Engineering High Reliability Learning Lab (EHRLL) is a collaborative project between
the Department of Health Policy and Management at the Harvard TH Chan School of Public Health
and The Healthcare Systems Engineering Institute at Northeastern University.


Despite substantial effort and resources, progress toward re-engineering health care to ensure it is reliably safe has been unacceptably slow. More disconcerting is the lack of attention to safety in the primary care setting and at the intersection of primary and specialty care, where communication and coordination challenges abound. Health information technologies (HIT)aim to facilitate integration among providers, but often fail to fulfill their promise. Innovative approaches to ensure provider workflows and HIT systems are mutually supportive are needed to address common patient safety problems in primary care.

Our goal is to establish an Engineering High Reliability Learning Lab (EHRLL) to enhance capacity for innovation and to develop highly reliable systems that address communication and coordination challenges at the intersection of primary and specialty care, particularly for high risk patients.

A five-stage innovation cycle (i.e., problem analysis, design, development, implementation, and evaluation) will drive EHRLL efforts to develop highly reliable systems within 19 Harvard-affiliated primary care practices and their specialty care partners that collectively care for more than 260,000 patients through 1.4 million encounters each year. EHRLL will include an Administrative Core and an Engineering Core to provide a supportive re-engineering infrastructure that will incorporate a theory-driven, flexible, shared Learning Program; and a multidisciplinary team of experienced investigators and outside “Disruptors”.

Four synergistic projects will engage health system-based re-engineering and design (R&D) of highly reliable (1) closed loop systems for high priority primary to external specialty referrals; (2) coordination systems for children with medical complexity undergoing surgery; (3) management systems for patients on chronic opioids; and (4) coordination systems for patients between hospital and homecare.