Patient-Centered Network of Learning Health Systems: Developing a resource for clinical translational research.

INTRODUCTION: The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions. METHODS: The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network. RESULTS AND CONCLUSIONS: Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.

The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Outcomes and Metrics of Pharmacogenetic Implementations Across Diverse Healthcare Systems.

Numerous pharmacogenetic clinical guidelines and recommendations have been published, but barriers have hindered the clinical implementation of pharmacogenetics. The Translational Pharmacogenetics Program (TPP) of the National Institutes of Health (NIH) Pharmacogenomics Research Network was established in 2011 to catalog and contribute to the development of pharmacogenetic implementations at eight US healthcare systems, with the goal to disseminate real-world solutions for the barriers to clinical pharmacogenetic implementation. The TPP collected and normalized pharmacogenetic implementation metrics through June 2015, including gene-drug pairs implemented, interpretations of alleles and diplotypes, numbers of tests performed and actionable results, and workflow diagrams. TPP participant institutions developed diverse solutions to overcome many barriers, but the use of Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines provided some consistency among the institutions. The TPP also collected some pharmacogenetic implementation outcomes (scientific, educational, financial, and informatics), which may inform healthcare systems seeking to implement their own pharmacogenetic testing programs.

Clinical Informatics Fellowship Programs: In Search of a Viable Financial Model: An open letter to the Centers for Medicare and Medicaid Services.

In the US, the new subspecialty of Clinical Informatics focuses on systems-level improvements in care delivery through the use of health information technology (HIT), data analytics, clinical decision support, data visualization and related tools. Clinical informatics is one of the first subspecialties in medicine open to physicians trained in any primary specialty. Clinical Informatics benefits patients and payers such as Medicare and Medicaid through its potential to reduce errors, increase safety, reduce costs, and improve care coordination and efficiency. Even though Clinical Informatics benefits patients and payers, because GME funding from the Centers for Medicare and Medicaid Services (CMS) has not grown at the same rate as training programs, the majority of the cost of training new Clinical Informaticians is currently paid by academic health science centers, which is unsustainable. To maintain the value of HIT investments by the government and health care organizations, we must train sufficient leaders in Clinical Informatics. In the best interest of patients, payers, and the US society, it is therefore critical to find viable financial models for Clinical Informatics fellowship programs. To support the development of adequate training programs in Clinical Informatics, we request that the Centers for Medicare and Medicaid Services (CMS) issue clarifying guidance that would allow accredited ACGME institutions to bill for clinical services delivered by fellows at the fellowship program site within their primary specialty.

Clinical research informatics: survey of recent advances and trends in a maturing field.

OBJECTIVES: To provide a survey of the field of clinical research informatics (CRI), focusing in particular on significant developments over the past 3 years and the insights they provide about the progress and state of the field. METHODS: An iterative "scoping review" of the literature published in scientific journals and conference proceedings that are relevant to CRI, from late 2009 to early 2013. RESULTS: 212 articles were identified, and 64 were selected to illustrate recent advances in the field. Based on those, six categories of CRI activity were identified: Data and Knowledge Management, Discovery and Standards; Clinical Data Re-Use for Research; Researcher Support and Resources; Participant Recruitment; Patients/Consumers and CRI; Policy, Regulatory and Fiscal Matters. CONCLUSIONS: This survey demonstrates that the field of CRI has matured and is now well established. The ongoing work is essential to overcome many of the challenges the clinical research enterprise is facing and more work is needed. Even as work continues to establish necessary infrastructure, methods, and best practices, CRI researchers should strive for more rigorous study designs to evaluate the impacts of the work in the field. There is little doubt that the field is poised for rapid growth, and that the CRI literature will continue to reflect that growth in years to come.

Information at hand: using handheld computers in medicine.

Call them handhelds, palm-tops, or personal digital assistants (PDAs), pocket-sized computers are becoming a common feature on the medical landscape. As the technology improves, more programs become available, and the demands of medical practice heighten, physicians are recognizing the benefits of having information available at the point of care. This article reviews the use of handheld computers in medicine, emphasizing how they might help the practicing physician.