Leveraging the "Learning Health Community" Concept in Education

These are good questions and hard to answer.

The principal, to his credit, tried to answer without being defensive but his absence of a detailed answer plagued him. In short, we need to be educating our elementary school students for the workplace of 2030 and beyond. And their physical and psycho-social health matters; without it, their potential success is diminished or will languish.

So, to answer the father’s questions well, we must consider how the world will actually look and function decades ahead and how that differs from the world in which we now live. We need to provide cross-disciplinary and cross-sector education with trained professionals who can prepare for that future fearlessly.

Take this example. Students of all ages will, unlike their parents, no longer be learning primarily from standardized, printed textbooks, a movement that is already underway. This change in learning materials is occurring for many reasons: current substantive course materials are static; printed textbooks are expensive and they obsolesce (and often their use continues because schools cannot afford replacements); the content cannot be customized and personalized, something that would add immeasurably to the learning experience. Texts also cannot be adapted quickly to changing information and new discoveries and research.

A few supportive statistics: college textbook costs increased by 82% between 2002 and 2012. The average price of a new undergraduate textbook is now about $175. (Forget the cost of law and medical school texts.) Five major publishers currently control about 90 percent of this market. But, more than 60 percent of students don't purchase these books because of their cost; 50 percent of students take fewer courses because of textbook costs; and 10 percent have withdrawn from a course due to textbook cost. That’s hardly a recipe for narrowing the achievement gap. Instead, we need solutions that meet students where they are and course materials that take students where they need to be in terms of recognizing a future with changing information and new pathways for developing knowledge and understanding.

Now, the healthcare arena is likely one in which the school principal will not have expertise. Suppose the father was sitting in a doctor’s office with his young daughter, and she has just been diagnosed with a serious illness. The father wants to hear: “There is a guaranteed cure; it’s painless; it’s instant; and it’s free.” In the absence of such a rare and likely nonexistent response, what could the doctor say today that would give that gather peace of mind at this scary and emotional moment? What information would diminish the uncertainty that would be gnawing at him?

In all likelihood, were the situation to arise today, the doctor would advise the father of the range of treatments of which she was aware (and whether covered by insurance); she might send the child to a specialist within the same medical group. The doctor might consult on available clinical trials; popularly, might recommend some online reading material. In short, the doctor’s universe of information and recommendations would be limited. As a parent, this would not be enough.

Marc WineNow, suppose it is 2030 and instead of the above response, the doctor says (assuming one is seeing an actual as opposed to robotic or virtual doctor): “I will make a treatment recommendation informed not only by the latest clinical trials (those completed and those still underway), but also by the real-world health experiences over time of every patient like your daughter who has had or still has this illness, and in turn I can tell you with a specified range of confidence which treatment has the greatest change of success for a patient specifically like her.”

How beneficial would that be for the patient and the patient’s family? And how much better would the medical provider feel about the advice being given in this difficult situation? How valuable would it be for the parents, possibly the young patient and the physician to review the information together?

This idea of an iterative engaged learning environment (we can call it a “Learning Health Community”) is not far-fetched. Such a system would require quality evidence-based data and information delivered in real-time based on the real-world experiences of millions of patients.

As new verified information and data develop, these would be incorporated and then deployed. We would harness the power of existing and future knowledge in a form that is usable by both medical professionals and the patients they serve. The questioning fathers and others similarly situated could access the Internet for augmented and personalized health information.

But, as in education, we need to ask: are patients ready, willing, and able to “visit” their physicians via the web? In an earlier study from the Center for Studying Health Systems Change, investigators did demonstrate a dramatic change in the way consumers are seeking health information, with a doubling of the number of survey respondents stating that they seek health information from the Internet – a step in the direction of obtaining care via the web. But, receiving information is surely different from receiving care, and another study reveals 86 percent of the adults responding would still seek a “human” engagement as opposed to Internet delivered care.

As in education, a hybrid model may be the most effective, blending the convenience of the Internet with a trusted source who understands one’s personal medical history. The use of eVisits and personal portals in health or education may be an acceptable way to communicate and enable effective communication between consumers, teachers and health professionals. Perhaps some of the intimidation of face-to-face contact with a professional would be eased through the online environment.

The result would be better informed decisions that would improve educational outcomes, save lives, improve health services uptake, and transform our education and health care systems into ones that rapidly learn and continuously improve. It is not as if current health care or education outcomes – regardless of race and socio-economic class – are so stellar in the US.

To be sure, to operationalize a Learning Community fully, there are key needed steps and some embedded assumptions. We would need to collect electronically health information about all patients (presuming all records were electronic by then), clinical trials and experiments (in the US and possibly in other nations) and pharmaceutical research and outcomes.

Artificial intelligence could be developed and deployed to categorize and display these data in meaningful ways and perhaps even propose options for treatment. Integrated technology, now in existence and to be developed, would facilitate these outcomes.

And, assume we could insure privacy and anonymity of health records and other records maintained about us in education, finance, food and alcohol consumption. Assume we could convince researchers and companies to share data they are collecting. Assume we could insure the quality of clinical and drug trials so that the data available were accurate. Assume too we had people to program the artificial intelligence so that it was able to sort effectively and provide treatment viable options.

But, high as these hurdles are, they are not the most difficult obstacles to overcome. The realization of Learning Communities rests on our willingness to change how we engage with each other, on our commitment to the greater good and on our will to improve the world in which we live even if that means some self-sacrifice. Stated in its starkest form, we need live in a world in which autonomy does not rule, and we have an embedded desire to help others and a belief in their capacity to succeed – regardless of their age, race, ethnicity, national origin, religion, sexual orientation, level of education, socio-economic status.

Learning Communities raise the familiar “nimby” problem – the acronym used often in housing and advancement of other social programs where individuals like the idea of the intervention but do not want it in their backyard. We want free needle exchanges – but not near my house. We want integrated housing and schools – but not in my community. We want housing for parolees but not on my street. We want blood for those in need but we don’t donate ourselves. We want organs for transplants but we do not authorize them on our licenses. You get the idea.

For Learning Communities in health, in housing, in education and other disciplines to be developed and to function, we surely need to teach content; that is actually the easy part. The rubber meets the road when we need to teach about commitment to community and the need to believe in student and consumer capacities. This last sentence – so simple to state – holds the key to jobs of the future and an appreciation of how advanced technology can benefit us.

To get at these harder “value” issues, we must appreciate the importance of the collective over the individual while respecting autonomy and free choice and creativity. We need teachers who understand their expanded role. We need health professionals who also appreciate the “new” world in collaboration with their end users – patients.

To concretize, try this response of a hypothetical principal to the parent’s spot-on questions: we need to have our students in this school – our ever growing diverse students – learn to work together, to help each other, to collaborate on projects, to appreciate compromise, to adjust to changes in rules and design, to herald success in others. We need to create activities that harness creativity among students; they cannot work not isolation. And we need to insure that the institutions where we work now (of all shapes and sizes) move out of their prized silos that run vertically and horizontally and even diagonally.

They need to share mistakes. They need to flatten hierarchy and respect the wide range of knowledge, feelings, experiences and thoughts of all people. And they need to be healthy – mentally and physically – for as Maslow rightly observes, if basic needs are not met, learning can’t happen.

As workers and leaders, as teachers and health care workers, these have to be our mantras. To adjust a commonly cited statement by Ryunosuke Satoro: individually we are but one drop of water; collectively, we are an ocean. That’s is what we need to teach our children and communities. It’s that thinking that will enable Learning Health Communities to be created and sustained and to flourish. That is what the principal needed to share with the questioning father – today.