Table 1. Opportunities for AMCs to advance PHC.
ActivityChallenges to implementing PHCResources and capabilities of AMCsOpportunities for AMCs
Rapid-learning health careNonuniform data capture

Integration of research methods into health system workflow
Information technology

Electronic data capture

Clinical-decision support

Health-services research
PHC learning laboratories

Data governance policies

Comparative effectiveness research

Knowledge dissemination
Development of common discovery resourcesLimited awareness of availability of biological samples

Limited ability to combine data sets

Paucity of standardized biobanks
Access to research subjects, biological samples, and annotated clinical data

Organizational structure capable of centralizing biobanking activities.
Development of data standards for clinical sample characterization and annotation

Centralization of biobanking

Data and sample sharing across labs and institutions

Value-creating partnerships with industry and payers
Establishing evidence for initial PHC adoptionHistorical lack of funding for clinical evidence development

Uncertainty around levels of evidence necessary to achieve adoption, coverage, and regulatory clearance
Synergistic co-location of research and clinical care

Established relationships with payers and industry
Value-creating partnerships with industry and payers to gather evidence of utility

Development of data standards for PHC usage, outcomes, and costs
Enabling of clinical effectiveness research and population studiesLimited coordination of PHC implementation and data collection among providers and payersAlong with payers, AMCs have access to treatment-history and health-outcomes dataDevelopment of data standards for electronic health records (EHR) to foster cross-institutional data mining

Multicenter outcomes research using deidentified clinical data
Overcoming barriers to implementation of new models of carePerverse microeconomic incentives of providers—focus on “sick care”Culture that promotes innovation

Flexibility in developing care models
“Learning laboratories” for new models of care, quality metrics, and accounting
Modernizing health professional and public educationLimited genomic literacy among providers and publicScholarship and education is a core missionTrain next generation of MDs in genomics and PHC