societal benefit at a realistic marginal cost. With appropriate design and integration, current collections of databases, health record systems, health information exchanges, financing, workforce, policies, and governance, it can be evolved into a system that addresses a range of needs in care delivery, process improvement, and research. T. Bruce Ferguson from the East Carolina Heart Institute discusses clinical database work in the field of cardiology and identifies key opportunities to apply data resource and analysis infrastructure toward the development of dynamic, real-time learning systems, centered on the patient and decisions at the point of care. Finally, Daniel E. Ford of Johns Hopkins University discusses opportunities to improve the efficiency and effectiveness of clinical research by streamlining and standardizing processes and policies, increasing investments in practice-based networks and training and retaining research support personnel. Two papers focus on the workforce at the front lines of evidence application and development—health professionals and clinical researchers. Benjamin K. Chu from Kaiser Permanente describes changes to the healthcare delivery system that will shape the future practice environment and illustrates how training and practice environments for health professions education should seek to emulate and improve upon current models of best care. Steven A. Wartman of the Association of Academic Health Centers describes a needed expansion of medical research to a multidisciplinary approach that addresses all aspects of health. He offers some suggestions on how the training capacity might be developed to accelerate a shift to research focused on the discovery, dissemination, and optimized adoption of practices that advance the health of individuals and the public.

This chapter concludes with discussion highlighting opportunities to take best advantage of existing infrastructure elements—such as data resources, expertise, and technology platforms. Speaking from key sector perspectives, Carmella A. Bocchino from America’s Health Insurance Plans, Rachael E. Behrman from the Food and Drug Administration (FDA), and William Z. Potter from Merck Research Laboratories, discuss how public–private partnerships can create needed space for cross-sector collaboration around common areas of interest and expertise.


Mark E. Frisse, M.D., M.Sc., M.B.A., Professor of Biomedical Informatics, Vanderbilt University


The overarching intent of this publication is to better understand the requirements necessary to transform our fragmented healthcare infrastruc-

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