The Roles of Biomedical Informatics for an Equitable Learning Health System: Lessons from a Year of Scientific Informatics Literature

Background: Biomedical informatics plays a central role in supporting learning health systems (LHSs) which aim to continuously improve care by transforming data into knowledge and knowledge into action. However, healthcare data reflect existing disparities in access, delivery and outcomes, raising concerns whether the LHS cycle can improve care equitably without intentional design. Objective: To describe the recurring theme of health equity found in recent biomedical informatics literature, using a convenience sample of articles contributed to the 2025 AMIA Year in Review (YIR). Methods: In developing the 2025 AMIA YIR presentation, we found that 240 articles submitted by AMIA experts could be organized into multiple themes to allow summarization and synthesis for efficient presentation of 140 of them. Many themes could themselves be organized around the concept of the learning health system, which further streamlined the presentation. We were struck by the frequency with which the issue of the contribution of biomedical informatics are related to health equity related to learning health systems was addressed. We therefore applied our own expertise to distill relevant articles from the larger set to explore this recurrent issue. Results: Here, we present 56 papers selected from nine of the 19 themes that illustrate how biomedical informatics can support equity at each stage of the LHS. Mature LHS implementations provided large-scale examples of how learning cycles can be designed for equity. Real-world evidence and inclusive data themes showed that equitable learning depends on whether data are complete enough to represent the populations the system intends to serve. Natural language processing and Artificial Intelligence modeling showed how data are transformed into knowledge and translated into clinical action through decision support. Trust and justice in data use, health equity as infrastructure, and equitable access emerged as interdependent conditions that influence whether the learning cycle operates equitably and effectively. Conclusions: Equity emerged as a condition influencing every stage of the LHS cycle. The value of informatics interventions cannot be judged by technical performance alone, but by whether they build learning cycles that are inclusive, accountable, and equitable for the populations they serve.