Speaker: Dr Edison Liu

Hospitals in early medicine were always centres for learning but used a research model based on a single practitioner building a body of observations and case series. As research became more systematic and funding mechanisms distinguished between the provision of care and medical research, the separation grew into a chasm. The two cultures grew independent of each other, and like evolutionary speciation, the systems became more and more incompatible. In this century, the power and speed of research, which includes information technology, is demanding greater integration between research and patient care in order to simply provide contemporary care to populations. Moreover, that health services research can improve health and reduce costs has legitimised such systematic analysis of organisational processes as science. Thus came into being the concept of the  learning healthcare system—which is a healthcare system that continuously analyses internal data and experiments to improve health metrics while reducing costs.

The basic requirements of a learning healthcare system spelled out in an Institute of Medicine Report (2012) include investments in digital infrastructure, develop the ability to utilise the data, enhance the use of clinical decision support tools, centre the outcomes on patients and communities, provide financial incentives for quality improvement, seek always to optimise operations, there should be transparency in the presentation of the data, and finally a deep commitment of institutional leadership to this concept. What this report did not address was how fundamental discoveries can be integrated in the fabric of care. Here, the application of technologies whether they are IT, device, or diagnostic based, when strategically implemented can reduce cost in a system and improve care. Ideally, a panel of managers, physicians, scientists, and entrepreneurs can work together to identify the best technologies that can be embedded in a healthcare system. An internal funding mechanism can support the first internal trial with clearly defined metrics. A clinical trial can then be structured. The outcome revealed with full transparency should determine future investments. Often this cycle is corrupted by the lack of expertise, or the inability to accept a negative result. Such pilot studies need not be extensive or expensive.

Singapore is uniquely suited to execute such a learning healthcare system.