Preview of the March 22nd OpenClinica Global Conference

With just a week to go, the OpenClinica Global Conference is shaping up to be an excellent event for learning about OpenClinica and networking with members of the OpenClinica community.

This is the first ever Global Conference and we are thrilled to have as a keynote speaker Mark Adams, Project Manager for the National Cancer Institute’s Cancer Biomedical Informatics Grid (caBIG). As a fellow pioneer working to bring open source to clinical research domain, caBIG has developed a set of interoperable, open source clinical informatics tools which address functions such as adverse event reporting, patient registries, study calendaring, clinical trial management, imaging, and tissue banking. The caBIG project and OpenClinica together illustrate the broad impact open source is having on clinical trials.

The conference program extends along three tracks with case studies, panel discussions, tutorials, and presentations from clinical trial sponsors, CROs, academic groups, and IT services companies. Content is oriented towards both technical and non-technical audiences. Selected topics include:

  • An unveiling of the new OpenClinica CRF Library, a curated repository of standards-based eCRFs for OpenClinica
  • Case studies from sponsors and CROs showing how they have used OpenClinica
  • Presentations of tools and extensions developed around OpenClinica
  • Tutorial for installing OpenClinica
  • Tools, tips, and techniques for using OpenClinica data in SAS
  • Live demonstration of automated data interchange with OpenClinica
  • Automating the data import process
  • Validating OpenClinica for 21 CFR Part 11 compliance
  • Generating ad hoc reports
  • Modularization of the OpenClinica source code and introduction to the OpenClinica Developer Network

A full suite of training classes for data managers, biostatisticans, project managers, system administrators, and developers are also being offered immediately preceding and following the conference.

There is still time to register for this event. See www.openclinicaconference.org for more program information and registration details.

We look forward to seeing you next week!

OpenClinica CRF Library

UPDATE (03-May-2010): The CRF Library is now live at library.openclinica.org.

Our vision at Akaza Research is to accelerate clinical research through open technology infrastructure. We do this through an open source software license, supporting a participatory community, and adhering to published open standards.

We are nearing another milestone that will further this vision. The OpenClinica CRF Library, currently in the final stages of development, will allow users to find, share, and re-use case report forms (CRFs) for OpenClinica. By utilizing the OpenClinica CRF Library, users will be able to:

  • Enable faster study startup by accessing a well organized, searchable database of OpenClinica CRF templates
  • Promote data standardization within their organization through re-use of CRFs that adhere to open industry standards
  • Derive customized versions from standardized CRF templates simply by editing the OpenClinica CRF Templates
  • Minimize time and cost spent on study training, testing, and validation by accessing value-added resources and documentation (including implementation guides, CRF Completion Guidelines, and test scripts) associated with the CRF templates in the library.

The library will be searchable by keyword and browsable by CRF type. Most CRFs are derived from authoritative, public standards sources such as the CDISC Clinical Data Acquisition Standards Harmonization (CDASH) initiative and the National Cancer Institute’s Cancer Data Standards Repository (caDSR).

In keeping with our vision, the CRF Library is the product of a participatory community and is based on open source software. Last April, we assembled a volunteer Steering Committee to guide development of the library. Committee members Liz Watts of Starfire Research, Lori Brix of Silent Partners, Derek Wimmer of Wimmer Clinical, and Elisa Priest of Baylor Research Institute have worked scrupulously to identify content, develop supporting materials for the CRFs, and implement workflows that will ensure quality resources. Their substantial knowledge of the CDASH standard and data management expertise has been invaluable. The broader community has also had a hand in building out this resource, through the user mailing list and at meetings of the OpenClinica Community Virtual Forum.

Content & Quality

One of the first questions the Steering Committee asked was, ‘How do we manage quality of content and metadata?’ There are many community-driven, peer-review, and commercial validation models that could work, from a loose ‘wikipedia’-style structure to more rigid frameworks for curation and standardization. We needed to adopt the right mix for our content and our community. The Committee emphasized the need for a high-quality ‘core’ set of CRFs that have broad applicability across studies, align to leading standards, and are accompanied by detailed resources which aid in implementation. At the same time, a larger, more diverse repository of CRF content would make the library useful to many in the OpenClinica community.

The result of this has been to create two broad classes of CRFs in the library, Curated CRFs and and Non-Curated CRFs.

Curated CRFs have gone through a rigorous peer review, testing, and annotation process. They include enhanced metadata, detailed specifications, validation test scripts, enhanced edit checks, and reference documentation such as an Implementation Guide and CRF Completion Guidelines. The initial collection of Curated CRFs in the library will be aligned with the CDASH Domains. The intent is to make it as easy as possible to implement these CRFs into a study, in ‘as-is’ or customized form, with confidence in the quality and accuracy of the CRF.

Non-Curated CRFs will be contributed by members of the community who wish to share their CRFs with others, or will be derived from existing non-proprietary electronic sources such as the National Cancer Institute’s Cancer Data Standards Repository (caDSR). These CRFs undergo less formal review and testing and have fewer supporting materials, instead will rely more heavily on community feedback and annotations.

Because of the significant investment made in annotation, review, and testing, full access to Curated CRFs and all the associated metadata, documentation, and associated resources will be available only to OpenClinica Enterprise Edition Subscribers. Non-Curated CRFs, and limited versions of Curated CRFs without detailed metadata or documentation will be freely available to all members of the OpenClinica community.

Contribution

Based on past discussions on the OpenClinica mailing lists and the Community Virtual Forum, we see substantial interest among community members in contributing and sharing CRFs. This is a very exciting prospect, and we will need community members to contribute enough quality CRF content to make the approach viable. Many community members have expressed interest in sharing their CRFs for others’ benefit, but also identified it as a way to get feedback and improve the forms for their own purposes. To provide a foundation for such contributions, the CRF Library will adhere to the following principles:

1) Contributors will be appropriately attributed and recognized for their contributions. Creative Commons (http://creativecommons.org/) provides widely used guidelines and license agreements to enable this type of sharing. CRFs in the library or derived therefrom will be made available under the Creative Commons Attribution 3.0 License. Contributors must represent that they (or their organization) have the legal right to contribute a CRF, and are not infringing on someone else’s copyright. When featuring the most popular or most highly rated CRFs, the CRF Library will highlight the identity of the contributor (at least by screen name).

2) Members of the community will be empowered to build on and improve others’ contributions for the benefit of all. All community-contributed CRFs will also be freely available to community members, and we will put into place popularity, versioning, and annotation features to allow users of a CRF to provide feedback and/or modifications to the original author.

Next Steps

As I mentioned at the start of the post, we are approaching roll-out of the CRF Library within initial CDASH-based content, and starting acceptance of community contributions. The roll-out will be aligned with the OpenClinica Global Conference (March 22nd in Bethesda, MD USA) and the CRF Library will be a featured topic at the event. It’s been a long time in development and we are excited to be nearing this milestone!

An Opportunity for Transformational Change in Clinical Trials

Life sciences research is recognized as one of the most technologically advanced, groundbreaking endeavors of modern times. Nevertheless until very recently the preferred technology for executing the most critical, costly stage of the R&D process – clinical trials – has been paper forms. Only in 2008 did adoption of electronic alternatives to paper forms take place in more than half of new trials. This recent uptick in adoption rates is encouraging, but further transformational change in the industry is necessary to fully realize the promise of Electronic Data Capture (EDC) and associated “eClinical” technologies. Two developments that could provide the framework for such change are adoption of open data standards and the use of Open Source Software.

Data standards provide uniform ways to represent information or processes within a specific frame of reference and according to a detailed specification. A standard is “open” when it is not encumbered by patent, cost, or usage restrictions. Open Source Software (OSS) is defined loosely as software that allows programmers to openly read, redistribute, and modify the source code of that software. The combination of OSS and open standards is a proven way to deliver improved flexibility, quality, and efficiency.

A community-driven open source offering that harnesses open standards can produce robust, innovative technology solutions for use in regulated clinical trial environments. Most Open Source Software is built using a collaborative development model. The OSS development and licensing model encourages experimentation, reduces ‘reinvention of the wheel’, and allows otherwise unaffiliated parties to build on the work of others. The result is that OSS can become a key driver of increased IT efficiency and a way to wring out unnecessary costs. In many cases, users can have the best of all worlds: the ability to adopt software rapidly and at low cost, the flexibility to develop and extend their systems as they choose, and the ability to reduce risk by obtaining paid commercial-grade support.

As clinical research struggles to become more automated and efficient, we need to rely on interoperable systems to meet challenges of flexibility, quality, and speed. The OSS development model also naturally leads to the adoption of well-documented, open standards. Because OSS product designers and developers tend to reuse successful components and models where available, OSS technologies are often leading implementers of standards. For example, the National Cancer Institute’s Cancer Bioinformatics Grid (caBIG) initiative is “designed to further medicine’s potential through an open source network” based on open data standards and infrastructure that support sharing of heterogeneous data. This remarkable effort aims to connect large networks of researchers in ways that enables efficient re-use of data, eliminates duplicate systems, and enables new types of translational research.

In industry-sponsored clinical trials, standards such as the CDISC Operational Data Model (ODM), Clinical Data Acquisition Standards Harmonization (CDASH), and Study Data Tabulation Model (SDTM) have gained adoption in both proprietary and OSS software platforms. In some cases, standards are mandated for regulatory submission and reporting (SDTM, clinicaltrials.gov) and obviously must be adopted. Other cases, such as use of ODM, CDASH, and general web standards such as web services and XForms tend to be adopted to the degree they have a compelling business case.

The business case for standards centers on increasing accuracy and repeatability, enabling reuse of data, and enhancing efficiency by use of a common toolset. A well-designed standard does not inhibit flexibility, but presupposes idiosyncrasies and allows extension to support ‘corner cases’. Leading industry voices share compelling arguments how to use standards such as ODM, CDASH, XForms, and Web Services to achieve these goals. Though the details are complicated, the approach offers orchestration of disparate applications and organization of metadata across multiple systems. There is change control support and a single ‘source of truth’ for each data point or study configuration parameter, so when study designs change (as they inevitably do) or a previously committed data point is rolled back, it is automatically shared and manual updates to systems are not necessary. Because the ODM, CDASH, and SDTM are used as a common “language”, the systems know the meaning and structure of data and can process transactions accordingly. Here’s a tangible example:

Lets imagine an IVR system wanted to check with an EDC system if a subject was current in a study (current meaning not dropped out, early terminated or a screen failure).  A Web Service could be offered by the EDC system to respond with a ‘True’ or ‘False’ to a call ‘IS_SUBJECT_CURRENT’ ?  Of course hand-shaking would need to occur before it hand [sic] for security and so on, but following this, the IVR system would simply need to make the call, provide a unique Subject identifier, and the EDC system web service would respond with either ‘True’ or ‘False.  With Web Services, this can potentially occur in less than a second.

Electronic Data Capture – Technology Blog, September 28, 2008

While this integration requirement could be satisfied by development of point-to-point, proprietary interfaces, this approach is brittle, costly, and does not scale well to support a third or fourth-party system participating in the transaction. It is critical that standards be open so that parties can adopt and implement them independently, and later interface their systems together when the business case calls for it. A leading industry blogger makes the case for the openness of standards within the ODM’s ‘Vendor Extension’ architecture: ”The ODM is an open standard, the spec is available for free and anyone can implement it. This encourages innovation and lowers the barriers to entry and therefore costs. Vendor Extensions are not open, the vendor is under no obligation to share them with the market and the effect is that meta-tools and inter-operability are held back.”

Having the software that implements these standards released as open source code only strengthens its benefits. Proprietary software can implement open standards, however given the proprietary vendor’s business interest to lock-in license revenue, might the vendor be tempted into tweaking or ‘extending’ the standard in a way that is encumbered to lock users into their platform? This strategy of “embrace, extend, extinguish” was made famous in the Microsoft anti-trust case of the 1990s, where it came to light that the company attempted to apply these principles to key Internet networking protocols, HTML and web browser standards, and the Java programming language. They hoped to marginalize competing platforms that did not support their “extended” versions of the standards. Thankfully, they had limited success in this effort, and the Internet has flourished into the open, constantly innovating, non-proprietary network that we know today. The eClinical technology field is at a similar crossroads. By embracing open standards, and working concertedly to provide business value in re-usable OSS technology, we can achieve a transformation in the productivity of our clinical technology investments.

CDASH: A new way to standardize data elements

Many people who work with EDC systems have heard of or been impacted by CDISC, Clinical Data Interchange Standards Consortium.  CDISC’s mission is to develop and support global, platform-independent data standards that enable information system interoperability to improve medical research and related areas of healthcare.  They have many different initiatives, but one of their newest ones promises to aid the development and use of electronic Case Report Forms (eCRFs), the foundation of an EDC system.

Clinical Data Acquisition Standards Harmonization, (CDASH) aims to standardize ways of collecting data in a clinical trial.  The current EDC landscape has hundreds, even thousands, of different eCRFs that capture essentially the same information, but with CDASH’s initiative one common data element can be used for each piece of information collected.

The initiative is not being pushed to enforce the way an eCRF looks and feels; rather, it seeks to standardize the way the fields and data on a form map to a database.  Allowing users to create eCRFs with one standard in mind will allow the users to re-use their work again and again rather than having to create new eCRFs the next time they begin a study.

By mapping OpenClinica CRFs to CDASH content standards (element name, definition, and the related metadata) users of OpenClinica can access a basic set of global data collection fields with semantics agreed upon by representatives from Contract Research Organizations (CROs), Academia, Government and Industry.  These CRFs can be found in the OpenClinica Enterprise CRF Library.