June 17, 2026
When the system learns differently
Why this matters
A treatment gap identified through a single patient transfer led to a new frostbite protocol in Calgary, helping reduce amputations and raising new questions about how Learning Health Systems operate in practice.
A request to transfer a frostbite patient from Golden, B.C. to Whitehorse, Yukon caught Calgary clinicians by surprise.
"The request raised eyebrows," says Dr. Catherine Patocka, emergency physician, associate professor and academic and clinical department head in the Department of Emergency Medicine at the Cumming School of Medicine.
"Why Whitehorse? That's not how patients usually move through our system. They typically come to Calgary."
When asked, the referring physician explained that Whitehorse had access to a treatment unavailable in Calgary. The emergency physician assumed there must be a misunderstanding. When the patient arrived, however, it turned out to be true.
The treatment involved iloprost, a drug that is not commercially available and requires special authorization through Health Canada. When used in frostbite cases, it can help prevent tissue damage and reduce the need for amputation.
"We didn't have access to that treatment because it required special authorization through Health Canada," says Patocka. "That moment when we realized a smaller centre could offer something a tertiary academic centre could not became the catalyst for everything that followed."
Over the next year and a half, clinicians, nurses, pharmacists and operational leaders worked together to secure the medication, develop a treatment protocol and navigate the operational complexities required to bring it into practice.
Since 2023, the protocol has been used to treat hundreds of patients and has contributed to a significant reduction in frostbite-related digit amputations in Calgary.
A bigger question emerges
Reflecting on this experience, Patocka initially viewed it as a Learning Health System in action.
Along with Dr. Jessalyn Holodinsky and Bea Rivera, she launched a study to better understand how the frostbite protocol was successfully implemented and what factors contributed to its success.
Using interviews with clinicians and operational leaders, the team explored the mechanisms that supported rapid adaptation and implementation within Calgary's emergency departments.
Their goal was not simply to confirm that the protocol worked. They wanted to understand how change happened.
What the team learned
The study identified five key stages that drove the change:
- Identifying a service gap
- Overcoming barriers
- Implementing a solution
- Embedding the change into routine practice
- Improving patient outcomes
What surprised the team was that this process did not align neatly with traditional Learning Health System models.
Rather than being driven primarily by continuous cycles of data collection and evidence synthesis, learning was driven by urgency, relationships, collaboration and local context.
The frostbite case suggested that health systems may learn and improve in ways that existing frameworks do not fully capture.
Rethinking how health systems learn
The findings do not dismiss the concept of Learning Health Systems. Instead, they raise important questions about whether current frameworks accurately reflect how learning happens in real-world environments.
Before investing heavily in artificial intelligence and other data-intensive initiatives under the Learning Health System banner, Patocka argues that researchers and health-system leaders should ensure the underlying framework accurately reflects reality.
She also points to more than 150 years of scholarship on learning theory that may offer valuable insights for the field.
For Patocka, the frostbite story is ultimately about more than a treatment protocol.
It is a reminder that meaningful change often begins when people identify a problem, bring the right partners together and take action.
The study highlights the importance of remaining open to different pathways for learning and improvement and challenges researchers to continue refining Learning Health System frameworks so they better reflect the complexity of real-world practice.
How this advances a Learning Health System
✓ Identified a gap in care and responded to a real-world challenge
✓ Brought together clinicians, pharmacists and operational leaders to develop a solution
✓ Embedded learning directly into clinical practice
✓ Improved patient outcomes
✓ Generated new knowledge about how health systems learn and adapt
This article is part of the LHS in Action series, which highlights real-world examples of Learning Health Systems work across the O'Brien Institute community. Through stories of research, collaboration and practice change, the series explores how people, data and evidence come together to improve health systems and outcomes.