-data network","volume":"33","author":"Curtis","year":"2014","journal-title":"Health Aff"},{"key":"2020110613004354800_R38","author":"Summit"},{"key":"2020110613004354800_R39","author":"The TRANSFoRm Project EU"},{"key":"2020110613004354800_R40","author":"See e.g., CDISC","year":"2013"},{"key":"2020110613004354800_R41","author":"Sullivan"},{"key":"2020110613004354800_R42","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5751\/ES-01360-100206","article-title":"\u201cIntegration and Implementation Sciences: Building a New Specialization\u201d. The Resilience Alliance","volume":"10","author":"Bammer","year":"2005","journal-title":"Ecol Soc"},{"key":"2020110613004354800_R43","first-page":"30","author":"Gorry","year":"1997"},{"key":"2020110613004354800_R44","author":"Internet Hall of Fame"},{"key":"2020110613004354800_R45","author":"See e.g."},{"key":"2020110613004354800_R46","volume-title":"Toward precision medicine: building a knowledge network for biomedical research and a new taxonomy of disease","author":"National Research Council","year":"2011"},{"key":"2020110613004354800_R47","author":"Sullivan"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/1\/43\/34145380\/amiajnl-2014-002977.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/1\/43\/34145380\/amiajnl-2014-002977.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:44:55Z","timestamp":1604688295000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/22\/1\/43\/834511"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,23]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2014,10,23]]},"published-print":{"date-parts":[[2015,1,1]]}},"URL":"https:\/\/doi.org\/10.1136\/amiajnl-2014-002977","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,1]]},"published":{"date-parts":[[2014,10,23]]}}}