Most clinical decisions involve bridging the inferential gap: Clinicians are required to "fill in" where they lack knowledge or where no knowledge yet exists. In this context we consider how the inferential gap is a product, in part, of how knowledge is created, the limits to gaining access to such knowledge, and the variable ways in which knowledge is translated into decisions. We consider how electronic health records (EHRs) will help narrow this gap by accelerating the creation of evidence relevant to everyday practice needs and facilitating real-time use of knowledge in practice.

A provider-driven pay-for-performance process for CABG, enabled by an electronic health record system, can reliably deliver evidence-based care, fundamentally alter reimbursement incentives, and may ultimately improve outcomes and reduce resource use.

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Thi s paper explores the junction of research and clinical practice, and its important role in optimizing health care. Increasingly, bi-directional linkage of practice and research is viewed as an advantage for health care organizations; the ability to create a successful relationship is critical to their positioning for competition in the modern world.The challenge that health care organizations face going forward is leveraging the full capacities and data assets of medical practices, health plans, research units, hospitals, and of course, consumers, to create new strengths and capabilities. Critical to this challenge is the ability of research to help identify the optimal ways for health care organizations and medical groups to position themselves in order to achieve their mission. Today, this mission can be referred to as the "triple aim:" maximizing patient experience, making sure we have outstanding clinical outcomes, and explicitly addressing the affordability of health care. The only way to achieve all three parts of the mission is collaboration.With these thoughts in mind, a panel of clinical leaders from three integrated, large, health care financing and delivery organizations were asked to share and discuss their comments in view of a recent article offering a new perspective for optimizing health care through research. 1 The author of that paper was the introductory speaker and he presented five broad principles that could guide future work on this challenging problem. Underlying Dr. Kottke's main points is a call to move the goal of health sciences research away from merely the pursuit of knowledge and its 'translation' into clinical practice, and instead toward a partnership that optimizes clinical practice through research in order to improve the health of the population. 1 Tom KottkeThe five principles for optimizing care through research are summarized in table 1. The first key principle is that the needs of patients and populations should determine the research agenda. Heart disease serves as an example of the importance of asking whether a particular line of research is A close partnership between care delivery and research organizations has the potential to provide essential elements needed to optimize health and health care. This clinical leadership panel, held during the 14th Annual Health Maintenance Organization Research Network (HMORN) Conference, identifies the value, opportunities and challenges of those close partnerships between three HMORN care delivery and research organizations. The objectives of this plenary session were: (1) identify the important facets of partnership that bring value to care delivery and research, (2) pinpoint the critical alignments of care delivery and research that are needed to fulfill the promised value between clinical and research organizations, and (3) recognize the challenges that clinical and research organizations need to address.