Abstract
The widespread implementation of electronic medical records (EMRs), stimulatedby thePatient Protection andAffordable Care Act, provides a major opportunity to conduct inexpensive pragmatic randomized trials1,2 that are embedded into the clinical practice of health care delivery. Electronicmedical recordsallowhealthsystemsto identifyparticular types of patients, deliver targeted interventions designed to improve health, and measure how those interventions impact health care delivery and health outcomes. With optimal use of EMRs, the administrative costs of a trial need not increasewith the sample size; this decouplingof costs and size facilitates large, simple, and inexpensive trials that have thepotential to transformhealthsystems intoentities that learn and continuously improve.3
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