Clinical Informatics Research: Spearheading a new field
The Clinical Informatics Research Programme (CIRP) is based at the DRIVE unit. Funded by GOSH Children’s Charity it is the largest research programme of its kind.
The programme builds vital skills and evidence for the application of data and computer science in healthcare. This is essential to support GOSH and its academic partners, including University College London (UCL), to lead cutting-edge digital innovation.
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It offers the opportunity for data and computer scientists to work alongside clinical specialists and other hospital professionals to generate a portfolio of technology projects.
Academic projects supported by the CIRP have resulted in publication of over 150 academic papers and abstracts since 2019. These have attracted interest from the BBC, the Times and Forbes.
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The CIRP has supported and collaborated on 27 successful grant applications, leveraging further funding of approximately £10.5million for clinical informatics and technology projects nationally from a range of funders. The programme has also built an impressive network of partners including higher education institutes across the UK and National Institute for Health and Care Research Biomedical Research Centres.
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Filling in the gaps to improve medicines for children
Most medications prescribed for seriously ill children have not been tested in children through clinical trials therefore there is uncertainty about how they work.
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By necessity, doctors must give these children medicines ‘off-label’ which means that the use falls outside of what has been approved by regulatory authorities. Data in electronic patient records can be used to fill in the gaps and better inform doctors about the use of ‘off-label’ medicines in children.
This is exactly what Professor Joe Standing at UCL Great Ormond Street Institute of Child Health is doing. He said:
“We conducted the largest ever study of posaconazole by using data from GOSH’s electronic health records. Posaconazole is a medication that treats and prevents fungal infections in patients with compromised immune systems, for example children that need stem cell transplants. For this research we collated data on medicine and administration, and data on levels of posaconazole from blood tests. This allowed us to find the optimal dose for children under the age of 12, where previously there was no guidance for doctors.
When the DRE was introduced, it revolutionised the way we could study the use of medicines in children by data management processes. It reduced the chance of human error in data input and offered a more secure and collaborative way to do research. It allowed for standardisation of measures, for example all weights recorded using
the same metric. This is particularly important for studying response to medicines as a key measure to determine is weight. The speed at which we can now extract data is incomparable. Tasks now take a matter of minutes which previously would have taken days or weeks.”
Professor Standing’s research has grown, and he now supervises around nine students, many of whom have been supported by the DRE in some way. Emma Vestesson is one of these students.
Speaking about her project, Emma said:
"Antibiotics are life-saving medications that can treat and prevent disease. However, overuse of antibiotics can be harmful for patients and contribute to the rise in antibiotic resistant diseases which is a threat to public health world-wide.
Antibiotic stewardship refers to how healthcare systems monitor the use of antimicrobials and data in electronic health records is vital to guiding these policies. I am studying how to tackle overuse of antibiotics to protect patients and the public.
The DRE facilitated secure access to anonymised data from GOSH about the prescription of antibiotic medications and I will use this to look for patterns in their use. This also means that I can build statistical models that could be used to predict what type of antibiotic could work best for a patient depending on the illness they have, and various other factors such as their age, or when they came to GOSH. By utilising data in electronic health records, we can provide better care by learning from previous similar patients, and this can prevent the overuse of antibiotics by helping doctors to get the prescription right the first time.
During the COVID-19 pandemic I led a study that analysed data on antibiotic administration for patients at GOSH. I found that there was no evidence that antibiotic prescribing was significantly affected by the pandemic which provided helpful information around antimicrobial stewardship policies and responses to future pandemics."
Supporting the skills needed in our future NHS
Since 2019, the CIRP has supported projects across a range of clinical areas including pharmacy, intensive care, imaging, cancer and operational hospital management. They have also looked at a range of technical areas within healthcare innovation including data science and imaging analysis, human-computer interaction, and virtual environments.
Our programme has high demands and has offered flexibility in opportunities to meet the needs of each person on the programme, from medical to computer science students, at Master’s level to Professorships. This demonstrates the necessity of this programme at all levels, where resources can be rare.
Tianxiao Wang, CIRP PhD student
"I will use the data in electronic health records of cardiomyopathy patients to track their condition over time and build algorithms to find out how patients could be grouped based on the symptoms they have.
Some of these patients have received ACE inhibitors a common treatment for heart problems. I will use an advanced computer technique to find out what may have happened to the patient had they not had this treatment. This is called counterfactual prediction. This model can be used to understand the treatment effects of ACE inhibitors depending on the sub-type of symptoms a patient may experience.
When starting this project, I needed to understand the day-to-day life of a patient with cardiomyopathy in hospital. It was crucial to have advice from clinical academics, who have insights on the experience at hospital paired with my knowledge of data science."