NIH Clinical Research Information System
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Department of Clinical
Research Informatics
 
CRIS Overview

CRIS

The Department of Clinical Research Informatics (DCRI) is responsible for management of applications and information technology for clinical research. DCRI collaborates with departments across the NIH Clinical Center (e.g., Nursing, Pharmacy, Radiology, Laboratory Medicine, and Transfusion Medicine) as well as multiple institutes that bring their patients to the NIH CC with the shared focus on the Clinical Research Information System (CRIS).

CRIS is the primary computer information system used to support patient care, research, and administrative activities in the Clinical Center. CRIS is based on the Allscripts Sunrise Acute Care Manager 5.5 SP1. CRIS is used directly by physicians, nurses, and ancillary and administrative staff in performing a variety of information tasks related to patient care. Tasks include:

  • Managing admissions, transfers and discharges
  • Managing patient registration
  • Maintaining patient demographic data
  • Maintaining patient protocol information
  • Providing bed management
  • Writing all medical orders
  • Attributing of medical activities (orders, appointments and documents) to a specific research protocol
  • Retrieving laboratory results
  • Retrieving radiology results
  • Documenting of patient care plans
  • Documenting of vital signs
  • Documenting of medication administration
  • Documenting of intake and output
  • Documenting of progress notes
  • Reviewing of outside documentation

Approximately 90% of the Clinical Center's medical record content is generated from CRIS. The 10% not in CRIS are contained in Institute and Center (IC) systems that currently do not interface to CRIS and handwritten progress notes from the outpatient clinic areas.

The original architecture of CRIS was based on Dr. Rosenfeld's (NIH CC's CIO when CRIS was implemented) CRIS Flower Diagram (Figure 1) which shows that all systems connect together representing the various business requirements of the Departments and Institutes/Centers.

Over 2,750 users access CRIS daily using over 600 Standard Clinical Desktops (280 Desktops,Workstations on Wheels (WOWs)), 300 Sunray Workstations and hundreds of remote computers that utilize CITRIX. Over 400 printers produce output ranging from work lists, medical care plans, lab specimen and pharmacy labels and permanent medical record documents.

Departmental Ancillary Systems

The NIH Clinical Center hosts numerous information systems that support individual hospital departments and functions. Uni-directional and bi-directional interfaces are used to support the flow of data between CRIS and the Ancillary Systems. For example, the Radiology Information System (RIS) receives orders from CRIS with status message results being reported back to CRIS. The overall goal is to configure CRIS so that all clinical information needed to support patient care is available via one system – CRIS.

Figure 2 depicts the major current state of Ancillary Systems which interact with CRIS within the NIH Clinical Center, with their major functions and data flows. Each department is responsible for the administration of system content, while DCRI is responsible for maintaining the system hardware and interfaces with CRIS.

Electronic Health Record (EHR) Background

The EHR journey for the NIH Clinical Center (NIH CC) began back in 1975 with the implementation of Technicon's system that we called the "Medical Information System" (MIS). It was a mainframe hospital information system whose servers took up the majority of the basement level of the Clinical Center. Clinicians accessed MIS originally through dummy terminals with light pens. All text on the monochromatic screen was in block capital letters and when one item was selected, the screen would move along a linear path to the next appropriate screen. Order entry and clinical documentation were entered via MIS. You could say we were early adopters of Computerized Physician Order Entry (CPOE) before it was even called CPOE. MIS interfaced with the lab system and was integrated into the workflows of the radiology and pharmacy departments. Since all patients at the CC are on research protocols, the system had to be customized to support both clinical care and complex scenarios with investigational treatments and medications.

As EHR technology advanced, it was clear that we would need to make a change in order to take advantage of available IT capabilities that MIS could not provide. We needed a relational database that offered enough flexibility to support research and clinical care as well as to provide improved methods of storage, querying, and bringing together and sharing the clinical and research data contained within.

In 2001, we began planning for the replacement of MIS, now known as the Clinical Research Information System (CRIS). CRIS, at its core, is a vendor based system provided by Allscripts. It was selected for its flexibility and scalability, which was needed to support a combined clinical and research environment. In addition, it was selected for its ability to electronically interface with other clinical systems. We went live with a "Big Bang" implementation in August, 2004.

We then "officially" had CPOE with an emphasis on order entry by our physicians, and are now consistently at the 90% mark for medications ordered. We started with approximately 800 protocol order sets built in CRIS and now support over 1,500 active research protocols, many with investigational medications that require more sophisticated security settings. Clinical documentation has been in our EHR for our nurses and ancillary departments since the 1970s, but has flourished in the last 6 years with improved support of workflows and clinical decision support elements. Our physicians began their on-line documentation journey in 2009 with a small pilot that has now become the norm. The ability to efficiently pull data from other locations in the chart into progress notes has been key to adoption. Barcoding for specimen collection and blood transfusion verification have not only increased our ability to provide accurate research data, but have improved patient safety as well. We now have over 100 interfaces developed to exchange data so that is available in the right place, at the right time, to the right care provider, for the right patient.

Figure 1. CRIS Diagram

Figure 1. CRIS Flower Diagram, which shows that all systems connect together representing the various business requirements of the Departments and Institutes/Centers

Figure 2. Current CRIS Diagram

Figure 2. Current CRIS Diagram, depicting the major current state of Ancillary Systems which interact with CRIS within the NIH Clinical Center, with their major functions and data flows. Each department is responsible for the administration of system content, while DCRI is responsible for maintaining the system hardware and interfaces with CRIS

This page last updated 04/28/2015
 

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