CRIS (Akrivia platform)

CRIS enables access to data held on RiO in a pseudonymised form. This includes progress notes and user assessment forms. This can be done using a standard search or one of the many NLP tools available on the platform to help interpret data currently not available elsewhere. This makes CRIS appropriate for projects such as research or clinical audit. 

CRIS can be used in various ways to help with your project:

• Feasibility searches - to check if the patient population exists for your project
• Pseudonymised service user data - access data for research, clinical audits, service evaluations, and QI projects.
• Re-Identification - Help identify service users who meet your eligibility criteria for audit or research (with relevant approvals).

 

Cohort Builder - You can build and save cohorts based on user-specified inclusion and exclusion criteria, including functions for grouping and sets of criteria.

 

Natural Language Processing (NLP) - Akrivia Health’s AI-driven NLP tool allows access to data on demographics, diagnoses, medication, psychotherapy, electroconvulsive therapy (ECT), and signs and symptoms. The NLP available data is derived from our service users' progress notes and interprets these written notes into easy searchable data removing the need review each entry manually. For example, the NLP can make sense of mentions of medication to identify if a patient is currently on a particular medication, was previously on it, or if it was just discussed.

 

CRIS Network - It's possible, with permission, to combine our data with that of other Trusts in the CRIS Network in a way that provides a far richer source of information to identify patterns and trends.

 

All our records are deidentified, meaning service users personal information is removed from the system, and access to CRIS is through a secure and trusted research environment that protects and maintains the anonymity of our service users. Patients who, through the national data opt-out, have opted out of their confidential patient information being used for research and planning, are not included in CRIS.

 

Please feel free to contact us for more information: cris@nottshc.nhs.uk. 

Feasibilities  – Are often conducted to determine the feasibility of conducting research studies, audits and service evaluation projects in the Trust by seeking the likely numbers of eligible patients in services.

 

Audits – Are usually conducted by the Clinical Audit Team, clinicians, and students to assess adherence to national clinical standards and guidance. The CRIS system can be used to identify patient cohorts by searching for data from patients’ progress notes and/or the medication, diagnosis and psychotherapy natural language processing (NLP) tables within the system. Once the cohort has been finalised, it is then possible to request their NHS numbers so further investigation can be conducted using RiO. Below are some examples of audits conducted using CRIS data.

• An audit to assess the utilisation of clozapine within general adult inpatient services
• An audit to assess prescribing of agomelatine as per the Nottinghamshire Area Prescribing Committee Joint Formulary and to ascertain whether the necessary liver function monitoring is taking place for patients on agomelatine as per the manufacturers’ Summary Product of Characteristics (SPC)
• Valproate Prescribing in Females of Childbearing Potential: An audit of adherence to the MHRA Pregnancy Prevention Programme Guidance
• Prescribing Observatory for Mental Health Audit: Monitoring of patients prescribed Lithium
• An audit of patients prescribed lithium under the care of Newark and Sherwood LMHT examining whether recommended monitoring is being carried out and whether drug-drug interactions have been identified
• Prescribing Observatory for Mental Health UK - Improving the quality of valproate prescribing in adult mental health services
• Auditing compliance with following local guidelines for screening for and treating alcohol dependence in patients with a moderate to severe risk of alcohol withdrawal at Highbury Hospital  
• An Audit of Covert Administration of Medication
• DNACPR / ReSPECT Form Audit: To review documentation and policy adherence in relation to Emergency Treatment Plans, in particular DNACPR / ReSPECT
• Food and Fluid refusal: Medical monitoring including blood glucose measurement and nasogastric feeding decisions in CAMHS inpatients with acute food and fluid refusal
• Use of Aripiprazole in older adults’ liaison psychiatry at Nottingham University Hospitals.

 

Service Evaluations  – Are conducted to ascertain the current standard that a service is achieving without reference to a predetermined standard. Below are some examples of service evaluations that have been completed using CRIS.

• Dual diagnosis in secondary mental health services
• Investigation into the benefit of screening patients at the Department of Psychological Medicine on behalf of Dermatology following recommendation for commencement of Isotretinoin for acne
• Out of area psychiatric admissions in CAMHS
• Mental health problems among refugee and asylum-seeking children
• Trajectories of adolescents with emerging personality disorders or traits (up to 25 years of age)
• Treatment resistant depression in children and adolescents.

 

Research  – As a research active Trust, we lead on and support a variety of research studies. In some instances, CRIS has been used to provide data and in others, the system has been used to help identify potential participants. Below are the most recent projects using CRIS.

• CHRONOSIG Part 1 - Quantifying representation of under-represented and minority patient groups by intersecting protected characteristics with service and diagnostic data
• MILOS - Using neuroimaging to determine the pathology of Lewy Body Disorder
• COBALT - Combining memantine and cholinesterase inhibitors in Lewy body dementia treatment Trial
• SATURN - Stimulant medication for ADHD and tics: Understanding response versus non-stimulants
• ASCEND - Aripiprazole/sertraline combination: Clinical and cost-effectiveness in comparison with quetiapine for the treatment of bipolar depression. An open label randomised controlled trial.

 

Scoping/Planning – Are projects conducted by Trust colleagues to help better understand services and gather data to help plan for future improvements. See below for a recent example.

• Mental Health Services for Older People (MHSOP) mental health diagnosis data for training planning.

The data within CRIS has had all identifying information removed, masked or modified to protect patient privacy and ensure no one can be identified.

Access to the database is tightly controlled and the data can only be accessed in a secure environment that prevents downloading data without explicit permission. As well as controlling access, only approved projects will be allowed access to the system.

These controls are managed by our CRIS Coordinator who carries out regular checks and audits on the system to ensure it is used appropriately. The Trust’s CRIS Oversight Committee oversees the use of CRIS.

 

CRIS is available for people doing relevant research, clinical audits, service evaluations, or Quality Improvement projects.  Please email CRIS@nottshc.nhs.uk for a CRIS Feasibility Search Request form (current version: 1.0) or a CRIS Project Registration Form (current version: 2.0). Please read the Terms and Conditions of use. The CRIS coordinator will send a Data Plan (if relevant), and advise you about the next steps.