Background: The continued challenges of making Evidence-Based Medicine (EBM) work in health care policy and practice have triggered a series of evidence ecosystem concepts, one of them being the digital and trustworthy evidence ecosystem (Evidence Ecosystem) spearheaded by MAGIC in partnership with Cochrane and other international partners. This is happening while other communities aiming to implement EBM in healthcare advocate for Learning Health Systems (LHS). To what extent these concepts align and how they optimally could interact warrants further exploration, for example to inform Cochrane efforts in evidence synthesis.
Objectives: To describe the Evidence Ecosystem and LHS concepts in terms of what problems these are trying to solve and proposed solutions
Methods: The Evidence Ecosystem represents a conceptual framework for a cyclical and continuous process, with a focus on more efficient evidence synthesis and trustworthy decision support through common standards, methods, processes and platforms (Figure 1). Recently a major LHS initiative has been launched in the US; The AHRQ evidence-base Care Transformation Support (ACTS, figure 2). The ACTS community includes > 140 organisations working together to reach the quadruple aims of US health care. The main focus is on digital decision support, delivered care and continuous quality improvement in practice. MAGIC is conducting pilots with ACTS on digital production and access to evidence and decision support through interoperable platforms (e.g. MAGICapp). This provides an opportunity to study concerted evidence synthesis and guidance at the international level (e.g. BMJ Rapid Recommendations) can inform LHS at national and local levels. Here LHS is set up to cover the final Evidence Ecosystem steps of downstream implementation, evaluation of impact and production of more relevant and reliable evidence.
Results: We find the two concepts completely aligned and complementary in describing problems and proposed solutions concerning evidence from its inception to documented improvements in delivered health care. Both concepts underscore the need for an overarching infrastructure to provide orchestration, governance and support to organisations currently working in silos. The Evidence Ecosystem can provide trustworthy and digital decision support informed by systematic reviews, ideally at the international level to increase efficiency and reduce duplication of work. LHS can assist health care organisations working at national and local levels in optimally re-using and adapting the decision support to improve delivered care.
Conclusions: The synergy between Evidence Ecosystem and concepts are striking but it remains to be seen how these could optimally interact. In the absence of an international orchestrator in the Evidence Ecosystem and explicit links to LHS we will likely continue to work in silos.
Patient or healthcare consumer involvement: Patient partners are contributing in the development of the Evidence Ecosystem and LHS concepts.