Study Monitors have a lot on their plates. While VISION’s automated data cleaning capabilities make their jobs easier, we thought it be useful to provide them with a tool that would automatically flag database fields that are more “challenging” for sites to complete. Our new AI Monitoring Enhancement Engine (AIMEE) does just that. When monitors are reviewing a form, they can turn AIMEE on with a single click of the mouse and instantly focus on database fields that are historically known to require attention.
A single click of an icon turns on AIMEE.
AIMEE calculates a score for each field and highlights those that require attention.
Of all the effective methods used to ensure subjects complete a clinical trial, our favorite is probably the ePRO mobile application. This ingenious app reduces the need for in-person visits to clinics. And who doesn’t love playing with new apps on their phone?
Both human subjects and owners of animal subjects can download this app (on either iOS or Android devices) and use it to fill in surveys and forms from anywhere. All entered data gets uploaded straight to the VISION database with a fully attributable audit trail. That means wherever your patients have cell service, they can intuitively perform contemporaneous data entry. The ePRO app offers a huge advantage over having to wait for a visit or telephone call with the clinic in order to relay daily or weekly observations. Now subjects and owners can don’t even have to get dressed or get in their cars to participate in a clinical trial anymore. Finally, a data management solution for the Netflix and Chill generation!
The ePRO app reduces the loss of subjects who do not want to risk their health by coming into the clinic for a checkup. It gives them the opportunity to enter their data into the system before they forget. Sites can even set up notifications for the users to ensure they enter their information within the expected timeline. This in turn ensures data integrity and reduces site follow-up requirements.
Data can be entered remotely using radios, check boxes, dates, times, text boxes, drop-down menus, and visual analogue scales. Images and videos can be recorded and uploaded for uses such as wound healing checks. All this flexibility and ease-of-use makes subjects significantly more inclined to continue their clinical trial participation. It will also continue to be useful into the future for subjects who would normally have a long commute to get to their required clinic.
CVM’s Office of New Animal Drug Evaluation (ONADE) has launched an initiative that will greatly increase the efficiency of the study submission process. They will now allow submissions through read-only access to online databases in lieu of the submission of copies of the data. Prelude Dynamics is participating in this pilot program with two study sponsors, and we are optimistic for successful outcomes in both. The primary advantages of allowing CVM direct study access as opposed to the submission of copies of the data are:
For CVM: With access to the online database they will be able to view the data in a more natural, intuitive way. Spreadsheets do not provide the context that the full database can and are therefore not as suitable. With access to the database, CVM can view all the audit trail information right alongside the source data.
For Sponsors/CROs: Online access eliminates problems with multiple file uploads and file size restrictions that make the current submission process cumbersome. The burden of “packaging up” study data in a eSubmitter-ready format is removed. Submissions will be faster and less costly.
Preliminary results with one EDC system are promising. Both CVM and pharmaceutical companies are enthusiastic for the future of the study submission process.
For studies to participate in the program, some documentation is required up front. Prelude Dynamics has also removed this burden from Sponsors and CROs by offering prepared templates for interested parties. If you are interested, ask your Prelude project manager for a template today! They can help you submit your information to the right people at CVM.
Prelude’s unique eConsent functionality is the latest in a long line of enhancements aimed at eliminating paper from clinical trials. Up until now, most clinicians have obtained owner and subject consent on paper forms that are then uploaded into the system. Now sites can obtain owner and subject consent electronically the same as for any other user signature for the study.Animal Studies
For animal studies, the process for obtaining owner signatures begins with an owner profile added by the site. The owner then logs on and immediately signs an electronic signature agreement. After the generic agreement is signed the owner is able to electronically sign any study-specific consent forms. Once the subject is enrolled the owner is free to fill in their own demographic information as well as any forms that are required for the study such as a dosing schedule or owner diary.
For human studies, brand-new technology has been implemented to attach the signed consent form directly to the appropriate PDF document. No personal data will be collected about the subject until the informed consent is signed electronically by the subject.
The eConsent feature of VISION includes the ability to send (and re-send) notifications to the subject to remind them to sign relevant forms. A notification can also be sent to site personnel to alert them when a form has been signed. The forms can also be provided with multiple language options for studies enrolling non-English-speaking subjects.
An electronic signature is a distinctive mark appended to a document for verification. It offers the same validity as an ink signature yet with an even higher degree of contemporaneousness as it also includes the time/date stamp and logged-on user information. It is a safer, faster, and more cost-effective approach for capturing signatures.
Integrated invoicing is a powerful mechanism for incentivising site participation. It alsoeliminates extraneous trial management activities. What is it and how does it work? This article takes a closer look at integrated invoicing and how it can work for you.
Sites deserve to be paid for completed study activities in a timely manner. Payment milestones such as examination completion, lab result analysis, subject visits are known in advance and documented in the master fee schedule for the study or site. Since these billing milestones are well-defined, the study can be configured to automate the creation and submission of site invoices. This eliminates paperwork for the sites, ensures accuracy, relieves study managers of invoice verification activity and speeds payment.
VISION™’s integrated invoicing functionality allows configuration of invoice line items in a flexible and powerful manner. Examples include:
Study visit completion
Physical exam completion
Lab samples drawn and sent to lab
Invoice line item generation can be tied to field completion, a form’s state (e.g., Reviewed or Finalized), the states of a set of related forms, or a combination of the above. Sites across a study are rarely run the same, and it is not uncommon to see a variation in payment schedules across sites. VISION™ allows the invoiced amount for each line item to be configured for each individual site if desired.
It’s common practice to configure the EDC so that the investigator sign off on each invoice activates submission. This serves as an indication that the investigator has reviewed and approved each invoice. Did you know that VISION™ can also be configured so that the invoice can be annotated when payment has been made? Study monitors and project managers can easily see the real-time status of all invoices using VISION™’s reporting tool.
Streamline trail administration activities by using this powerful feature! Sponsors/CROs who don’t take advantage of integrated invoicing often tell us they wish they had used it.
Prelude Dynamics, LLC, has released some exciting new enhancements to the VISION™ Reports tool. This function of their Electronic Data Capture (EDC) system allows users to view data according to the criteria of their choosing at any point in the study. Reports can be saved, shared with other users, and added to each user’s Dashboard for convenience.
Users can now…
Easily specify report content using a drag and drop interface.
Include data from forms in multiple visit days (e.g., Physical Exams across all visits)
Sort results by any column’s ascending or descending order by clicking on the column header
Filter fields by typing into a field at the top of each column
Download any report into Excel with a new and improved interface
The Reports feature of VISION™ has always been a useful data management solution, and is one of many ways to ensure data ingegrity. All clinical staff have the ability to create sets of reports that help them focus in on important data such as clinical end points. The ability to export these reports is a valuable tool for bio-statisticians and project managers alike. Now, clinical trial conduct and management have gotten even easier with Prelude’s addition of a convenient, new user interface.
Prelude constantly strives to assist the health industry in their pursuit to bring innovative pharmaceuticals to consumers. Stay tuned for even more updates from Prelude as we make it easier than ever to conduct a successful clinical trial.
Prelude Dynamics, LLC, is proud to announce our partnership with Johns Hopkins on three COVID-19 related studies. This new partnership expands on previous collaborations between Prelude and Johns Hopkins in the areas of Traumatic Brain Injury (TBI), multiple sclerosis, and vertigo. Prelude Dynamics’ VISION™ EDC was selected from a field of EDC providers based on advanced system capabilities, our ability to stand up studies in days, and Prelude’s high level of service.
Study 1: Plasma Donor Registry
The first study Prelude and Hopkins are collaborating on is a registry of individuals who have recovered from COVID-19 and are candidates for plasma collection. Once donors are qualified, their Human Coronavirus Immune Plasma (HCIP) can be used in the second and third studies. These follow-up studies are both Phase 2 and will be randomized and double-blinded.
Study 2: Convalescent Plasma as a Preventative Treatment
The second study will investigate the use of convalescent plasma in high risk subjects who have experienced a close contact exposure to a person with COVID-19 but are not yet symptomatic. With an enrollment goal of 150 subjects, the project will study the efficacy and safety of using HCIP as a preventative treatment.
Study 3: Convalescent Plasma to Reduce Complications
The third study will investigate the use of HCIP as a therapy for ambulatory subjects who have tested positive for COVID-19 through an RNA detection test and have at least one symptom. With an enrollment goal of 1,344 subjects, this project will study the efficacy and safety of using HCIP to reduce complications due to COVID-19. In addition to saving lifes, a positive outcome for this trial will mean HCIP has the potential to greatly reduce hospitalization and ICU requirements for COVID-19 patients.
The randomized studies will use VISION™‘s integrated Just-in-Time randomization algorithm as well as our sophisticated masking and source data verification (SDV) functionality . Both studies will be conducted in the US from April 2020 through December 2022. We are excited that Johns Hopkins has chosen our VISION™ EDC for this potentially life-saving work and look forward to successful outcomes!
Prelude announces a new EDC feature that streamlines data entry for Proof of Concept (POC) or Phase 1 studies. Multiple Subject Data Entry allows users to enter data for multiple subjects at the same time using a single form. Users can configure this form at the site level by selecting the subject level forms and fields for entry. Filters can then be used to select a subset of subjects for processing.
The VISION™ EDC will post the data to the each subjects’ eCRFs once the data entry is complete. The system will also update the audit trail so that the field changes are attributed correctly. If errors or warnings resulted from the data entry, the subject list page can used to quickly identify those subjects and forms.
This feature is very useful when values are collected for subjects in rapid succession e.g., taking everyone’s vital signs or (for animal studies) counting fleas. In such instances, data is typically manually entered on a clipboard and then transcribed to EDC. Transcription typically requires navigating from subject to subject, which can be error prone and time consuming. Use of Multiple Subject Data Entry eases transcription and facilitates using the EDC as eSOURCE.
The new Multiple Subject Data Entry feature was designed to offer an extreme level of efficiency for users. It is easy to configure and easy to use. Ask your Prelude project manager today about including multiple subject data entry in your next POC or Phase 1 study! This feature in combination with our powerful EDC, CTMS and CDMS functionality truly makes the VISION™ EDC an industry leader.
There has been a great deal of discussion lately on remote trials, remote monitoring, e-consent, etc., in the context of COVID-19. Another greattopic worth discussing is remote auditing. Sponsors and CROs typically conduct on-site audits of their EDC vendors on a bi-annual or tri-annual basis, but what if that can’t be done on schedule? Add in the fact that experienced auditors are amongst the most vulnerable population, and the need for an alternative becomes painfully obvious.
Recently, Prelude Dynamics has experienced an increase in Requests for Information and Vendor Qualification Questionnaires.Instead of becoming overwhelmed by filling in the same information multiple times, we have come up with a solution to streamline the process. We created aproprietary Remote Audit Response document for distribution to our Sponsor and CRO clients. It is a comprehensive document which will provide a suitable baseline for remote audits going forward. If you’re interested in receiving a copy, Contact Us.
We recently attended a webinar on the topic of remote audits so that we could provide helpful information to our Sponsor and CRO clients. Here are the most important tips we learned:
Use a risk-based approach to identify providers to audit.
The FDA uses a risk formula to determine inspection priorities.
It may be appropriate to assess less risky organizations and sites using a questionnaire.Software-as-a-Service (SaaS) providers are very good candidates for remote audit.
Consider auditing 10% of the riskiest providers. The complexity of the service provided and proximity to market (GMP) factor into risk.
Establish protections for Intellectual Property and methods of communication and data transfer.
Non-Disclosure agreements protect both Sponsors/CROs and vendors andpromote the flow of information.
Test web-based video teleconferencing platforms and data transfer mechanisms in advance.
Conduct the remote audit in phases.
Ask the provider for an initial set of documentation and use that as a basis for a second request for information. Establish a deadline for submittal.
The initial set should include indices (such as an SOP list), Organization Charts and Quality Manuals.
Plan subsequent phases to address issues and questions that remain after the initial set has been reviewed.
Formulate and communicate the agendas for additional phases in advance. Both parties should confirm receipt of all auditrelated communications.
Requests for information should not be allinclusive. Request subsets such asspecific training records, validation resultsand backup and restore evidence.
Conduct opening and closing meetings to review status and remaining agenda items.
If interviews with specific personnel are required, collaborate on scheduling.
Conduct a closeout meeting to discuss observations. Only assign severities in the final report.
Set realistic timeline for audit response. Define how results of any CAPAs will be reviewed (e.g., video telecon, copies of documentation).
We are ready to collaborate with you on your next remote audit of Prelude Dynamics!
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 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 form. This 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.
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 responsibilities. Occasionally, 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!
What does it mean to conduct effective remote clinical monitoring? It’s critical to be using an EDC in order to accomplish this, but what else is necessary? Keeping the primary goals of the monitor in mind, we will outline several techniques for streamlining this process.
What are the primary goals of the study monitor? First, and most critical, is to ensure the safety of all study participants – including clinical personnel. Second, is ensuring data quality and integrity.
Let’s discuss the EDC features that can help in each of these areas.
Monitors are relied upon to use their knowledge and expertise to recognize potential safety risks, and to report them when discovered. The EDC can’t replace monitors, but it can assist them greatly in their daily workflow.
Use of Notifications. The EDC can be configured to automatically notify monitors when certain events occur. Examples of this includethe entry of adverse events, the reporting of out-of–range lab results and new subject enrollment. When automatic notifications are used, monitors are informed in real time and the need to continually review eCRFs for potential issues is eliminated – saving valuable time. Think about the potential risk factors for a study and consider how notifications can be configured to assist the monitor.
Use of Reports and Graphs.Some EDCs support flexible, configurable reporting tools that facilitate the aggregation of data for review. Graphs can be used to more intuitively spot outliers and aid in understanding trends. If such tools are not available, consider asking your EDC provider for custom summary reports that can be used to review study endpoints, exam results and adverse events in a comprehensive way.
Use of Study Dashboards.Dashboards that aggregate reports from multiple sources can provide a convenient starting point for a monitor’s daily workflow. Monitors can log in to the EDC and navigate to a central page to review notifications, study metrics and risk-aware reports.
By proactively thinking about the types of information monitors need, each study can be configured to provide tools such as these before the first subject is enrolled. With the VISION™ EDC system, mid-study updates can easily be made to support data monitoring needs that weren’t anticipated at study build time.
Ensuring Data Quality and Integrity
Sophisticated EDC systemssupport automated data cleaning in a variety of ways, which naturally improves data quality. Monitors and data managers can contribute their expertise at study build time to make sure that this automation is included as comprehensively as possible.
Use of “Completeness” Checks. Completeness checks answer the question “is all required data on the eCRF?”. This is especially important when some data can be entered conditionally (e.g., only if another data entry element has a certain value).A related question is “why wasn’t this form been filled out?”. It’s a good practice to implement a “Not Done” checkbox on forms such as Adverse Events and Necropsy that are (hopefully) not often used. This practice lets monitors know in a proactive way that the form is intentionally blank,which effectivelyreduces the amount of questions from the monitor.
Use of “Correctness” Checks. Correctness checks help answer the question “is the data correct and in the right format?”.While study protocols usually provide information about the resolution (e.g., number of decimal places) of data to be collected, they don’t always specify things such as the expected range for data points. Enlisting the support of data managers at study build time will help ensure these checks are in place and are as complete as possible.
Use of Visual Error Indicators. When visual error clues are present and easily viewable, monitors don’t have to spend time manually reviewing each form for errors. They can focus their efforts on strategic reviews instead. Such indicators also provide immediate feedback when data is entered, which prompts clinical personnel to correct entries in real time.
Use of Document Uploads. When it is necessary to transcribe data from paper forms, it’s good practice to provide an upload mechanism for those forms so the transcription can be reviewed more easily. This mechanism, along with Source Data Verification (SDV) functionality, is also useful in converting a paper study to EDC. VISION’s SDV functionality allows the monitor to sign off on each data entry field individually or at the form level.
Use of Integrated Query Functionality.Having the ability to enter queries directly into the EDC system, and to easily see whether queries have been resolved, is an enormous aid to monitors. It eliminates the need for them to revisit queries that have been resolved and move on to more important work.
Qualify the EDC Vendor’s Infrastructure. We’ve defined mechanisms for ensuring the completeness and correctness of data, but how secure is it? EDC vendors should be asked about their backup strategy. How often is data backed up? How much data could I potentially lose? How long does it take to restore data? How long is data retained? These are some good questions to ask your EDC provider before your study commences. Prelude recommends (and performs) hourly backups. Questions about barriers to system access are also important. Ask your vendor what theiraverage up-time is.If clinical personnel can’t enter data in real time, data integrity could be impacted.
Monitor Workflow – Continuous Monitoring
Here are some recommendations for conducting remote clinical monitoring using VISION™.
Identify a monitoring schedule and stick to it. For slow-enrolling studies, this might be once or twice a week. Larger, more active, studies may require full time monitoring efforts.
Create focused reports that highlight potential risk areas andpromote identification of outliers or undesired patterns. Configure the Dashboard to include these reports and share them with other clinical personnel to promote awareness.
Consult the Dashboard to make sure notifications have been handled and to get an idea of emerging trends thatrequire analysis.
Review forms that have been submitted by clinical personnel and use the Query function to call attention to questionable data.
Review recent lab results for out-of-range results and determine if those relate to Adverse Events.
Review fields with changes to see if there are any patterns and clarify their use with clinical personnel.
It’s important to perform these activities continuously. Contemporaneous identification of issuesis critical when safety is concerned and helps clinical personnel recall specificsthey are likely to forget after time passes. Also, when monitoring is done continuously, study close-out activities can be completed much earlier since most of the work has already been done!
Monitors who understand the capabilities of their EDC provider and the automation that has been included in their study have an advantage. They can rely on the EDC system to handle the “grunt work” and concentrate instead on critical outcomes and analyses that can’t be automated.