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Architectural frameworks: defining the structures for implementing learning health systems

Overview of attention for article published in Implementation Science, June 2017
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (84th percentile)
  • Average Attention Score compared to outputs of the same age and source

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18 tweeters


39 Dimensions

Readers on

103 Mendeley
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Architectural frameworks: defining the structures for implementing learning health systems
Published in
Implementation Science, June 2017
DOI 10.1186/s13012-017-0607-7
Pubmed ID

Lysanne Lessard, Wojtek Michalowski, Michael Fung-Kee-Fung, Lori Jones, Agnes Grudniewicz


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. We present an architectural framework for LHSs that incorporates five dimensions-goals, scientific, social, technical, and ethical-commonly found in the LHS literature. The proposed architectural framework is comprised of six decision layers that model these dimensions. The performance layer models goals, the scientific layer models the scientific dimension, the organizational layer models the social dimension, the data layer and information technology layer model the technical dimension, and the ethics and security layer models the ethical dimension. We describe the types of decisions that must be made within each layer and identify methods to support decision-making. In this paper, we outline a high-level architectural framework grounded in conceptual and empirical LHS literature. Applying this architectural framework can guide the development and implementation of new LHSs and the evolution of existing ones, as it allows for clear and critical understanding of the types of decisions that underlie LHS operations. Further research is required to assess and refine its generalizability and methods.

Twitter Demographics

The data shown below were collected from the profiles of 18 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 103 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 103 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 23 22%
Student > Master 16 16%
Researcher 12 12%
Professor 9 9%
Other 6 6%
Other 15 15%
Unknown 22 21%
Readers by discipline Count As %
Medicine and Dentistry 20 19%
Nursing and Health Professions 16 16%
Computer Science 9 9%
Social Sciences 6 6%
Business, Management and Accounting 5 5%
Other 17 17%
Unknown 30 29%

Attention Score in Context

This research output has an Altmetric Attention Score of 12. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 August 2017.
All research outputs
of 21,005,902 outputs
Outputs from Implementation Science
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Outputs of similar age
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Outputs of similar age from Implementation Science
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Altmetric has tracked 21,005,902 research outputs across all sources so far. Compared to these this one has done well and is in the 88th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,673 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.7. This one has gotten more attention than average, scoring higher than 64% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 284,570 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 84% of its contemporaries.
We're also able to compare this research output to 8 others from the same source and published within six weeks on either side of this one. This one has scored higher than 3 of them.