Custom Software Solutions
Research IT develops fully integrated custom software solutions to meet your workflow needs. We work with other Stanford teams to provide integrated hosting services either on-premise or on Cloud. Our staff of experienced medical research application software developers have built dozens of special purpose applications for a wide variety of customers, ranging from bereavement support for pediatric oncology to a state-wide program that offers services to newborns considered to be at risk for developmental problems.
While the applications are specific to customer workflows, we use consistent software stack and best practices while making sure that PHI handling requirements at Stanford are met.
Pediatric Oncology Bereavement Tracking
While the primary focus of pediatric oncology is to attempt to cure each child diagnosed with cancer, inevitably in some cases the attempt fails and the patient dies. The surviving family members then face a difficult period of bereavement, where they must learn to come to terms with their loved one's death. The Bereavement Tracking application was commissioned in 2004 by Dr. Clare Twist, Associate Professor of Pediatrics (Hematology/Oncology) at the Stanford Children's Hospital. The system facilitates the existing practice of following up with parents of deceased patients in order to offer them ongoing bereavement support.
The application consists of a data entry page to create a record of the patient, associated physicians and caregivers, parental figures, siblings and spouses. Other pages in the application permit locating a specific patient by name or a group of patients by their associated caregiver or the month of their death, in order to support sending out monthly letters of condolence on the anniversary of a patient's death. There is also the ability to manage annual bereavement ceremony dates and venues, and to keep track of which parents attended each ceremony.
Retinitis Pigmentosa Registry
Retinitis pigmentosa is a progressive degeneration of the retina (part of the eye) which affects night vision and peripheral vision. Professor Michael Marmor, former chairman of the department of Ophthalmology, who has seen many patients with this relatively rare retinal dystrophy over the years, now feels that a cure to this condition, previously considered untreatable, may be discovered fairly soon. With this in mind Prof. Marmor has been compiling a list of patients with this disease in order to contact them should a cure be discovered. Looking for help in bringing his patient database into HIPAA compliance, Prof. Marmor commissioned the Retinal Dystrophy Patient Database.
The data entry component of the system consists of two pages, one to locate patient records and one to enter or modify a patient record. There is also a read-only version of the patient record page for use when browsing rather than editing. The patient population tracked by this application consists of three distinct groups, one with retinitis, another with macular dystrophy, an hereditary condition in which there is a degeneration of the retinal receptors in the region of the macula, and a third population who have other related retinal degenerations or dystrophies. A query-by-example page permits rapid construction of arbitrarily complex queries.
There is also an administrative section to the application that is used to maintain the structured data used in the patient record. The centerpiece of this section is a duplicate patient management page. About 1% of the legacy patient records may be duplicated; from the patient identity management page you can quickly compare two similar records and determine whether one should be deleted or both flagged as distinct from each other.
Cardiothoracic Surgery Department
Research IT has developed a department-wide research database for the Department of CT Surgery. The data comes from a variety of sources including the quarterly submissions from Hospital to the Society of Thoracic Surgeons (STS Adult Cardiac, STS Thoracic Surgeries and STS ACC Transcatheter Valve Therapy Registry), EMR data from Epic in the form of structured procedure documentation captured using SmartForm fields in the immediate op note, as well as the departmental appointment scheduling system. Besides collecting data, ResearchIT also supports CT Surgery with data extractions for studies. We query the database for specific data, help create and manage their Redcap projects and have written PHP scripts to expand Redcap capabilities for their specific needs.
Hematology Divison of Cancer Institute
Myeloproliferative Neoplasm Comprehensive Registry
ResearchIT supports the Hematology Division of the Cancer Institute by running a comprehensive registry system for tracking patients with Myeloproliferative neoplasms (MPN). The system includes patient facing surveys, integration with the clinical lab system to automatically record pertinent lab results, and integration with the existing biospecimen tracking system for rapid lookup of research samples.
Hematology Tissue Bank
Research IT provides biospecimen data management services to the Stanford Hematology Division Tissue Bank on the STARR platform. Under the sponsorship and direction of Jason Gotlib MD, Associate Professor of Hematology, this project was initiated in September 2007 and completed in late 2009. The project's first phase targeted the deployment of a custom rapid data entry module to ensure the highest possible accuracy and completeness for each biospecimen bank record, and a custom designed "box report" that presents the contents of each freezer box as a spatial map corresponding to the physical layout of the box itself. The second phase of the project added the generalized data extraction and advanced search tools of the STARR platform.
Department of Orthopedic Surgery
Research IT has developed a custom patient survey system for Orthopaedic Surgery allowing patients to complete a self assessment prior to their clinic appointment, either at home or while in the clinic waiting room. Results of the self assessment are transmitted electronically to Epic and attached to the patient's clinical record where it can be referred to by the physician.
Total Joint Replacement Registry
The Arthritis Service in the Department of Orthopaedic Surgery started collecting comprehensive outcomes research data on their total hip and knee replacement patients in September 2007. The STRIDE Orthopaedic Surgery Joint Replacement Registry module consists of over 300 highly structured data input fields, 150 per encounter type, spread over CRFs covering the pre-operative visit, operative notes, implant details and post-operative follow-up, including complications. The project was conceived of and designed by William Maloney, Professor and Chair of the Department of Orthopaedic Surgery, and James Huddleston, Assistant Professor of Orthopaedic Surgery.The data collected over time will enable the department to evaluate post-operative outcomes. Says Dr. Huddleston: "The data collection module custom-built for us in STRIDE is elegantly designed and precisely suits our needs. This data will become an invaluable source of information for research into the effectiveness of the various implants and surgical procedures used to treat hip and knee arthritis."
Key features of the Total Joint Replacement registry database include:
- Bar code scanning of catalog numbers from implant labels to auto-fill a set of linked fields
- Integrated viewing of discharge summaries, operative notes and history & physical
- Integrated display of all radiology images
Data Submission to American Joint Replacement Registry
Stanford's Arthritis and Joint Replacement clinic submits extensive data to the American Joint Replacement Registry (AJRR). The data submission machinery was developed and automated by the software developers at Research IT. The department also keeps a local copy of this data set for research purposes, augmented by suitably de-identified DICOM images (X-Rays).
Bone Marrow Transplant Tissue Bank
The BMT Tissue Bank is an important core facility of the Bone Marrow Transplant Program. Research IT worked with researchers and lab managers at the BMT Tissue Bank to define a simplified workflow for processing incoming plasma and cell samples. In order to streamline the process, the team built a custom application to print out all the vial processing labels required for each incoming sample.
Stanford Cancer Institute Tissue Bank
The Stanford Comprehensive Cancer Center Tissue Bank stores research samples of both solid tumor and blood from cancer patients, with an emphasis on prostate.
Emergency Medicine Enrollment Alert
Both SHC and LPCH send selected clinical data to the Clinical Data Warehouse in real time via an HL7 feed. We use this real time data feed to drive a Complex Event Processing Engine that can send out research related notifications to interested parties when specified conditions are met. For instance, an ongoing Stanford study of injuries caused by dog bites requires that a consent form be presented to the patient while still being treated in the emergency room; this STRIDE alerting system pages study personnel so they can interact with the potential study participant in a timely manner.
The components of the system are:
- A set of trigger rules that define events, sequences of events, or even failure to appear of anticipated events in a given time frame
- A set of lookup tables derived from the Clinical Data Warehouse to supply additional context as needed in determining whether a rule should fire
- An event processing engine that applies the trigger rules to the log of recent events driven by
- The stream of incoming events from the HL7 feed
- The set of rules defining significant patterns in the event stream
- Integration with a lookup table
- A secure HIPAA-compliant notification engine that emits alerts when directed to do so by the event engine. Our current implementation sends a secure email to the physician's smart phone.