practices, often partnered with hospitals, academic health centers, insurers, and others to perform research and improve the quality of primary care. These networks constitute an important portion of the clinical research enterprise by providing insight from research at the “coalface” of clinical care. Robert L. Phillips suggests that many lessons could be learned about essential elements in building learning communities—particularly the organization and resources necessary—as well as how to establish such networks between many unique practice environments. The electronic component of the Primary Care Research Network PBRN has the potential to extend the capacity of existing PBRNs by providing an electronic connection that would enable the performance of randomized controlled trials (RCTs) and many other types of research in primary care practices throughout the United States.

While the work of the VA and PBRNs demonstrates immense potential for the integration of research and practice within our existing, fragmented, healthcare system, the papers that follow look at how we might bring their success to a national scale. George Isham of HealthPartners lays out a plan to develop a national architecture for a learning healthcare system and discusses some recent activities by the AQA (formerly the Ambulatory Care Quality Alliance) to promote needed systems cooperation and use of data to bring research and practice closer together. In particular, AQA is focused on developing a common set of standardized measures for quality improvement and a strategy for their implementation; a unified approach to the aggregation and sharing of data; and common principles to improve public reporting. Citing a critical need for rapid advance in the evidence base for clinical care, Lynn Etheredge makes the case for the potential to create a rapidly learning healthcare system if we build wisely on existing resources and infrastructure. In particular he focused on the potential for creating virtual research networks and the improved use of EHR data. Through the creation of national standards, the many EHR research registries and databases from the public and private sectors could become compatible. When coupled with the anticipated expansion of databases and registry development these resources could be harnessed to provide insights from data that span populations, health conditions, and technologies. Leadership and stable funding are needed along with a shift in how we think about access to data. Etheredge advances the idea of the “economics of the commons” as one to consider for data access in which researchers would give up exclusive access to some data but benefit from access to a continually expanding database of clinical research data.



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