DOI
https://doi.org/10.1186/s13012-017-0607-7

Summary
The vision of transforming health systems into learning health systems (LHSs) that rapidly and continuously transform knowledge into improved health outcomes at lower cost is generating increased interest in government agencies, health organizations, and health research communities. While existing initiatives demonstrate that different approaches can succeed in making the LHS vision a reality, they are too varied in their goals, focus, and scale to be reproduced without undue effort. Indeed, the structures necessary to effectively design and implement LHSs on a larger scale are lacking. In this paper, we propose the use of architectural frameworks to develop LHSs that adhere to a recognized vision while being adapted to their specific organizational context. Architectural frameworks are high-level descriptions of an organization as a system; they capture the structure of its main components at varied levels, the interrelationships among these components, and the principles that guide their evolution. Because these frameworks support the analysis of LHSs and allow their outcomes to be simulated, they act as pre-implementation decision-support tools that identify potential barriers and enablers of system development. They thus increase the chances of successful LHS deployment.

Relevance for Complex Systems Knowledge
This article describes a framework assisting design of Learning Health Systems. It could be read as an example of the leverage points suggested by Donella Meadows, focusing on the management of information, the norms and the ethical paradigms guiding the construct of health systems.

At the heart of the article lies the socio-technical system combining the health workers with the information technology systems, but put in context of the legistlative and normatve frameworks. It includes the scientific dimension of learning within the system and point to how data flows and relationships between actors interact to achieve the goals set up for the system

Point of Strength
The article clearly describes principles for analysis and design of health system and contributes not only to Health systems research but also to the understanding of socio-technical systems. Furthermore it clearly examplifies how systems thinking can be applied to real world situations