Real-Time Enrollment Dashboard For Multisite Clinical Trials

Development of a risk-tailored approach and dashboard for efficient management and monitoring of investigator-initiated trials

BACKGROUND

Most randomized controlled trials (RCTs) in the academic setting have limited resources for clinical trial management and monitoring. Inefficient conduct of trials was identified as an important source of waste even in well-designed studies. Thoroughly identifying trial-specific risks to enable focussing of monitoring and management efforts on these critical areas during trial conduct may allow for the timely initiation of corrective action and to improve the efficiency of trial conduct. We developed a risk-tailored approach with an initial risk assessment of an individual trial that informs the compilation of monitoring and management procedures in a trial dashboard.

METHODS

We performed a literature review to identify risk indicators and trial monitoring approaches followed by a contextual analysis involving local, national and international stakeholders. Based on this work we developed a risk-tailored management approach with integrated monitoring for RCTs and including a visualizing trial dashboard. We piloted the approach and refined it in an iterative process based on feedback from stakeholders and performed formal user testing with investigators and staff of two clinical trials.

RESULTS

The developed risk assessment comprises four domains (patient safety and rights, overall trial management, intervention management, trial data). An accompanying manual provides rationales and detailed instructions for the risk assessment. We programmed two trial dashboards tailored to one medical and one surgical RCT to manage identified trial risks based on daily exports of accumulating trial data. We made the code for a generic dashboard available on GitHub that can be adapted to individual trials.

CONCLUSIONS

The presented trial management approach with integrated monitoring enables user-friendly, continuous checking of critical elements of trial conduct to support trial teams in the academic setting. Further work is needed in order to show effectiveness of the dashboard in terms of safe trial conduct and successful completion of clinical trials.

Design and Virtual Workflow of a Patient Database for Clinical and Pharmaceutical Trials Part II: A Prototype for Endocrinology

Background In previous work, we have reported that patient recruitment is closely related to electronic health records (EHR). As a result, the next step of investigation would lead to the implementation of research practices for using EHR in selecting patients for clinical trials. Towards that end, open-source software offers several integrated solutions that can meet the needs of an EHR and patient recruitment.  Aim In the present work, we have designed a prototype of a patient recruitment system using open-source tools. The proposed prototype can draw data from a patient management system and present selected patients based on specific criteria.  Methods For the objective of the present study, we have used the methodology described previously. In particular, we recorded numerous integrated solutions for EHR from the area of free and open-source software. Open Electronic Medical Records (OpenEMR) ranked first for functionality and second for usability efficiency. Hence, we relied on OpenEMR to design a prototype patient recruitment system. After the installation and commissioning of OpenEMR, we created appropriate test scenarios. Therefore, populated appropriate patient data in OpenEMR. PhpMyAdmin was installed and commissioned along with the OpenEMR installation. This tool is used to manage MySQL database systems. MySQL is the database system that programmers rely on to develop OpenEMR.  Results A prototype patient recruitment system was designed, which draws data from a view of the OpenEMR database to present results based on criteria.  Conclusions After the adaptation of the database and the design of the proposed solution, we concluded, based on the prototype results, that there is potential for developing an integrated patient recruitment management system. This management system can be based on the implementation of complex criteria and present results according to the needs of the end-user.

An Architectural Framework for Healthcare Dashboards Design

In today's competitive environment, one of the new tools in the field of information technology is business or organizational dashboards that are a backup in the process of strategic management of organizations. The purpose of the current research is to provide a framework to design the healthcare dashboard through technical architecture with fulfilling the decision-makers' requirements. In this study, a common qualitative research method, metasynthesis, is applied, including a seven-step set of research questions, conducting systematic literature search and selection of suitable papers, data extraction, analysis and findings of the qualitative composition, quality control, and presentation of findings. During this process, 102 articles were found by saturation of information resources and then 12 articles were selected for extracting data using acceptance and rejection criteria. A critical evaluation method was used to evaluate the quality of selected articles. After investigating the selected articles and scoring them, in terms of quality, one article was very good, 10 articles were good, and one article was moderate. Then, with regard to the principles and guidelines of technical architecture, the required information was extracted from the selected articles and was analyzed with the method of open, axial, and selective coding. Following the steps of metasynthesis methods, the principles extracted with major and minor titles principles and guidelines in the form of multilayered system architecture including presentation layer, application layer, data layer, and technical infrastructure layer were classified. In the obtained framework, 15 indicators as the main principles and 66 subcriteria as the subsidiary principles for the design and technical architecture of enterprise dashboards were identified.

Concept and development of an interactive tool for trial recruitment planning and management

Background

Predicting and monitoring recruitment in large, complex trials is essential to ensure appropriate resource management and budgeting. In a novel partnership between clinical trial investigators of the South African Medical Research Council and industrial engineers from the Stellenbosch University Health Systems Engineering and Innovation Hub, we developed a trial recruitment tool (TRT). The objective of the tool is to serve as a computerised decisions-support system to aid the planning and management phases of the trial recruitment process.

Method

The specific requirements of the TRT were determined in several workshops between the partners. A Poisson process simulation model was formulated and incorporated in the TRT to predict the recruitment duration. The assumptions underlying the model were made in consultation with the trial team at the start of the project and were deemed reasonable. Real-world data extracted from a current cluster trial, Project MIND, based in 24 sites in South Africa was used to verify the simulation model and to develop the monitoring component of the TRT.

Results

The TRT comprises a planning and monitoring component. The planning component generates different trial scenarios for predicted trial recruitment duration based on user inputs, e.g. number of sites, initiation delays. The monitoring component uses and analyses the data retrieved from the trial management information system to generate different levels of information, displayed visually on an interactive, user-friendly dashboard. Users can analyse the results at trial or site level, changing input parameters to see the resultant effect on the duration of trial recruitment.

Conclusion

This TRT is an easy-to-use tool that assists in the management of the trial recruitment process. The TRT has potential to expedite improved management of clinical trials by providing the appropriate information needed for the planning and monitoring of the trial recruitment phase. This TRT extends prior tools describing historic recruitment only to using historic data to predict future recruitment. The broader project demonstrates the value of collaboration between clinicians and engineers to optimise their respective skillsets.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05112-z.

Key components and IT assistance of participant management in clinical research: a scoping review

Objectives

Managing participants and their data are fundamental for the success of a clinical trial. Our review identifies and describes processes that deal with management of trial participants and highlights information technology (IT) assistance for clinical research in the context of participant management.

Methods

A scoping literature review design, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, was used to identify literature on trial participant-related proceedings, work procedures, or workflows, and assisting electronic systems.

Results

The literature search identified 1329 articles of which 111 were included for analysis. Participant-related procedures were categorized into 4 major trial processes: recruitment, obtaining informed consent, managing identities, and managing administrative data. Our results demonstrated that management of trial participants is considered in nearly every step of clinical trials, and that IT was successfully introduced to all participant-related areas of a clinical trial to facilitate processes.

Discussion

There is no precise definition of participant management, so a broad search strategy was necessary, resulting in a high number of articles that had to be excluded. Nevertheless, this review provides a comprehensive overview of participant management-related components, which was lacking so far. The review contributes to a better understanding of how computer-assisted management of participants in clinical trials is possible.

Health Communication and Decision Making about Vaccine Clinical Trials during a Pandemic

The COVID-19 pandemic has magnified the importance of clinical trials for finding a safe and effective vaccine to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Although communication about vaccines and vaccine hesitancy were challenges long before COVID-19, the twin facts of a pandemic and an "infodemic" of health information, misinformation, and disinformation have raised new challenges for vaccine-related communication and decision-making. The goal of this commentary is to highlight strategies to improve communication and decision-making for adults considering participation in COVID-19 vaccine clinical trials. First, I present a general conceptual model for clinical trial participation that can be applied to various vaccine and other clinical trial contexts. Next, I introduce the ASK (Assume, Seek, Know) approach for enhancing clinical trial participation: (1) assume that all patients will want to know their options, (2) seek the counsel of stakeholders, and (3) know your numbers. The ideas presented in this commentary are intended to enhance vaccine-specific clinical trial communication, decision-making, and literacy, while dually offering strategies and resources that may help reduce vaccine hesitancy and increase vaccine uptake over time.

Utilizing open-source platforms to build and deploy interactive patient-reported quality of life tracking tools for monitoring protocol adherence

PURPOSE

Tracking patient-reported outcomes (PROs) and quality-of-life response rates is essential for clinical trials. Historically, rates are monitored through scheduled reports, which can require gathering, merging, and cleaning data from multiple databases. At the end of this process, if gaps are found, new data are entered and the cycle repeats, leaving a trail of reports that are not up-to-date or immediately accessible to the investigator. The financial and person-hour cost of utilizing clinical research staff for this purpose is impractical. Online dashboards are continuously updated to monitor data, providing on-demand access to promote successful research.

METHODS

Dashboard implementation utilizes R, an open-source statistical programming language, RMarkdown, a markup language, Flexdashboard, which creates structural elements, and Shiny, allowing investigators the ability to interact with data within the dashboard. By leveraging these four elements, powerful, cost-effective interactive dashboards can be built.

RESULTS

Numerous dashboards have been utilized to identify potentially missing data and increase protocol adherence. Immediate patient consultation can occur to retrieve protocol-related forms, reducing research staff and patient burden while improving trial effectiveness. Dashboards can monitor PROs, enrollment, demographics, toxicity, and biomarker data, clinical outcomes, and implemented predictive models, creating a single hub for on-demand clinical trial monitoring.

CONCLUSION

By employing a set of freely available tools, the burden of utilizing study staff to continuously monitor trials is greatly reduced. These tools allow users to rapidly build and deploy dynamic dashboards capable of meeting the research needs of any investigator while limiting missing data through simplified monitoring of protocol adherence.

Improving Health Care Management in Hospitals Through a Productivity Dashboard

Health information systems have been developed to help hospital managers steer daily operations, including key performance indicators (KPIs) for monitoring on a time-aggregated basis. Yet, current literature lacks in proposals of productivity dashboards to assist hospitals stakeholders. This research focuses on two related problems: (1) hospital organizations need access to productivity information to improve access to services; and (2) managers need productivity information to optimize resource allocation. This research consists in the development of dashboards to monitor information obtained from a hospital organization to support decision makers. To develop and evaluate the productivity dashboard, the Design Science Research (DSR) methodology was adopted. The dashboard was evaluated by stakeholders of a large Portuguese hospital who contributed to iteratively improving its design toward a useful decision support tool. Additionally, it was ascertained that monitoring productivity needs more study and that the dashboards on these themes are valuable assets at a monitoring level and subsequent decision-making process.

Using Facebook for Large-Scale Online Randomized Clinical Trial Recruitment: Effective Advertising Strategies

Targeted Facebook advertising can be an effective strategy to recruit participants for a large-scale online study. Facebook advertising is useful for reaching people in a wide geographic area, matching a specific demographic profile. It can also target people who would be unlikely to search for the information and would thus not be accessible via Google AdWords. It is especially useful when it is desirable not to raise awareness of the study in a demographic group that would be ineligible for the study. This paper describes the use of Facebook advertising to recruit and enroll 1145 women over a 15-month period for a randomized clinical trial to teach support skills to female partners of male smokeless tobacco users. This tutorial shares our study team’s experiences, lessons learned, and recommendations to help researchers design Facebook advertising campaigns. Topics covered include designing the study infrastructure to optimize recruitment and enrollment tracking, creating a Facebook presence via a fan page, designing ads that attract potential participants while meeting Facebook’s strict requirements, and planning and managing an advertising campaign that accommodates the rapid rate of diminishing returns for each ad.

Molecular Tumor Boards: Ethical Issues in the New Era of Data Medicine

The practice and development of modern medicine requires large amounts of data, particularly in the domain of cancer. The future of personalized medicine lies neither with "genomic medicine" nor with "precision medicine", but with "data medicine" (DM) (big data, data mining). The establishment of this DM has required far-reaching changes, to establish four essential elements connecting patients and doctors: biobanks, databases, bioinformatic platforms and genomic platforms. The "transformation" of scientific research areas, such as genetics, bioinformatics and biostatistics, into clinical specialties has generated a new vision of care. Molecular tumor boards (MTB) are one response to these changes and are now providing better access to next-generation sequencing (NGS) and new cancer treatments to patients with inoperable or metastatic cancers, and those for whom the usual treatment has failed. However, MTB face a crucial ethical challenge: maintaining and improving the trust of patients, clinicians, researchers and industry in academic medical centers supported by private or public funding rather than providing genetic data directly to private companies. We believe that, in this era of DM, appropriate modern digital communication networks will be required to maintain this trust and to improve the organization and effectiveness of the system. There is, therefore, a need to reconsider the form and content of informed consent (IC) documents at all academic medical centers and to introduce dynamic and electronic informed consent (e-IC).

Concept and implementation of a study dashboard module for a continuous monitoring of trial recruitment and documentation

BACKGROUND

The difficulty of managing patient recruitment and documentation for clinical trials prompts a demand for instruments for closely monitoring these critical but unpredictable processes. Increasingly adopted Electronic Data Capture (EDC) applications provide novel opportunities to reutilize stored information for an efficient management of traceable trial workflows. In related clinical and administrative settings, so-called digital dashboards that continuously visualize time-dependent parameters have recently met a growing acceptance. To investigate the technical feasibility of a study dashboard for monitoring the progress of patient recruitment and trial documentation, we set out to develop a propositional prototype in the form of a separate software module.

METHODS

After narrowing down functional requirements in semi-structured interviews with study coordinators, we analyzed available interfaces of a locally deployed EDC application, and designed the prototypical study dashboard based on previous findings. The module thereby leveraged a standardized export format in order to extract and import relevant trial data into a clinical data warehouse. Web-based reporting tools then facilitated the definition of diverse views, including diagrams of the progress of patient accrual and form completion at different granularity levels. To estimate the utility of the dashboard and its compatibility with current workflows, we interviewed study coordinators after a demonstration of sample outputs from ongoing trials.

RESULTS

The employed tools promoted a rapid development. Displays of the implemented dashboard are organized around an entry page that integrates key metrics for available studies, and which links to more detailed information such as study-specific enrollment per center. The interviewed experts commented that the included graphical summaries appeared suitable for detecting that something was generally amiss, although practical remedies would mostly depend on additional information such as access to the original patient-specific data. The dependency on a separate application was seen as a downside. Interestingly, the prospective users warned that in some situations knowledge of specific accrual statistics might undermine blinding in a subtle yet intricate fashion, so ignorance of certain patient features was seen as sometimes preferable for reproducibility.

DISCUSSION

Our proposed study dashboard graphically recaps key progress indicators of patient accrual and trial documentation. The modular implementation illustrates the technical feasibility of the approach. The use of a study dashboard might introduce certain technical requirements as well as subtle interpretative complexities, which may have to be weighed against potential efficiency gains.