In 2020 the professional specialty societies, providing leadership for knowledge, are one of the most influential factors moving research participation into the definition of successful practice. Research participation is highlighted and promoted in the educational programs, publications, and recogitions of the societies. The societies support research directly by maintaining registries of clinical experience to which they have unique access and through fellowships that enable community-based practitioners to gain research experience. Board-certification requirements recognize research and particularly translation skills.

Academic health centers are integrally related to IHSs. The missions and priorities of AHCs have been clarified to distinguish between those with a substantial investment in basic and translational research, and those that are primarily focused on education and service. The more comprehensive of the former have been designated as academic health science systems (AHSSs) (Dzau, et al. 2010). All AHSSs are organized to serve as research sites for enrollment in observational studies and interventional trials. All IHSs are affiliated with an AHC, which could be an AHSS, which serves them as a resource for education and clinical research through an affiliated IHS office or department. In most cases, the affiliated academic centers have access to the IHS databases for the purpose of maintaining registries and conducting collaborative projects.

A fundamental element undergirding mature electronic health and medical records is the application of an ontology that permits the same terms to be used for describing clinical phenomena and for billing; they also form the basis for quality measurement and for providing adjustments for severity of illness when efficiency measures are assessed. These same terms will also constitute the fundamental “vocabulary” for both observational research databases and randomized controlled trials (RCTs). When needed, additional data elements are added for more detailed investigation and randomization is applied to the record. While the nation has yet to reach this envisioned state of health system integration and effective use of the EHR, the implementation of national health care reform legislation and the efforts of organizations to display their accountability for health care outcomes and costs will likely bring us closer to this stated vision.

PART II: THE FUTURE OF CLINICAL RESEARCH

Controlled clinical trials are the essential cornerstone of modern evidence-based medical care and health practice. Although multiple types of information are needed to fully inform practice, the interventional clinical trial (ICT) plays a particularly critical role. When we view scientific studies as a continuum, we see that they are translated into treatments



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