Conclusions: The Learning Health System of the Future

I introduce the Institute of Medicine’s idea of a learning health system, in which the boundaries between research and clinical practice are blurred. The historical roots of this idea are identified by exploring initiatives in the business world such as knowledge management, business process reengineering, and enterprise resource planning. The practical issues related to implementing these ideas, which have had their share of failures in the context of the US healthcare system, are then explored. The issues that can prevent success relate to organizational factors—employee/employer and patient/employer relations, “big bang” approaches that overwhelm the ability of humans to adapt, and the individual dimension. Not all people who undergo the same experience will use it as a trigger to do something about it. Knowledge of the barriers is likely to increase the probability of success.