There has never been a scientific resource like the Clinical Center. Therapies incubated here have had far-reaching impacts on the quality of world health for more than 40 years. As the scope and sophistication of clinical research have increased over the past decades, so have the requirements of a physical plant to house that research. And as scientific inquiry and medical care have evolved, so has the vision of what the Clinical Center needs to provide. This evolution is central to revitalizing clinical research within the NIH intramural programs.

At the core of our current plans to revitalize clinical research is the construction of a new 250-bed research hospital. The Department of Health and Human Services, acting on recommendations from the External Advisory Committee, is considering funding a competition to develop a concept for this facility. The complex will include a prominent day hospital; contiguous laboratory space -- a hallmark of the Clinical Center since its inception; and access to the current Ambulatory Care Research Facility, as well as diagnostic and surgery suites. As currently conceived, the $380 million needed for this facility would come from existing and future intramural funds.

In preparing for the new facility, we must streamline current Clinical Center programs. Consolidations of patient-care units now under way are designed to reduce the number of beds from 416 to 325 over the next few years.

This reduction will help alleviate another pressing concern for intramural researchers: shortage of laboratory space. Cutting the number of patient beds will free an additional 15,000 square feet of space throughout the building for reassignment. We plan to move offices that now encroach on laboratory space into the newly vacated areas. Laboratories can then be added and expanded, contributing to a much-needed NIH Director's reserve of space to support new recruitment and scientific initiatives. We have also initiated a massive program to provide essential maintenance and repair to the existing facility.

The patient-care unit consolidations will result in another major shift -- a cultural one. Institutes will, by necessity, share space for patient care, an arrangement that should foster a new era of intellectual cross-fertilization, a concept that has traditionally served as the foundation for creativity here at NIH.

We are also exploring ways to control the cost of providing Clinical Center services. One new policy allows us to structure an accurate, detailed measure of how much it costs for the Clinical Center to support an institute's protocol. Those accounting steps, coupled with efforts to better coordinate with the institutes to anticipate support needs, should enable us to work more efficiently.

The Clinical Center does more than provide services for the institutes. Staff members also conduct their own high-quality research, which has yielded important results. I encourage this research, and have instituted new policies to support it, including clearly defined budgets for Clinical Center research and rigorous quality review by the intramural Boards of Scientific Counselors. These changes have been a tremendous morale booster for the scientists and health-care providers at the Clinical Center. An additional incentive for improving the efficiency of Clinical Center operations is a new policy that earmarks a percentage of money saved in service functions to be applied to research activities. Other efforts to breathe new life into clinical research here include development of a program to identify and recruit minority patients, a step crucial to achieving diversity in our patient populations.

A revitalization of medical information systems is opening doors for innovative patient evaluation and consultation. Digitized images such as X-rays will soon be available on desk-top computers for patient-care providers throughout the Clinical Center. This technology can also extend the digital images to remote locations, allowing referring physicians to follow the care of patients here. The system will also be able to transmit other clinical data, such as retinal photographs and electrocardiograms, to in-house computers and to monitors in the offices of referring physicians.

Developing strategies for electronic transmission of clinical images will pave the way for another innovative aspect of medical care, remote assessment and monitoring of patients. Telemedicine technology could enable patients to go to nearby regional centers to be interviewed and examined by NIH physicians via video links, thereby reducing travel-related expenses, always a substantial component of clinical-care costs.

We are in a unique position to help define the roles of computer technology in clinical research, roles that will strengthen protocol monitoring and the interactions between extramural and intramural research. A regional linkage will establish a framework for clinical trials not previously possible. It will enhance patient and data monitoring, as well as increase the involvement by referring, primary-care physicians. This direct interaction between the principal investigators and the primary-care physicians will help provide consistency of clinical decisions during trials and improve the quality of clinical research.

It makes sense to place these regional centers in the existing network of General Clinical Research Centers. I am exploring this possibility with the Directors of the National Center for Research Resources and the Division of Computer Research and Technology.

We will continue to develop these and other ideas to strengthen research at the Clinical Center. In the next issue of The NIH Catalyst, we will discuss the second part of NIH's clinical research future: a major new training initiative that the Clinical Center plans to launch later this winter.

John I. Gallin, M.D.
Warren Grant Magnuson Clinical Center
Associate Director for Clinical Research

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