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Table 2 Illustration of the application of the proposed LHS architectural framework

From: Architectural frameworks: defining the structures for implementing learning health systems

Layer Learn From Every Patient initiative [42] PaTH clinical data research network initiative [21]
Performance Goal: continuous quality improvement in clinical care for children with cerebral palsy.
Measures: changes in healthcare utilization rates and related costs
Goal: informatics-supported infrastructure for cohort identification and data sharing for idiopathic pulmonary fibrosis, atrial fibrillation, and obesity.
Measures: not discussed
Scientific 12-month study of one cohort, within a series of learning projects for continuous quality improvement Comparative effectiveness
randomized trials with specific research questions informed by clinical data research experts and vetted by informatics group
Organizational Program team includes key clinical stakeholders, clinical and information technology teams Steering Committee includes representatives from each site, three advisory committees (including patients), four working groups (research questions, information technology, methodology, regulations)
Data Source: data fields and questions added to institution’s EHR.
Data quality: ensured by database manager
Source: Complete set of longitudinal data about target populations taken from site EHRs.
Standards: Standardized descriptions of data elements using established standards and vocabularies; use of HL7 by all participating health systems.
Quality: manual and automated monitoring by data engineers.
Information technology Existing EHRs and related infrastructure Source data loaded onto centrally-maintained data warehouse; queriable through analytics interface
Ethics and security No review board authorization required (all data collected appropriate for standard clinical care) Not directly discussed; data transformation process includes de-identification prior to loading into warehouse