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2017-06-02 Learning Health Systems Call

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Facilitator Russell Leftwich Note taker(s) Emma Jones
Attendee Name Affiliation

X Russell Leftwich InterSystems
X John Roberts Tennessee Department of Health
X Stephen Chu Individual
Evelyn Gallego ONC
Kathy Walsh LabCorp
Asim Muhammad Philips Research Europe
Laura Heermann-Langford Intermountain Healthcare
X Emma Jones Allscripts
Jeff Brown Cancerlinq
X Lisa Nelson Individual
Dave Carlson VA
Chris Melo Phillips Healthcare
Michelle Miller Cerner
Benjamin Kummer Columbia University
Matt Rhan
Michael Padula
Serafina Versaggi VA
X Elaine Ayres NIH
X Laurie McDonald Tennessee Department of Health


  • Chair: Russell Leftwich
  • Scribe: Emma Jones
  • Motion to approve previous call minutes, 2017-05-19_Learning_Health_Systems_Call: Stephen/Lisa
  • Continue Mode of Contact Discussion
    • Reflects if the care team member is face-to-face with the patient
      • Example are folks who author diagnostic reports. LHS will need a feedback loop so the providers can know what the eventual outcome was of their input into the actual care plan
    • Clinical Research Teams as care team participants
      • When the role is an organized group and not an individual. If an individual, there is a research team behind the individuals. This is one of the driving factors for a LHS - Need to get the result of the research study into clinical care as quickly as possible. shorter feedback loop between research team and the clinical care team
      • Typical structure of a research team - may be one of the patient providers are part of the research team
      • Feedback from NIH (Elaine) - does clinical research only. There is a defined structure of the team
        • Will always have a principal investigator that may or may not be involved directly with the patient
        • Associate investigator may administer the study. The various protocols may include many more team members - e.g research nurses, pharmacist, dietician, social worker, statistician - are all associative investigators. May have a hospitalist involve in the care and also the administrative support staff
        • Other protocols may be smaller and more direct
        • Contract studies may have other sponsors
        • IRB requires the name of everybody involved - for their guiding rules
        • How many roles? Study coordinator, medically accountable investigator (PhD as well as an MD). May be five or six roles
        • Associate Investigator, Principle Investigator, medically responsible investigator, study coordinator. Other institutions may have co-investigators (NIH limits to only one principal investigator who may also be called an accountable investigator
        • They would all have decision making power - why they are named as assoc investigator. they are directly involved in the study
        • Can have folks not involved in the study directly but provide care - if they have a direct involvement in the protocol they would be an associated investigator in the study.
      • Communications between the research team and non-protocol team members does happen. Feature of a out-patient visit is shared with the researchers. Patient can use their portals to provide information.
      • Requesting information - if patient self-refers, the research nurse would request records from their care providers
      • Study subject have a record that includes outside records
      • This topic will come up later as part of communication between care team members
      • John and Laurie - 6 job types - in Public Health
        • consultants
        • public health nurses
        • APN - nurse practitioners
        • Nutritionists - includes the WIC program; diabetic education to primary care patients. SNAP is the economic program
        • Public Health investigators or Public Health reps - identifies people spreading diseases
        • epidemiologist
        • enviromnmental scientists? These folks will be involved in a large group outbreak. Will have the occasional environmentalist - borderline PH activity if it involves patients
        • How universal are the 6 roles? within the US? In the US PH looks after the health of the nation. In many countries it's built into the health care system. This is very common in Canada
        • In the US there is a fair amt of variability in public health between counties and states
        • How does CDC fit into the Public health scenario? Have a national mission and funded nationally. They work with the states that have the authority. Boots on the ground are state and local
        • Does individuals from CDC be involved in the public health episodes? Will they provide experts as consultants, or the epidemiologist? In all the roles, expertise or man power can be supplied on request. CDC also serve as a consultant and provide advice - e.g HIV, Hepatitis, etc
        • CDC provides equivalent of treatment protocols that would become part of the care plans; burial plans
        • Australia difference may be the interventional specialists. The other roles are the same - have infection control nurse. In the US these nurses are employed by the hospitals.
        • Is behavioral health part of public health? Not in TN. Federal health services attempt to provide primary services thru public health for under-served areas
        • Public health have 2 facets. One is managing individuals and the second is managing groups (for containment etc)
        • Reference lab and microbiology - every state in the US provide a public health lab. Its a clinical lab that focus on community level concerns.
    • Other non face-to-face teams talked about last week
      • Disease managers, care coordinators
      • Telehealth - seeing the patient but not being with the patient is a different version of F2F. May have a robot in the room witht he patient but the physician behind the robot is not f2f
  • Stephen - will provide overview of the spreadsheet next call. Will circulate the spreadsheet prior to the call.