Next NIH system to support research
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The Medical Information System, which handles clinical care data at the National Institutes of Health's Clinical Center in Bethesda, Md., was a landmark system when first implemented in 1975.
The Medical Information System, which handles clinical care data at the National Institutes of Health's Clinical Center in Bethesda, Md., was a landmark system when first implemented in 1975.The Eclipsys E7000 mainframe system handled clinical orders, result retrieval and charting for all NIH inpatient and outpatient visits for 27 years and did the job very well, according to Dr. Stephen Rosenfeld, chief of clinical informatics at the center.But time and technology have passed the system by, and NIH is looking toward a massive upgrade, to be called the Clinical Research Information System, that will let the agency use data for research as well as clinical purposes.'Levels of expectations from computers have risen enormously,' Rosenfeld said. 'MIS is primitive by those standards.'The shortcomings of MIS limit how medical researchers use data generated at the Clinical Center. MIS cannot amass data for studies conducted over time, Rosenfeld said. The functions of its proprietary database can only be adjusted by the manufacturer to change how it reports and retrieves data.'We need to manually move in data and that means double data entry,' Rosenfeld said.For example, the system cannot send out warnings about errors such as typos or incorrect orders for patients.The agency released a request for proposals for CRIS in May. It expects to award the contract by October and will spend about $60 million on the project over the next five years.CRIS will consist of a clinical data repository and a clinical data warehouse.The repository database will store information about patient demographics, lab results, pharmacy orders, referring physicians, doctors' notes and links to patient images.The repository will retrieve information by interfacing with various subsystems, for example the radiology, laboratory and pharmacy information systems already in use at the center, Rosenfeld said.The data from the repository will be copied into the warehouse, which will be available to researchers at the 24 institutes that make up NIH, he said. Each institute has its own research system that will have to be connected with the warehouse.Dr. John I. Gallin, director of the Clinical Center, said CRIS not only will 'efficiently process electronic patient records, but also will let the institutes mine patient information for research.'For example, a researcher could 'merge and compare the graphs of a group of breast cancer patients,' he said.Rosenfeld said the research component makes CRIS unique among hospital information systems.Hospitals typically use IT systems to handle clinical care. But at the NIH center, research is a main focus, which makes the warehouse an essential component of CRIS.The center does not function like most hospitals. It does not handle emergency cases, and all the patients it admits are part of clinical studies of new medicines or treatments.'That's a data field absent from the systems,' Rosenfeld said. 'We have to build a piece into any information system that we end up with. That's a big edit.'
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Sources: National Institutes of Health and Input of Vienna, Va.
The Clinical Research Information System will support both clinical care and research, unlike most hospital information systems that are care-oriented, NIH's Dr. Stephen Rosenfeld says.
Henrik G. DeGyor
All for one, one for all
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