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Introduction Learning health systems (LHS) enable continuous improvement and innovation in healthcare. In a LHS, knowledge is disseminated and implemented to its users, and routinely collected clinical data is used to evaluate and generate new knowledge. This cycle allows health systems to effectively implement new evidence, evaluate themselves and generate new knowledge. Methods We conducted several studies to explore three aspects of a LHS: a knowledge database for evidence dissemination, the culture for healthcare quality and the technical infrastructure for evidence implementation and evaluation. We aimed our studies specifically at the Belgian primary care healthcare setting. Results We demonstrated that it is possible to create a comprehensive database of clinical practice guidelines through a process of guideline adaptation and succeeded in engaging general practice (GP) trainees in this effort. We demonstrated that currently used clinical coding systems in Belgian primary care are capable of capturing the clinical data required to efficiently deploy clinical decision support systems (CDSS), an important vehicle for evidence implementation. We demonstrated, through a systematic review of existing literature, that CDSS can be effective at improving appropriateness of laboratory test ordering. We deployed a secure and safe technique to extract clinical data directly from the electronic health record (EHR) of primary care healthcare professionals that enables outcome assessment for randomized trials. To test the various steps of this LHS, we used available guidelines on laboratory test ordering in primary care to develop a CDSS. We conducted a cluster randomized trial among almost 300 GPs and demonstrated that CDSS improved appropriateness of laboratory test ordering. Discussion We were able to demonstrate that a LHS is possible in Belgian primary care, more specifically in an effort to improve appropriateness of laboratory test ordering. The LHS we designed and tested, can be used across multiple domains within primary care to implement evidence and to generate new knowledge, but this effort will require resources and oversight. It will be important to ensure that the silos in a LHS remain connected and that the necessary measures are guaranteed for safe and secure handling of data.

Academic collection --- Theses

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