4. We should recognize that academic medical centers, facing constraints on payments for clinical care, will be less able to support the environment for grant-funded research. Increases at NIH may be small compared with the squeeze on Medicare and Medicaid payments. 5. We should invest in learning what works and what does not, and what is safe and what is not, in clinical care. We must make our healthcare much more patient-centered, recognizing the importance of chronic care for common conditions, and encourage patients, families, and other caregivers to become more knowledgeable so that they may contribute actively to the management of these conditions. In the 2009 economic stimulus package, the federal government appropriated $19 billion to subsidize and incentivize purchase and installation of electronic medical records and computerized recording and monitoring of physicians' orders for lab tests, x-rays/imaging procedures, and prescriptions, plus $1.1 billion for comparative effectiveness research. Both of these approaches may be helpful in building institutional capability and making better clinical decisions.910 Performing Translational Research and Communicating its Value To meet the descriptive needs of the increasingly multidisciplinary new sciences, a new concept— translational research—has sprung into existence at the NIH as part of the initiative to "re-engineer the clinical research enterprise."1 The NIH stimulates transformative changes in research and training through highly competitive institutional Clinical and Translational Science Awards, of which there were 46 by July 2009, with a plan to increase to 60 around the country. The Institute of Medicine (IOM) Clinical Research
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