the health care system is currently undergoing a great deal of change, many current practices are able to be reconsidered. Much of the change is caused by new incentives. Payers are starting to gear payment levels to value rather than volume and are prodding providers to assume risk for the health of the populations they serve. These payment changes make use of best practices that undergird the provision of adequately reimbursed care.

Other actions by payers also could facilitate further development of a learning health system. Just as federal “meaningful use” incentives are driving health systems nationwide to adopt EHRs more rapidly, so could Medicare be used to create incentives for providers to use EHRs for research (not just to make care more efficient and easily monitored) and to help determine ways to connect data repositories.

CEOs of health systems have been a largely untapped resource in promoting clinical research. Box 6-2 suggests ways health system leadership can serve transformation of the CTE. Engaging this group of leaders can be accomplished by appealing to their business and clinical interests.

BOX 6-2a
CEOs of Integrated Health Systems Could Promote Clinical Research

Health system CEOs could play a crucial role in transformation of the CTE. This role might include

•      acting assertively to embed research in the mission and culture of the health system, creating opportunities for the pursuit of scientific evidence within clinical care in order to improve quality, and moving their organizations in the direction of becoming learning health systems (as discussed in Chapter 2);

•      promoting clinician training in research (as discussed in Chapter 3);

•      facilitating research projects, partly by creating incentives for clinicians to engage in research (as discussed in Chapter 4) and by providing seed grants for health professionals to pursue their research interests; and

•      joining research collaboratives or networks on behalf of their organizations (as discussed in Chapter 5).


a This box is based on the presentation by Douglas Cropper, President and CEO, Genesis Health Systems.

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