A systematic review and proposed framework for sustainable learning healthcare systems

Background: The healthcare sector is a complex domain that faces challenges in effectively learning from practices and outcome data. The Learning Health System (LHS) has emerged as a potential framework to improve healthcare by promoting continuous learning. However, its adoption remains limited, often involving only a single clinical department or a part of the LHS cycle. There is a need to gain a better understanding of implementing LHS on a larger scale. Aim: To identify complete implementations of the LHS for providing recommendations into their implementation strategies, success factors, barriers, and outcomes. Methods: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Scopus databases. Data from the included papers were thematically categorized into four primary areas: (1) Scale of LHS Implementation; (2) Implementation strategies and the factors that facilitated the implementation of LHS; (3) LHS outcomes; and (4) Barriers /challenges related to the LHS implementation. Results: We identified 1,279 papers, of which 37 were included in the final analysis. Barriers to implementing LHS included interoperability, data integration, electronic health records (EHRs) challenges, organizational culture, leadership, and regulatory hurdles. Most LHS initiatives lacked discussion on long-term economic sustainability models, and only 16 papers provided objective measurements of performance changes. Drawing from the findings of the included studies, this paper offers recommendations for the effective implementation of the LHS. Conclusion: The establishment of sustainable LHS necessitates several key components. First, there is a need to develop long-term economic sustainability models. Secondly, governance at the national level should promote common Application Programming Interfaces (APIs) across LHS implementations, communication channels to share tacit knowledge, efficient Institutional Review Board, ethical approval processes, and connect various initiatives currently operating independently. Lastly, the success of LHS relies not only on technological infrastructure but also on the active participation of multidisciplinary teams in decision-making and sharing of tacit knowledge.