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A Permissioned Blockchain-Based Clinical Trial Service Platform to Improve Trial Data Transparency. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5554487. [PMID: 34368352 PMCID: PMC8346314 DOI: 10.1155/2021/5554487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
The clinical research faces numerous challenges, from patient enrollment to data privacy concerns and regulatory requirements to spiraling costs. Blockchain technology has the potential to overcome these challenges, thus making clinical trials transparent and enhancing public trust in a fair and open process with all stakeholders because of its distinct features such as data immutability and transparency. This paper proposes a permissioned blockchain platform to ensure clinical data transparency and provides secure clinical trial-related solutions. We explore the core functionalities of blockchain applied to clinical trials and illustrate its general principle concretely. These clinical trial operations are automated using the smart contract, which ensures traceability, prevents a posteriori reconstruction, and securely automates the clinical trial. A web-based user interface is also implemented to visualize the data from the blockchain and ease the interaction with the blockchain network. A proof of concept is implemented on Hyperledger Fabric in the case study of clinical management for multiple clinical trials to demonstrate the designed approach's feasibility. Lastly, the experiment results demonstrate the efficiency and usability of the proposed platform.
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Becker L, Ganslandt T, Prokosch HU, Newe A. Applied Practice and Possible Leverage Points for Information Technology Support for Patient Screening in Clinical Trials: Qualitative Study. JMIR Med Inform 2020; 8:e15749. [PMID: 32442156 PMCID: PMC7327588 DOI: 10.2196/15749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/08/2020] [Accepted: 03/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical trials are one of the most challenging and meaningful designs in medical research. One essential step before starting a clinical trial is screening, that is, to identify patients who fulfill the inclusion criteria and do not fulfill the exclusion criteria. The screening step for clinical trials might be supported by modern information technology (IT). OBJECTIVE This explorative study aimed (1) to obtain insights into which tools for feasibility estimations and patient screening are actually used in clinical routine and (2) to determine which method and type of IT support could benefit clinical staff. METHODS Semistandardized interviews were conducted in 5 wards (cardiology, gynecology, gastroenterology, nephrology, and palliative care) in a German university hospital. Of the 5 interviewees, 4 were directly involved in patient screening. Three of them were clinicians, 1 was a study nurse, and 1 was a research assistant. RESULTS The existing state of study feasibility estimation and the screening procedure were dominated by human communication and estimations from memory, although there were many possibilities for IT support. Success mostly depended on the experience and personal motivation of the clinical staff. Electronic support has been used but with little importance so far. Searches in ward-specific patient registers (databases) and searches in clinical information systems were reported. Furthermore, free-text searches in medical reports were mentioned. For potential future applications, a preference for either proactive or passive systems was not expressed. Most of the interviewees saw the potential for the improvement of the actual systems, but they were also largely satisfied with the outcomes of the current approach. Most of the interviewees were interested in learning more about the various ways in which IT could support and relieve them in their clinical routine. CONCLUSIONS Overall, IT support currently plays a minor role in the screening step for clinical trials. The lack of IT usage and the estimations made from memory reported by all the participants might constrain cognitive resources, which might distract from clinical routine. We conclude that electronic support for the screening step for clinical trials is still a challenge and that education of the staff about the possibilities for electronic support in clinical trials is necessary.
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Affiliation(s)
- Linda Becker
- Chair of Health Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Ganslandt
- Department of Biomedical Informatics, Heinrich-Lanz-Zentrum, Mannheim, Germany.,University Medicine, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Axel Newe
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Rolfo C, Caglevic C, Bretel D, Hong D, Raez LE, Cardona AF, Oton AB, Gomez H, Dafni U, Vallejos C, Zielinski C. Cancer clinical research in Latin America: current situation and opportunities. Expert opinion from the first ESMO workshop on clinical trials, Lima, 2015. ESMO Open 2016; 1:e000055. [PMID: 27843620 PMCID: PMC5070258 DOI: 10.1136/esmoopen-2016-000055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 12/05/2022] Open
Abstract
Latin America and the Caribbean have not yet developed strong clinical cancer research programmes. In order to improve this situation two international cancer organisations, the Latin American Society of Clinical Oncology (SLACOM) and the European Society of Medical Oncology (ESMO) worked closely with the Peruvian Cooperative Oncology Group (GECOPERU) and organised a clinical cancer research workshop held in Lima, Peru, in October 2015. Many oncologists from different Latin American countries participated in this gathering. The opportunities for and strengths of clinical oncology research in Latin American and Caribbean countries were identified as the widespread use of the Spanish language, the high cancer burden, growing access to information, improving patient education, access to new drugs for research centres, regional networks and human resources. However, there are still many weaknesses and problems including the long timeline for regulatory approval, lack of economic investment, lack of training and lack of personnel participating in clinical research, lack of cancer registries, insufficient technology and insufficient supplies for the diagnosis and treatment of cancer, few cancer specialists, low general levels of education and the negative attitude of government authorities towards clinical research.
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Affiliation(s)
- Christian Rolfo
- Phase I-Early Clinical Trials Unit , Antwerp University Hospital and Center for Oncological Research (CORE), Antwerp University , Edegem , Belgium
| | - Christian Caglevic
- Medical Oncology Department , Instituto Oncológico Fundación Arturo López Pérez , Santiago , Chile
| | - Denisse Bretel
- Grupo de Estudios Clinicos Oncologicos Peruano (GECOPERU) , Lima , Peru
| | - David Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Luis E Raez
- Thoracic Oncology Program, Memorial Cancer Institute, Memorial Health Care System , Pembroke Pines, Florida , USA
| | - Andres F Cardona
- Clinical and Translational Oncology Group , Institute of Oncology, Clínica del Country , Bogota , Colombia
| | - Ana B Oton
- Medical Oncology at Denver Health Care Medical Center and the University of Colorado Denver , Denver, Colorado , USA
| | - Henry Gomez
- Division of Medicine , National Cancer Institute (INEN) and Oncosalud , Lima , Peru
| | - Urania Dafni
- Biostatistics Laboratory , School of Health Sciences, University of Athens and Frontier Science Foundation -Hellas , Athens , Greece
| | | | - Christoph Zielinski
- Clinical Division of Oncology and Department of Medicine I , Medical University Vienna , Vienna , Austria
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Wagner S, Beckmann MW, Wullich B, Seggewies C, Ries M, Bürkle T, Prokosch HU. Analysis and classification of oncology activities on the way to workflow based single source documentation in clinical information systems. BMC Med Inform Decis Mak 2015; 15:107. [PMID: 26689422 PMCID: PMC4687307 DOI: 10.1186/s12911-015-0231-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 12/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, cancer documentation is still a tedious task involving many different information systems even within a single institution and it is rarely supported by appropriate documentation workflows. METHODS In a comprehensive 14 step analysis we compiled diagnostic and therapeutic pathways for 13 cancer entities using a mixed approach of document analysis, workflow analysis, expert interviews, workflow modelling and feedback loops. These pathways were stepwise classified and categorized to create a final set of grouped pathways and workflows including electronic documentation forms. RESULTS A total of 73 workflows for the 13 entities based on 82 paper documentation forms additionally to computer based documentation systems were compiled in a 724 page document comprising 130 figures, 94 tables and 23 tumour classifications as well as 12 follow-up tables. Stepwise classification made it possible to derive grouped diagnostic and therapeutic pathways for the three major classes - solid entities with surgical therapy - solid entities with surgical and additional therapeutic activities and - non-solid entities. For these classes it was possible to deduct common documentation workflows to support workflow-guided single-source documentation. CONCLUSIONS Clinical documentation activities within a Comprehensive Cancer Center can likely be realized in a set of three documentation workflows with conditional branching in a modern workflow supporting clinical information system.
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Affiliation(s)
- Stefan Wagner
- />Chair of Medical Informatics at the Friedrich-Alexander-University Erlangen-Nuremberg, Am Wetterkreuz 13, D-91058 Erlangen-Tennenlohe, Germany
- />Department of Anaesthesiology, University Hospital Erlangen, Krankenhausstraße 12, D-91054 Erlangen, Germany
| | - Matthias W. Beckmann
- />Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Östliche Stadtmauerstraße 30, D-91054 Erlangen, Germany
- />Department of Obstetrics and Gynecology, University Hospital Erlangen, Universitätsstraße 21-23, D-91054 Erlangen, Germany
| | - Bernd Wullich
- />Department of Urology, University Hospital Erlangen, Maximiliansplatz 2, D-91054 Erlangen, Germany
| | - Christof Seggewies
- />Medical Informatics and Communication Center, University Hospital Erlangen, Glückstraße 11, D-91054 Erlangen, Germany
| | - Markus Ries
- />Department for Organizational Development, Klinikum Nuremberg, Prof.-Ernst-Nathan-Str. 1, D-90419 Nuremberg, Germany
| | - Thomas Bürkle
- />Institute for Medical Informatics I4MI, Bern University of Applied Sciences BFH, Höheweg 80, CH-2502 Biel/Bienne/Bern, Switzerland
| | - Hans-Ulrich Prokosch
- />Chair of Medical Informatics at the Friedrich-Alexander-University Erlangen-Nuremberg, Am Wetterkreuz 13, D-91058 Erlangen-Tennenlohe, Germany
- />Medical Informatics and Communication Center, University Hospital Erlangen, Glückstraße 11, D-91054 Erlangen, Germany
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Haak D, Samsel C, Gehlen J, Jonas S, Deserno TM. Simplifying electronic data capture in clinical trials: workflow embedded image and biosignal file integration and analysis via web services. J Digit Imaging 2015; 27:571-80. [PMID: 24802371 DOI: 10.1007/s10278-014-9694-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To improve data quality and save cost, clinical trials are nowadays performed using electronic data capture systems (EDCS) providing electronic case report forms (eCRF) instead of paper-based CRFs. However, such EDCS are insufficiently integrated into the medical workflow and lack in interfacing with other study-related systems. In addition, most EDCS are unable to handle image and biosignal data, although electrocardiography (EGC, as example for one-dimensional (1D) data), ultrasound (2D data), or magnetic resonance imaging (3D data) have been established as surrogate endpoints in clinical trials. In this paper, an integrated workflow based on OpenClinica, one of the world's largest EDCS, is presented. Our approach consists of three components for (i) sharing of study metadata, (ii) integration of large volume data into eCRFs, and (iii) automatic image and biosignal analysis. In all components, metadata is transferred between systems using web services and JavaScript, and binary large objects (BLOBs) are sent via the secure file transfer protocol and hypertext transfer protocol. We applied the close-looped workflow in a multicenter study, where long term (7 days/24 h) Holter ECG monitoring is acquired on subjects with diabetes. Study metadata is automatically transferred into OpenClinica, the 4 GB BLOBs are seamlessly integrated into the eCRF, automatically processed, and the results of signal analysis are written back into the eCRF immediately.
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Affiliation(s)
- Daniel Haak
- Department of Medical Informatics, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52057, Aachen, Germany,
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Yu JPJ, Kansagra AP, Mongan J. The Radiologist's Workflow Environment: Evaluation of Disruptors and Potential Implications. J Am Coll Radiol 2014; 11:589-93. [DOI: 10.1016/j.jacr.2013.12.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 12/26/2013] [Indexed: 11/29/2022]
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Cofiel L, Bassi DU, Ray RK, Pietrobon R, Brentani H. Detecting dissonance in clinical and research workflow for translational psychiatric registries. PLoS One 2013; 8:e75167. [PMID: 24073246 PMCID: PMC3779159 DOI: 10.1371/journal.pone.0075167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/12/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The interplay between the workflow for clinical tasks and research data collection is often overlooked, ultimately making it ineffective. QUESTIONS/PURPOSES To the best of our knowledge, no previous studies have developed standards that allow for the comparison of workflow models derived from clinical and research tasks toward the improvement of data collection processes. METHODS In this study we used the term dissonance for the occurrences where there was a discord between clinical and research workflows. We developed workflow models for a translational research study in psychiatry and the clinic where its data collection was carried out. After identifying points of dissonance between clinical and research models we derived a corresponding classification system that ultimately enabled us to re-engineer the data collection workflow. We considered (1) the number of patients approached for enrollment and (2) the number of patients enrolled in the study as indicators of efficiency in research workflow. We also recorded the number of dissonances before and after the workflow modification. RESULTS We identified 22 episodes of dissonance across 6 dissonance categories: actor, communication, information, artifact, time, and space. We were able to eliminate 18 episodes of dissonance and increase the number of patients approached and enrolled in research study trough workflow modification. CONCLUSION The classification developed in this study is useful for guiding the identification of dissonances and reveal modifications required to align the workflow of data collection and the clinical setting. The methodology described in this study can be used by researchers to standardize data collection process.
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Affiliation(s)
- Luciana Cofiel
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Débora U. Bassi
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Ryan Kumar Ray
- Department of Management, Policy and Community Health of the University of Texas School of Public Health, Houston, Texas, United States of America
| | - Ricardo Pietrobon
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Helena Brentani
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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da Silva KR, Costa R, Crevelari ES, Lacerda MS, de Moraes Albertini CM, Filho MM, Santana JE, Vissoci JRN, Pietrobon R, Barros JV. Glocal clinical registries: pacemaker registry design and implementation for global and local integration--methodology and case study. PLoS One 2013; 8:e71090. [PMID: 23936257 PMCID: PMC3723676 DOI: 10.1371/journal.pone.0071090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/24/2013] [Indexed: 11/19/2022] Open
Abstract
Background The ability to apply standard and interoperable solutions for implementing and managing medical registries as well as aggregate, reproduce, and access data sets from legacy formats and platforms to advanced standard formats and operating systems are crucial for both clinical healthcare and biomedical research settings. Purpose Our study describes a reproducible, highly scalable, standard framework for a device registry implementation addressing both local data quality components and global linking problems. Methods and Results We developed a device registry framework involving the following steps: (1) Data standards definition and representation of the research workflow, (2) Development of electronic case report forms using REDCap (Research Electronic Data Capture), (3) Data collection according to the clinical research workflow and, (4) Data augmentation by enriching the registry database with local electronic health records, governmental database and linked open data collections, (5) Data quality control and (6) Data dissemination through the registry Web site. Our registry adopted all applicable standardized data elements proposed by American College Cardiology / American Heart Association Clinical Data Standards, as well as variables derived from cardiac devices randomized trials and Clinical Data Interchange Standards Consortium. Local interoperability was performed between REDCap and data derived from Electronic Health Record system. The original data set was also augmented by incorporating the reimbursed values paid by the Brazilian government during a hospitalization for pacemaker implantation. By linking our registry to the open data collection repository Linked Clinical Trials (LinkedCT) we found 130 clinical trials which are potentially correlated with our pacemaker registry. Conclusion This study demonstrates how standard and reproducible solutions can be applied in the implementation of medical registries to constitute a re-usable framework. Such approach has the potential to facilitate data integration between healthcare and research settings, also being a useful framework to be used in other biomedical registries.
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Affiliation(s)
- Kátia Regina da Silva
- Heart Institute, InCor, Clinics Hospital of the University of São Paulo Medical School, São Paulo, Brazil.
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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