Learning health system linchpins: information exchange and a common data model

Objective: To demonstrate the potential for a centrally managed health information exchange standardized to a common data model (HIE-CDM) to facilitate semantic data flow needed to support a learning health system (LHS). Materials and Methods: The Rhode Island Quality Institute operates the Rhode Island (RI) statewide HIE, which aggregates RI health data for more than half of the state's population from 47 data partners. We standardized HIE data to the Observational Medical Outcomes Partnership (OMOP) CDM. Atherosclerotic cardiovascular disease (ASCVD) risk and primary prevention practices were selected to demonstrate LHS semantic data flow from 2013 to 2023. Results: We calculated longitudinal 10-year ASCVD risk on 62,999 individuals. Nearly two-thirds had ASCVD risk factors from more than one data partner. This enabled granular tracking of individual ASCVD risk, primary prevention (ie, statin therapy), and incident disease. The population was on statins for fewer than half of the guideline-recommended days. We also found that individuals receiving care at Federally Qualified Health Centers were more likely to have unfavorable ASCVD risk profiles and more likely to be on statins. CDM transformation reduced data heterogeneity through a unified health record that adheres to defined terminologies per OMOP domain. Discussion: We demonstrated the potential for an HIE-CDM to enable observational population health research. We also showed how to leverage existing health information technology infrastructure and health data best practices to break down LHS barriers. Conclusion: HIE-CDM facilitates knowledge curation and health system intervention development at the individual, health system, and population levels.