VISION + IDEXX Labs – a Powerful Partnership

Prelude Dynamics’ VISION™ platform is the only EDC that provides an electronic interface with IDEXX labs – making VISION the preferred EDC in animal health. This interface greatly reduces the errors inherent in manual reporting, which saves clinicians and pet owners time and saves sponsors/CROs money.

IDEXX and Prelude Dynamics - a Powerful Partnership

IDEXX recently upgraded their Laboratory Information Management System (LIMS) to include some backend improvements as well as a new customer-facing feature that will clarify some aspects of reporting. Prelude and IDEXX developed and conducted a formal validation on this improved interface in a collaborative fashion – ensuring future smooth operations.

Previously, IDEXX provided the following flags with each reported lab result:

  • Normal – the result was within normal ranges.
  • High – the result was higher than normal.
  • Low – the result was lower than normal.
  • None (blank) – an observation for which there is no normal range.

IDEXX High/Normal/Low Flags

An additional flag of “Not Applicable” has been added and is now used for results of “Do Not Report” (DNR) or “Quantity Not Sufficient”, which were previously not flagged. This new flag will serve to alert clinicians when samples should be re-taken (or other appropriate action) and lessen the chance they will overlook these findings and assume they are normal.

New IDEXX "Not Applicable" Flag for results
Prelude Dynamics and IDEXX continue to be committed to improving the efficiency and accuracy of clinical data and streamlining clinical research.

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Announcing Source Data Verification in VISION EDC

Source Data Verification 

Prelude Dynamics continues to enhance our VISION™ platform with crucial features requested by our clinical trial user community. The ability to perform Source Data Verification (SDV) in the context of EDC has become more and more important as we’re migrating away from paper. VISION’s SDV functionality operates at the field level and complements the existing form review capability. How does it work? 

Users who have permission to review forms can activate the SDV feature simply by clicking an icon on the form. When this is done, check boxes appear next to the fields on the form.

 

Check boxes give clinical trial monitors an easy way to see which fields still need to be verified.

 

Check boxes are automatically cleared if the reviewed field is later changed – letting monitors easily see which fields need to be re-reviewed, while preserving the reviewed state of other data entry elements on the formThis is a time-saver for monitors, and saving time saves money! 

These field-level SDV reviews are fully attributed and preserved in the audit trail in a 21 CFR compliant manner. 

 

The audit trail shows information about the user who performed the Source Data Verification.

 

Even though most of our clients use VISION to directly enter data as the source (eSOURCE), in some cases there might be a need for SDV. Let’s consider a few scenarios. 

Transcription of data from paper forms 

First consider the transcription of data from paper forms (or pictures of paper forms) such as subject/owner logs or paper patient reported outcome forms to EDC. In the past, Double Data Entry (DDE) was typically used for situations such as these. SDV is an improved replacement for DDE, especially when used along with a file upload that allows a copy of the original paper form to be uploaded directly to the EDC.  

Review of Adverse Events 

Monitors typically want to review Adverse Events as soon as they are entered into the EDC as part of their safety assurance responsibilitiesOccasionally, investigators haven’t completed all the information in the Adverse Event eCRF because they are still conducting analysis on the possible cause. In cases such as this, Monitors can review the data that has been already entered. When they revisit the form later, they will know which information has already been reviewed. This also works well for Concomitant Medications. 

Want to learn more? Contact us to schedule a demo and stay tuned for news of other new features such as Site Level Batch Data Entry and quick report filters! 

 

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What is the Purpose of User Acceptance Testing?

The importance of testing all aspects and features of a study before Go-Live cannot be over-emphasized. That being said, testing can be a very messy process. If not undertaken with a great deal of planning and documentation, the whole process of testing a study can be rendered not only ineffective but counterproductive. In comes User Acceptance Testing (UAT) to the rescue!

First, you might ask, what is UAT and how is it different from other forms of testing? Think of UAT as a dress rehearsal before a play. The actors all know their lines, the lighting director knows all their queues, and the sets have all been built and tested for safety. But you need to see it all together before you fill the seats with spectators. What if those perfectly built sets don’t line up with the spotlights or what if the bulky costumes get in the way of the actors’ performances? All the parts are there and accounted for, but the picture as a whole has yet to be validated.

 

 

The study-build process is similar. After each form has been tested separately, and all of the summaries and reports have been set up to your satisfaction, there is still the issue of unforeseen scenarios. You won’t be able to find or fix all the potential conflicts until you test the entire study as one. Set up a new site, enroll several patients, take each one through the entire screening/dosing/withdrawal/etc., process. Then do it again with another patient and another, until you have ironed out as many eventualities as possible. Even then, there may still be unforeseen problematic scenarios, but the purpose of UAT is to mitigate the number of issues that might come up during the Live study as thoroughly as possible. UAT is also a good way to provide you and your team with a finalized, succinct idea of what, exactly, you are signing off on before your sites begin entering patients. Once you complete your final run-through of the study, you can rest assured that you have done everything you can to make your study run smoothly.

Best Practices for Conducting Clinical Trial EDC User Acceptance Testing

User Acceptance Testing (UAT) is a critical component of clinical trial development using Electronic Data Capture (EDC). It’s the responsibility of the Sponsor/CRO to perform UAT prior to using the EDC to collect data in accordance with a protocol.

Early and thorough UAT can result in studies that are easy to use and monitor, and have short submission preparation timelines. We’ve found this to be especially true when our best practices for conducting UAT are followed. Our VISION EDC provides tools and features that facilitate UAT every step of the way, making it a faster and more effective process. Prelude Dynamics’ seven best practices are described in more detail below. Perhaps you have some of your own you can share with us!

  1. Thoroughly test every e-CRF
  2. Verify masking and role-dependent access
  3. Involve a site
  4. Test the electronic lab interface
  5. Consider risk factors
  6. Involve the statistician early
  7. Conduct Pre-UAT

Thoroughly test every e-CRF

This may seem obvious, but it’s surprising how often this is not done. Sometimes test personnel become complacent when most e-CRFs work as expected, and abandon test efforts early. But then during study conduct it turns out that the Investigator Signoff form – which is the typically the last subject form to be filled out – isn’t working correctly.

It’s especially important to verify that the Inclusion/Exclusion e-CRF is working correctly. Imagine the consequences to the clinical trial if subjects that should be excluded are not. Similarly, dosing calculations should be rigorously vetted.

This is a good time to check the upper and lower limits on data entry fields and to make sure all calculations are operating as intended. VISION’s embedded Field Specification displays this information for every form in the study, which facilitates this process.

Verify Masking and Role-dependent Access

There’s almost nothing worse than unmasking a study, so don’t risk it! Identify every e-CRF where the treatment group (or other masked field) is present and verify that masked roles cannot see the value in either the e-CRF or the audit trail. VISION’s Field Specification is also useful for performing this task.

Inversely, imagine that the treatment dispenser has no access to the Dosing form. Avoiding mid-study changes to permissions reduces the probability of non-contemporaneous entry of critical study data. VISION’s Study Requirements Document (SRD) Configuration can be used to verify that permissions to view, edit, review and finalize each study form have been configured correctly.

Involve a Site

Sites are ultimately one of the most critical components of any successful clinical trial. If e-CRF layouts are clumsy or non-intuitive, sites will have trouble completing them correctly. When this is the case, site enrollment may suffer due to user frustration with the EDC.

Involving one or more trusted sites early in the UAT process can provide early insight into usability issues and allow them to be corrected before the study goes live. VISION’s Feedback function can be useful in capturing site input on usability issues. Happy sites require less monitor intervention and produce cleaner data.

Test the Electronic Lab Interface

Studies that benefit from the use of electronic lab interfaces, such as those supported by IDEXX and Marshfield, enjoy more accurate and timely lab results data in their study. It’s important to coordinate with lab company personnel to assure that data required by their LIMS is included in electronic lab requests, and in the e-CRFs if necessary. It’s typical to configure study-specific parameters used for tracking and billing in the EDC, and to test the interface in a training study (or training site) prior to going live. VISION supports fully validated electronic interfaces for both IDEXX and Marshfield Labs.

Consider Risk Factors

Every study has risks, but for every risk there is a way for the EDC to assist in detecting when a risk is becoming a reality. Many EDCs support ad-hoc query functions that generate reports based on user-entered criteria.  These can be configured to generate reports pertaining to potential risks such as a high number of reactions at a drug injection site, or abnormally high blood glucose level after dosing.

Losing subjects due to lack of adequate follow up poses both a financial and a schedule risk. Tools such as the VISION Event Calendar provide ways to quickly and easily detect missed visits before a protocol deviation occurs. EDC statistics functions can also be used to view data in graphical format, which is more intuitive than rows of numbers and can be used to identify outliers.

Custom reports can be developed in the EDC that are tailored to look for specific potentially risky outcomes. These can be developed at study build time, or added later when unanticipated risks begin to arise during study conduct.

Involve the Statistician Early

Configuring the study database so that the data is organized in a way that makes it easy for the statistician to prepare the data for submission is something that is sometimes overlooked when studies are being developed. This can result in both time delays in submission and difficulty with data analysis.

We recommend entering test data into either a training study or training site, and exporting the data for analysis as part of UAT. This approach allows the statistician to take an early look at the exported data, and test it with their statistical analysis software. If changes are needed to the database to facilitate analysis, these can be made and testing prior to going live.

Conduct Pre-UAT

Pre-UAT? It’s not unusual to identify multiple study changes while testing, especially when unfamiliar with the power and flexibility of EDC. Conducting a Pre-UAT ahead of the UAT schedule can help identify and address most of these changes ahead of time. When this is done, UAT consists of verifying that all requested changes have been implemented, tested and work together in an intuitive way.

Starting study test early is generally recommended to avoid cramming test efforts into the last week prior to going live. When testing is deferred, sites have a more difficult time entering data and study conduct is more difficult and lengthy than it needs to be.

Conclusion

In our experience, following these best practices for performing UAT results in less risky, higher quality studies with excellent usability and data integrity. EDCs such as VISION provide many validated, integrated tools that facilitate both UAT and study conduct. Prelude Dynamics provides training in the use of these tools prior to the conduct of Pre-UAT and/or UAT. We are increasing receiving requests to deliver the data from training studies/sites as part of study closeout. This data serves to demonstrate that UAT has been conducted.

If you’d like more information about any of the tools and features discussed in this article, or would like to schedule a demo, please contact us.

A Case for HTML Archives for FDA Submission

Currently FDA official submissions must be in XML or PDF format, with the preference being the submission of at least the XML format. The rationale for these is the need to have a document that will be readable and accessible in perpetuity. This is definitely an important consideration. However, these formats contain limitations when it comes to the review, oversight and approval process as clinical reviewers are more effective “seeing” a case as a set of forms the way the Investigator filled out those forms, while analysis staff are more effective with the XML raw information. How do you handle ancillary data, such as images and graphical information that were part of the process which cannot be imbedded in XML?

Below we will present a case for allowing HTML archives to be added as a part of or one of the allowable formats for FDA submission, fundamentally to support clinical case review. The raw XML would continue to be favored format for data analysis.

HTML, Hyper Text Markup Language, is the foundation of all computer languages used to create web-based interfaces. HTML is a specialized form of XML that when combined with images and style sheets (CSS) make a web page appear as it does. The Internet has been growing exponentially since its inception transforming business and everyday life; the Internet is here to stay and so is HTML. “Billions and billions” of HTML web pages exist in the world today. HTML can be compared to the alphabet. Like the alphabet, it provides us with basic element in which we can combine in order to communicate via web pages. HTML does for computer language what the alphabet does for our language. It is safe to say HTML will stand the test of time.

One might assume that HTML requires a web server to operate, but in fact, an HTML page is just a document that resides on a computer hard drive on a server, and can also be saved locally. All browsers support “Save As” and can save a web page for later viewing when the computer is disconnected from the Internet. All that’s needed is any brand of web-browser. As such, these HTML/XML pages are safe, secure, and as perpetual as any computer file on the hard drive.

Now that we have established that HTML is a viable solution in perpetuity, let’s examine the differences between XML, PDF and HTML archives. The main differences are listed in the table below.

[table id=archives /]

In conclusion, while the XML archive is a natural non-proprietary requirement for data submission because it does allow quick processing of the data in order to analyze the safety and efficacy of a drug, providing HTML data in addition is superior to PDF files in that it facilitates the case review within the same context in which the data was originally collected by Investigators. HTML will increase FDA reviewer’s confidence in the quality of the data and its outcomes.

Prelude Dynamics has initiated conversations with FDA CVM to discuss allowing HTML archives to be submitted. Among the discussion is also the possibility that Sponsors could chose to allow CVM to have access to the server in read-only mode where they could interact with the study data and even run reports, statistics and graphs within the system before final submission occurs in order to guide sponsors on any additional requirements or concerns they might have in order to help expedite the final review process, reduce the need for clarifications, and be quicker to market.

Contact

Jim Pedzinski – VP of Business Development
jpedzinski[at]preludedynamics.com – 512-476-5100 ext. 210

Inventory Management & Automatic Reordering

 

Challenge

 

It is challenging for working clinics to ensure sufficient inventory of treatment and control medications or supplies are available throughout a clinical study. Prelude Dynamics was challenged to identify an inventory management system that was smart enough to know when medications and supplies were used at the patient level, keep track of current inventory, and reorder supplies as they became low. One challenge to accomplish this is the varied sizes of clinics and expected enrollment for each site, which required something more sophisticated than a one-size-fits-all solution. Rather, inventory thresholds would have to be able to be customized per site, and at least some portions of the inventory management system needed to be blinded from other site personnel.

 

Proposal

 

Prelude Dynamics proposed the client use VISION™, an electronic data capture system, which already has an Inventory Management Module to manage inventory. As the Treatment Dispenser recorded when a patient had received medication or supplies and the amount dispensed, the inventory module would update the inventory on-hand. Prelude proposed to add to VISION™ a feature that would trigger an automatic order when supplies reached a certain threshold, which could be set separately for each site. In addition to VISION™ automatically placing an order, the Treatment Dispenser, study Project Manager and Monitor would be automatically notified via email that the order had been placed.

 

Background

 

It is often difficult for busy clinics participating in clinical research studies often to manage the inventory required to be available for the study. Successful inventory management requires a designated person to keep track of how much is on-hand and order additional inventory as necessary. This person usually has other day-to-day responsibilities that make keeping up with this task difficult. If the designated person were to forget or put off the task the enrollment and treatment of subjects could be jeopardized because medication or supplies are not available. Automating this process would greatly reduce the effort involved in participating in the study and would ensure a better outcome.

 

Solution

 

Prelude staff trained the study staff to utilize VISION™’s existing Inventory Management Module to keep track of inventory as it is dispensed to the patient and logged in the dosing eCRF. The solution included setting the module up to handle the following scenarios:

 

  • Allow study management to initial inventory sent and site shipping information.
  • Allow initial inventory and future inventory received to be logged and tracked.
  • Aggregate the dispensing information into a summary table.
  • Reconcile the on-hand inventory in real-time.
  • Allow minimum and maximum inventory threshold levels to be set at the site level.
  • Automatically order additional medication and/or supplies when the inventory meets or falls below the minimum threshold, for the difference between the actual amount on-hand and the maximum inventory threshold.
  • Notify the study management personnel at site treatment dispenser that an order has been placed.
  • Manage final reconciliation at the end of the study, allowing the site to enter return shipment information for remaining inventory and study management to reconcile the shipment when received.
  • Provide tracking method for deviations or comments/notes to file when medication is not returned by subject or when medication is missing or lost.
  • Provide ability to track if empty bottles are collected and shipped back or disposed of as required by the sponsor and protocol.
  • Allow site personnel access to certain information, such as inventory received, but not any information that might disclose the treatment group provided to each subject in order to protect study masking during the study, but allow access to all the information upon study completion.

 

Results & Benefits

 

As a result of using VISION™, the burden on site personnel to keep track of inventory has been greatly reduced. The sites report that they appreciate the automatic reordering and email notifications of placed orders, adding that it is “such as stress relief to have VISION™ order for them.”

 

The study Project Manager was able to enter initial inventory ordered and shipped to the site, along with site shipping information, simplifying tracking all inventory information in a central location. She received email notification when the Treatment Dispenser entered the initial receipt of the inventory into the system, confirming its arrival. She was very pleased with the entire module, noting that, “It is wonderful to know that I can relax about whether the sites are keeping up with the inventory and reordering meds and supplies when they are getting low because it happens automatically. There are so many other things I have to keep track of. It is helpful not to have to be burdened by the inventory management.”

 

The Treatment Dispenser finds it useful view a single table for a full history dispensed medication and/or supplies. He appreciates instant viewing of aggregate dispensed and automatic reconciliation of inventory, and is able to add notes directly on the dispensing form if there is a discrepancy in the amount of medication returned or if there are missing medications or supplies. All these notes are aggregated automatically in a note to file with details about the form and field, who entered the note and when it was entered. This makes it much easier than having to enter all these details manually. He indicated that he was extremely satisfied with the inventory management. He said that keeping up with the inventory and reordering was so much less burdensome and stressful that it had been previously. In fact, the Treatment Dispense indicated he wished all studies used VISION™’s Inventory Management module and thinks everyone should consider using VISION™ for future studies. He said it was intuitive, easy to use, and followed the work flow well. Other treatment dispensers at other sites had similar positive experiences.

 

Throughout the study, sufficient inventory levels were maintained to be able to enroll all patients eligible for the study who were willing to participate. This gave all study personnel more confidence in their ability to successfully enroll a new subject every time.