Unlocking the electronic health record
Researchers at the NIHR Maudsley BRC and South London and Maudsley NHS Foundation Trust have built a unique application which takes the electronic records of mental health patients and de-identifies health records so they can be used for research to improve healthcare services.
The Clinical Record Interactive Search (CRIS) is the first system of its kind to unlock the entire electronic health record, allowing researchers to search large volumes of clinical information and spot trends and patterns in routine clinical care (e.g. the effectiveness of different treatments).
This has been made possible by the development of state-of-the-art natural language processing technologies. These enable computers to understand the complexity of the English language (e.g. abbreviations) and analyse the most important information recorded in text (e.g. a patient’s experiences and history) rather than just simple facts like age, gender and diagnosis.
The CRIS project, which began in 2008, now has access to a mental health database of unrivalled scale and depth, including around 300,000 de-identified medical records that mirror the SLaM patient database. A CRIS Oversight Committee has been created to ensure that projects using CRIS comply with ethical rules and guidelines, and that the security and privacy of patients are fully protected. All patients have the choice to opt out of having their anonymised data used.
The CRIS programme has been used for a wide range of research studies, and over 70 papers have been published to date. Examples include: providing accurate estimates on homelessness among inpatients on mental health wards; determining the reasons for lower life expectancy in people with mental health problems; and analysing antipsychotic use in people with schizophrenia (the latter in collaboration with Roche Pharmaceuticals).
Looking ahead, there is huge potential for further use and development of CRIS. It has already been provided to four other UK hospitals and health trusts (D-CRIS), and the team has been working closely with the Department of Health and the Office of National Statistics to link the information in CRIS to other healthcare databases in hospitals and general practice in the UK.