ESO Emerging Leader Programme: The Development of a Stroke Learning Health System in Lithuania

In 2024-2026, I had the honour of being selected as one of three participants of the first ESO Emerging Leader Programme cohort. This opportunity has provided me with a strong platform for both professional growth and personal development, enabling me to deepen my understanding of stroke care challenges across Europe, strengthen my leadership skills, and learn directly from leading European stroke physicians. Throughout the programme, I have expanded my academic and professional activities, developed valuable networks for scientific collaboration, and applied these experiences to support ongoing improvements in stroke care in Lithuania.

A central benefit of the programme has been the mentorship and collaborative opportunities it enabled. Among all things, my mentor Prof. Alastair Webb played an important role in supporting my final research project, helping to secure funding through the Lithuanian Research Council. This funding allowed me to establish a research team at Vilnius University and build on my Emerging Leaders final project – strengthening stroke care quality monitoring at Vilnius University Hospital and contributing to the development and evaluation of a national Stroke Learning Health System in Lithuania.

Despite substantial advances in stroke care, quality improvement efforts worldwide still rely heavily on manual data collection, retrospective audits, and infrequent feedback cycles. These approaches are resource-intensive, slow to respond to emerging problems, and prone to reporting bias. At the same time, widespread adoption of electronic health records (EHRs) and national digital health infrastructures creates new opportunities to embed continuous learning directly into routine care. Lithuania, a small Baltic country with 11 accredited stroke centres, has systematically monitored stroke care performance since 2014. In addition, at Vilnius University Hospital, we developed fully automated data extraction using in-house EHRs, which enabled dashboards for near-real-time quality monitoring, providing a strong foundation for developing a Learning Health System (LHS) for stroke care. In 2024, the Lithuanian government decide to invest in a data exchange and monitoring platform for medical clusters, creating an opportunity to scale a similar model to the national level.

Therefore, my Emerging Leader Programme final research project aimed to describe, design, scale, and implement a national LHS for stroke care in Lithuania that transforms routinely collected clinical data into continuous measurement-learning-improvement cycles across the entire stroke care pathway. This was a part of a broader project initiated by the Lithuanian government, in which experts from most major Lithuanian stroke centres and other stakeholders have been involved, building on the available national digital infrastructure.

Lithuania’s centralised Digital Health Platform integrates national referrals, discharge summaries, e-prescriptions, mortality data, selected laboratory results, and imaging data. In addition, data from other health-related and administrative registries are available for secondary use through the National Data Lake, governed by the State Data Agency. With the engagement of relevant stakeholders, we attempted to identify key performance indicators (KPIs) for the Lithuanian Stroke Database and define the core variables that must be captured from participating hospitals’ EHRs. Stroke centres that did not record the required variables needed to adapt their EHR workflows and data structures to ensure systematic capture at the point of care and extraction from primary data sources. Finally, near-real-time dashboards would enable benchmarking across sites, analyses, and timely feedback loops to support clinical governance, transparency, and evidence-informed decision-making.

We have described the Lithuanian digital health architecture and the secondary data reuse pathway in two original scientific articles. Through a multi-stage Delphi process involving clinicians, Emergency Medical Services, a stroke non-governmental organisation, and policymakers, we established a Lithuanian Stroke Database, comprising 53 KPIs covering prehospital care, acute treatment, early rehabilitation, secondary prevention, and long-term outcomes. The process has been described, and the KPIs have been published as an original article. We have updated Vilnius University Hospital EHRs to be suitable for data extraction for variables that have not been included in our previous in-hospital model. As a side quest, structured data was supplemented with a large language model (LLM) to convert unstructured VUH clinical documentation into structured, registry-ready datasets. This approach enabled automated export of a hospital dataset to international registries (e.g., RES-Q) through an API without manual data entry. Preliminary validation suggests performance comparable to, or exceeding, that of trained clinical staff – an abstract detailing it has been presented at ESOC 2026, where it won the Best Poster Award, and an original article is in progress. Stroke-related variables are automatically extracted from hospital EHRs and, together with data from other hospitals, will be used to measure standardised KPIs at a national level. Data contribution from all Lithuanian stroke centres is anticipated by September 2026. The next stage will be to ensure that all the data is of satisfactory quality.

Lithuania’s national LHS for stroke care could potentially demonstrate how a mature digital health ecosystem can transform routine clinical data into continuous learning and improvement. The system is expected to reduce administrative burden, minimise reporting bias, and enable rapid responses to quality gaps. The platform could hopefully support research, registry-based clinical trials, and boost international collaboration.

Participating in the ESO Emerging Leader Programme has been a very important experience in my professional journey. It has helped me grow as a leader, academic, and clinician. The mentorship of Prof. Alastair Webb, the different learning opportunities, and the connections I built with leading European stroke physicians have greatly broadened my perspective. The programme also allowed me to become part of a growing network of future stroke leaders and created opportunities for collaboration in research, international projects, and future funding.

Most of all, the programme has helped me see more clearly how I can apply these experiences to improving stroke care in Lithuania. It has supported my goal of building my own research team at Vilnius University and strengthened my motivation to continue working at the intersection of stroke care and digital health innovation. I am leaving the programme with greater confidence, a stronger professional network, and a clearer sense of how I want to contribute to the field in the years ahead.

Are you an early-career stroke professional looking to develop your leadership skills, expand your international network and drive change in your own country? Applications for the ESO Emerging Leaders Programme are now open until 31 August 2026.
Learn more and apply now.