International CT embedding scan – a prelude to sector tools and guidance


Healthcare professionals and organisations in many countries share a vision of creating a Learning Healthcare System, an LHS. This is health care delivering high-quality, cost-effective care including optimal outcomes for consumers. It’s health care underpinned by systematic generation and application of clinical research-derived evidence. ACTA calls this “Better health through best evidence” and it is the vision guiding our work to grow, strengthen and support the clinical trials sector.

To inform discussion at the ACTA Summit which takes place later this month, our Embedding Clinical Trials in Healthcare Reference Group has published its report: International best practice towards a Learning Healthcare System. This prepares the ground for the Group’s substantive work towards Department of Health-mandated sector guidance and tools for routinely embedding trials, due for delivery in 2019.

The International Scan identifies and draws lessons from best practice in countries that have invested to clear obstacles on the path to an LHS. Reference Group leadership member, Prof Nik Zeps, says: “We identified six key elements [below] that, if we can adequately address them, will greatly enhance our clinical trial networks’ ability to generate high quality evidence faster and more cost-effectively from pragmatic ‘public good’ trials.”

  • A move to an LHS requires buy-in from all stakeholders, including health system leaders and health professionals who are not research active.
  • Traditional ethics and governance frameworks apply poorly to pragmatic trials. Continuous improvement and research form a continuum that should be better valued as a core responsibility of delivering safe and effective healthcare.
  • All stakeholders should value clinical trials as part of an LHS and be able to convey their importance with patients and the public.
  • Wider access to research design and trial coordination services is necessary to support an LHS and to avoid the potential for missed opportunities or wasteful research practice.
  • More resources and training are needed to develop and conduct trials with novel designs suitable for an LHS.
  • The lack of interoperable digital infrastructure makes it difficult to conduct rapid- pace trials of sufficient size to support decisions in an LHS.
  • The lack of clarity around privacy and the use of health data impedes the move to an LHS.
  • Changing the culture of the health service is seen as one of the biggest challenges.

Read the full report