Health information technology as a learning health system: Call for a national monitoring system

After over half a century of computer application development in medicine, the US health system has gone digital with an enthusiastic confidence for rapid improvements in care outcomes, especially those of quality of care, safety, and productivity. The bad news is that evidence for the justification of the hype around health information technology (HIT) is conflicting, and the expected benefits of a digital health system have not yet materialized. We propose a national system for monitoring HIT impact based on the paradigm of the learning health system (LHS): learning from practical experience through high-quality, ongoing monitoring of care outcomes. Our proposal aims at leveraging current de facto standard research data repositories used to support large-scale clinical studies by incorporating data needed for more robust HIT assessments and application of rigorous research designs that are now feasible on a large scale.