The Imperative for Learning Health Systems to Address Health Literacy

The following excerpt comes from the article by Cindy Brach posted October 11, 2017, on the Prevention Policy Matters Blog at

“Learn or perish” would be an apt slogan for health systems today. The rate of change in health care is high. Technological advancements, research, innovation, and market dynamics all drive the soaring complexity of the health care system. In order to survive, health systems must learn how to adapt, and in the process – we argue – address health literacy.

Integrating Knowledge into Practice

One aspect of a learning health system (LHS), according to the charter and vision of the Institute of Medicine’s (IOM) Roundtable on Evidence-Based Medicine, is “to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider.” This means that integrating new knowledge into practice requires adaptation to the unique context of patients and their families.  

The current model of translating knowledge into practice consists of clinicians keeping up with the research literature, consulting the practice norms of their community, deciding which care is appropriate (i.e., “choosing wisely”), prescribing tests and treatment, with the expectation that patients will be compliant. As clinicians increasingly work for large health systems, care has become more standardized. Evidence reviews inform the development of clinical decision support tools, and performance metrics enable physicians to better understand their personal practice patterns and improve where necessary.  

Under the emergent LHS model, however, clinicians elicit patient goals and preferences, use data to tailor evidence to the patient, and engage in shared decision making. This requires physicians and the health care team to be clear communicators who engage and support patients and families as integral partners in medical decisions.  

Want To Engage Patients? Be Health Literate

Engaging patients in their own health and health care fundamentally relies on health literacy—that is, their ability to obtain, process, communicate, and understand basic health information and services. Because many Americans have difficulty understanding health information as currently delivered, LHSs must reduce the cognitive demands placed on patients and the complexities of the health care system. To disrupt what has been called the cycle of crisis care, caused by the failure to deliver understandable information and simplify health care tasks, LHSs have to:  

  • Structure their delivery systems to take health literacy universal precautions, i.e., assume that all patients are at risk of not understanding.
  • Educate their workforce in communication, engagement, and shared decision making skills so that they can clearly convey tailored evidence and help patients make informed choices that are congruent with their values and goals.
  • Collect data to assess whether they are being health literate organizations that make it easier for people to navigate, understand, and use information and services to take care of their health.

Read the full article.