To ease data collection for clinical research and ongoing analysis of clinical processes, teams at Vanderbilt University Medical Center (VUMC) are working to bridge the gap between clinical systems and research systems.
Through these efforts, REDCap, or Research Electronic Data Capture, is becoming somewhat integrated with VUMC’s electronic health record and enterprise data warehouse.
REDCap is a Web-based data management platform developed at VUMC and used worldwide to securely collect and manage translational and clinical research data. Paul Harris, Ph.D., professor of Biomedical Informatics and Biomedical Engineering, devised REDCap and continues to lead its development and dissemination.
To support quality improvement and billing compliance, nurse practitioners with the Rapid Response Team fill out a REDCap survey form after each patient encounter.
The team is called to the bedside when adult non-intensive-care patients unexpectedly show early warning signs of rapid decline. The team initiated a REDCap survey in 2011, and in 2013 a link to the survey form was added to the electronic health record. When launched from the health record, REDCap survey forms are pre-filled with patient demographic data, thanks to a data exchange mechanism devised by Dario Giuse, Ph.D., associate professor of Biomedical Informatics, and Neal Patel, M.D., MPH, chief medical informatics officer.
“With the launch of the REDCap survey in 2011 by our nurse practitioners, we established a streamlined rapid response quality improvement process. In 2013, when the partially pre-filled survey form was embedded amid our medical record documentation, it made data collection that much more efficient,” said April Kapu, DNP, associate nursing officer and associate professor of Clinical Nursing.
The team’s adoption of REDCap was championed by Arthur P. “Art” Wheeler M.D., professor of Medicine and longtime director of VUMC’s Medical Intensive Care Unit, who died in December 2015. After five years, the Rapid Response Team’s REDCap database includes details on about 4,500 patient encounters.
For prospective clinical studies of perioperative organ injury, anesthesiologist Josh Billings, M.D., uses a standard REDCap module to automatically collect clinical lab results.
Billings is one of 45 faculty and staff at VUMC using the REDCap Dynamic Data Pull module, or DDP, to gather clinical lab data, vital signs and demographic data. The module, which is now being adopted by other medical centers, was developed and deployed first at Vanderbilt by software engineers Rob Taylor and Jon Scherdin.
Pending approval of a clinical research project by the IRB (Institutional Review Board), DDP users can use menus to easily map health record data fields to REDCap. With mapping established, as a study proceeds, REDCap automatically retrieves health record data for selected patients, per user-defined windows anchored to user-defined time points.
“For larger studies, this eliminates the potential for error that comes with manual data entry, and it saves countless hours for the investigator, the research nurse and the data manager,” said Billings, assistant professor of Anesthesiology and Medicine.
According to radiologist Jeff Carr, M.D., the performance of VUMC radiologists with regard to new patient care documentation standards improved dramatically when a team began using REDCap to automatically extract key text from radiology reports.
The Radiology faculty wanted to standardize documentation of radiation exposure and intravenous contrast usage associated with X-ray computed tomography, or CT. Working with Giuse’s electronic health record team, Radiology added fields for this information to the templates clinicians use to report CT results. As dictated reports travel from the radiology patient documentation system to the health record system, the information in these fields is captured in a REDCap database.
“We initially thought we would just perform periodic chart reviews of a sample of reports to determine faculty compliance. Collecting complete up-to-the-minute data in REDCap is both more informative and more powerful,” Carr said.
“REDCap allowed us to present the results of the quality improvement program at faculty meetings. Having data on all reports by all physicians, as opposed to say a 5 percent sample of reports, allowed us to identify and target those who needed additional assistance in setting up their templates for the new structured vocabulary. The faculty really stepped up to the plate, with 70-plus physicians reaching over 95 percent compliance within two months.”
To request help with REDCap for VUMC clinical registries or clinical process data collection and reporting, send an email to redcap@vanderbilt.edu.
For more information on using REDCap for VUMC research data management, visit StarBRITE (Vanderbilt login required) .
