Pragmatic (trial) informatics: a perspective from the NIH Health Care Systems Research Collaboratory.
Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, and federally driven standards and policies to ensure that future electronic health record systems have the flexibility to support research.
Division of Clinical Systems and Analytics, Duke University School of Nursing, Durham, NC, USA.|Duke Center for Health Informatics, Durham, NC, USA.
Rachel L
RL
Richesson
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Beverly B
BB
Green
Kaiser Permanente Center for Health Research, Portland, OR, USA.
Reesa
R
Laws
OCHIN Inc, Portland, OR, USA.
Jon
J
Puro
Department of Pediatrics, University of Colorado, Denver, CO, USA.
Michael G
MG
Kahn
Kaiser Permanente Center for Health Research, Portland, OR, USA.
Alan
A
Bauck
Clinical Research Informatics, Duke Clinical Research Institute, Durham, NC, USA.
Michelle
M
Smerek
Department of Surgery, University of Washington, Seattle, WA, USA.
Erik G
EG
Van Eaton
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Meredith
M
Zozus
Duke Center for Health Informatics, Durham, NC, USA.
W Ed
WE
Hammond
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
Kari A
KA
Stephens
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Greg E
GE
Simon
D057286:Electronic Health Records; D006801:Humans; D008490:Medical Informatics; D009316:National Institutes of Health (U.S.); D064792:Pragmatic Clinical Trials as Topic / Q000379:methods; D012107:Research Design; D014481:United States
National Institutes of Health; clinical informatics; demonstration project; electronic health records; pragmatic clinical trial