Table 1. Challenges and Potential Solutions to Practice-Based Research Network Research Missions in the Changed Practice Environment of Integrated Delivery Systems and Electronic Health Records
Activity IDS SupportsIDS Challenges for ResearchPBRN Solutions and Strategies
Provides consistent administrative policies for research participation across practicesPresence 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 outputBuild grant budget justification to compensate practice expenses incurred
Build in CME, maintenance of certification
Priorities may support a philosophy of rapid dissemination and implementationPractices 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 wholePackage 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 projectsEngage 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 dataEngage 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 researchHarmonize 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 typesStandardization 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 CDWEnsure 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 fashionBudget 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 enhancementsMay be reactive to external forces, may inhibit innovative solutionsCan 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.