With multiple sites and complicated protocols, clinical trials do not always run as smoothly as desired. So the US National Institutes of Health (NIH) has created a new initiative to determine how researchers can maximize the use of electronic medical records and engage patients over the internet to improve these trials, all of which is designed to help bring down the spiraling costs of running a clinical trial.

The NIH launched the Health Care Systems (HCS) Research Collaboratory on 25 September, awarding seven researchers a total of $11.3 million in grants to consider everything from the most efficient means of recruiting participants for trials to best ways of designing an experiment and handling large amounts of data. “Although the clinical projects deal with distinct diseases, the overall goal is to develop the research methods and best practices that can be readily used,” says Catherine Meyers, director of the Office of Clinical and Regulatory Affairs within the NIH's National Center for Complementary and Alternative Medicine, in Bethesda, Maryland.

For example, one of the grants went to internist Gary Rosenthal of the University of Iowa Carver College of Medicine in Iowa City. Rosenthal is investigating whether switching people from daytime to nighttime doses of antihypertensive drugs lowers the risk of heart attack—but the exact subject of the study isn't relevant to the HCS Research Collaboratory. The new grant is designed to help Rosenthal assess how best to identify prospective participants through electronic health records and obtain consent online. The award should also allow Rosenthal's team to design the experiment so that participants can report when they take the drugs and how they're feeling through a website. Researchers conducting clinical trials have made use of the Web for years, Rosenthal notes, but it has been a bit haphazard, lacking the unified protocol explaining best practices that this project hopes to establish.

The initiative also considers how pragmatic trials, which use information already collected in healthcare systems and run during the course of routine medical practice, can yield results comparable to those found under idealized trial conditions. That's the goal of Gloria Coronado, a grant recipient from the Kaiser Foundation Hospitals in Portland, Oregon. She's designing pragmatic studies to pinpoint who needs colorectal cancer screening and to analyze which methods of encouraging people to get tested work best. Pragmatic trials are “cost-saving and more akin to what happens in the real world, outside of clinical trial settings,” she says.