| Activity IDS Supports | IDS Challenges for Research | PBRN Solutions and Strategies |
|---|---|---|
| Provides consistent administrative policies for research participation across practices | Presence of an additional bureaucratic layer that requires negotiation (eg, need for subcontracts vs simple invoicing) | Develop standard governance agreements to share data across systems (eg, business agreements) |
| Clinical initiatives can align with practice-based research questions (eg, meaningful use, patient-centered home certification, maintenance of certification) | Practice interest is lessened because of pressure from the IDS to maximize their clinical output | Build grant budget justification to compensate practice expenses incurred Build in CME, maintenance of certification |
| Priorities may support a philosophy of rapid dissemination and implementation | Practices at the IDS geographic periphery suffer neglect regarding system integration, support of usual services, and administrative consideration of projects not related to the system as a whole | Package research with practice support services (eg, EHR support, patient education, mHealth, practice facilitation, purchase and maintenance of data mapping/ harmonization products) |
| Increased interest in research from the IDS through the lens of a “learning health care organization” | Adjacent IDSs may compete with each other for clinical market share; this competition could potentially have the unintended effect of reducing collaboration on research projects | Engage patients and other stakeholders with the idea of existing in a continuously learning health system and how all may benefit from this approach |
| IDSs may be in direct competition with PBRNs; may not see the worth of PBRN work when they are already connected and have data | Engage providers and staff in publications, presentations, and pursuit of better outcomes for patients based on sound science Initially avoid topics that might be “hot buttons” for administrators Look for win–win grants and contracts that require collaboration with multiple systems; PBRNs bring a primary care focus and insight, and IDSs bring a hospital focus | |
| EHR and data warehouse | ||
| Allows data collection and analysis consistency. | Reduced presence of safety net practices, since community health centers may not be part of the IDS and use a different EMR; this risks reducing the presence of participants with low socioeconomic status and minorities in research | Harmonize diagnostic, test, treatment, and utilization variables and codes across IDSs, including community health centers |
| Fragmentation of safety net clinic PBRNs as unique entities that are not included in studies that include other practice types | Standardization of interoperability methods (data transfer among EHR systems) across IDSs | |
| Provides an additional research tool for recruitment and quality improvement interventions. | Limited staff availability, even with funding, to program EMR modifications or extract data from CDW | Ensure the ability of commercial EHRs to provide prompts to enroll patients in studies, as well as adjust the care process through order sets and targeted and evidence-based educational materials |
| Lack of responsiveness to providing requested data in a timely fashion | Budget programmer time for all projects | |
| Joint governance of data warehouse by care delivery and academic components of IDS | ||
| Consistent roll out of quality improvement and regulatory practice enhancements | May be reactive to external forces, may inhibit innovative solutions | Can test novel interventions in practices that are early adopters External grant funds may partially support such innovation. |
CDW, clinical data warehouse; EHR, electronic health record; EMR, electronic medical record; IDS, integrated delivery system; PBRN, practice-based research network.