Reducing friction in patient engagement: an (unconventional) case study

Participate_SCDM_SurveyOur quest for frictionless, electronic patient reported outcomes (ePRO) data capture has us looking for novel ways to engage patients and streamline process. I’d like to share a fun and interesting example of this work, in which we used Participate (the OpenClinica ePRO solution) to engage study subjects at the recent SCDM annual conference.

Our goal at the SCDM conference was to get as many attendees to try OpenClinica Participate as possible. With the vast array of vendors, eye candy, and giveaways, it’s a big challenge to cut through the noise and offer a simple, fun way to engage an audience. The same holds true when engaging patients. With the enormous number of daily distractions, ensuring that your patients can quickly access, fill out and submit well-constructed, simple forms is key to compliance and ultimately, better data.

I built the form, shown here, in OpenClinica and enabled access to it via a custom URL, a new feature in our latest release.

Attendees filled out the form, sprinkled with fun health habit questions, then captured information to allow us to draw their names to win Fitbits and other giveaways. We were able to use this data and update our graphs to give the participant a view of how they stacked up with their peers—cool!

Imagine if patients could view a visual representation of the study they are enrolled in – see the parallels and possibilities?


Who says ePRO and patient engagement can’t be fun?

Engineering OpenClinica’s Future

We recently introduced OpenClinica Participate™.

We believe all research participants—patients, clinicians, researchers, should have technology that meets the ‘anytime, anywhere’ expectations of a mobile, smartphone enabled world. Based on conversations with the OpenClinica community, many of you share this view as well. We are committed to making sure, at minimum, that OpenClinica’s patient engagement technology ‘just works’ in mobile, real world environments. Wherever possible, we will go beyond that and work to make the participant experience engaging, fun, and inspiring.

As transformational as these patient engagement capabilities can be, what we’ve been working on is about more than that. This is about a foundation for the future of the OpenClinica project.

EnketoAs I briefly pointed out in an earlier post, OpenClinica Participate forms are powered by the new enketo-express app that was built around the widely used enketo-core form engine (both available on GitHub).

OpenROSA_LogoOpenClinica will soon natively support the OpenRosa API, which will let you run Enketo, ODK Collect, or any of a number of OpenRosa-compliant data capture clients. Eventually, we envision the Enketo forms engine will replace the current CRF engine in the OpenClinica code base.

odk_medium_squareIf you’re not familiar with Enketo, ODK, or OpenRosa, here’s a primer. Most important is understanding there is a rich global ecosystem of technology, developers and users around the OpenRosa Xform standard. The resultant solutions have been battle tested in diverse health care and field-based data collection settings over many years. In keeping with the open source principles of flexibility and choice, aligning the OpenClinica ecosystem with this community will provide new features and options that you can use.

As my 5 year-old son has taught me when we watch Spider-Man cartoons, with great power comes great responsibility. So it is with open source software. Tapping in to the richness and variety of the OpenRosa community creates new possibilities, but it can add complexity too by expanding the options you have to choose from. OpenClinica is released under an open source license so that many developers can improve, combine, and share their code in a way that enhances quality, usability, and features, and we believe that this richness will drive the next cycle of innovation.

With this goal of better encouraging code contributions, the focus of the repositories and downloads will be easy-to-use open-source libraries: building blocks for developers to create their own OpenClinica-powered apps and modules.

If you are developing on the OpenClinica code base to add features or build custom solutions, you’ll have a greater ability to mix and match just the pieces you need, and to share back your improvements in a modular fashion. It will be much easier for developers to use the libraries and share their experience and contributions back with the community. We will gladly help out if you experience issues. Our own engineers will be able to focus more of their time on improving quality, usability, and functionality, rather than on packaging, testing, and supporting so many different environments. We hope to build a strong collaboration with the Enketo and OpenRosa communities that spawns new ideas and developments.

So try it out! Check out OpenClinica Participate or get started by hooking up OpenClinica with Enketo.

And need I say, you’ll certainly be able to learn more about these OpenClinica innovations at the upcoming OC15 conference in Amsterdam, May 31-June 1.

Reacting to #ResearchKit

OpenClinica_AppleRK Apple, Inc. has a remarkable ability to capture the world’s attention when announcing “the next big thing.” They have honed their well-known Reality Distortion Field skills for over 30 years. As the largest company in the world, and bellwether of the technology industry, Apple’s announcements are immediately recounted, opined, lionized, and criticized all across the Internet—sometimes with very limited real information on the new product itself. Of course, it helps to have their unmatched track record in actually delivering the next big thing.

ResearchKit has grabbed such attention. Maybe not as much as The Watch, but amongst the minority of us who pay attention to such things. And the reactions have been typically polarized—it’s either an “ethics quagmire” or “Apple fixing the world.”

But reality rarely presents an either-or proposition. I’ve written before on the need to use technology in simple, scalable ways to engage more participants in research and capture more data. Every form of engaging with patients and conducting research is fraught with potential for bias, bad data, and ethical dilemmas. Properly controlling these factors is difficult, and the current handling of these factors lead many to conclude that clinical research is overly “bloated and highly controlled”. There’s truth to that, but the fundamental need for good controls is real. As technology enables us to engage in new ways, how we implement such controls is likely to transform, perhaps unrecognizably so.

I don’t think Apple—or anybody—has these problems fully solved yet. And I expect we’re going to a see a vigorous debate in coming years between #bigdata and #cleandata that I hope will lead us to more of both. But ResearchKit, or at least the announcement thereof, is a game changer. Whether or not ResearchKit in its present form becomes a widely adopted platform, the impact was felt overnight: “11,000 iPhone owners signed up for a heart health study using Apple’s newly-announced ResearchKit in the first 24 hours… To get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers around the country”. ResearchKit builds on momentum towards patient-centricity established in the last five years within pharma, NIH, online patient communities, mHealth, and health care, and uses Apple’s consumer clout to bring it to the attention of the average person on the street.

So let’s break down what we know about ResearchKit. Since this is a blog about OpenClinica, we’ll also share early thoughts on how we see OpenClinica, ResearchKit, and OpenClinica Participate fitting together.

It’s Open Source. Great move! We’ll learn more about what this means when the code is released next month.

The technical paper indicates it is a front-end software framework for research, and that they expect it to expand over time as modules are contributed by researchers. Through use of both platforms’ APIs, OpenClinica could serve as a powerful backend and ‘brain’ to ResearchKit.

It’s not clear if data goes through Apple’s servers on its way to a final destination. I also haven’t seen anything from Apple mentioning if it will be portable to other non-iOS platforms (which represent 80% of mobile device market share), though its open source nature would suggest that will be possible.

Surveys. Analogous in many ways to the forms module in OpenClinica Participate, it is a pre-built user interface for question and answer surveys. As somebody who’s worked in this realm for years, I know that this can mean a lot of things. What specific features are supported, how flexible is it, how easy is the build process? Perhaps most important, can it be ported to other mobile app platforms, or to the web?

Informed Consent. The need for fundamental ethical controls for for research conduct and data use are just as important in the virtual world as they are in the brick-and-mortar realm, and Informed Consent is a cornerstone. I’m glad to see ResearchKit taking this on; I don’t expect they have it 100% figured out, but their work with Sage Bionetworks, who has released an open toolkit on Participant Centered Consent, is a great sign.

Active Tasks. Maybe the most exciting component, here’s where ResearchKit takes advantage of the powerful sensors and hardware in the device and provides a way to build interactive tests and activities. In this way, I expect ResearchKit will be a great complementary/alternative frontend to OpenClinica Participate when specialized tests tied to specific, highly-calibrated devices are required.

In general, the promise is big: that technology will lower barriers in a way that leads to fundamental advances in our understanding of human health and breakthrough treatments. That we’ll go from data collected once every three months to once every second, and we’ll encounter–and solve–problems of selection bias, identity management, privacy, and more along the way. And that, according to John Wilbanks at Sage, “there’s coming a day when you’re not going to have an excuse to have a tiny cohort just because you chose not the use digital technologies to engage people.”

Introducing OpenClinica Participate

In clinical research, we all work towards better evidence-based, patient-centered health interventions. We all understand the importance of evidence. But how about patient-centered? We hear this phrase perhaps too often nowadays, but it’s more than just a buzzword. A patient-centered approach directs research toward questions that are important to patients so they can make more informed healthcare decisions. It measures the outcomes that are noticeable and important to patients, and produces results that help them weigh the value of healthcare.

At OpenClinica, we think increasing the patient-centeredness of research is vital. Industry, NIH, FDA, and the general public seem to agree, and furthermore share our view that technology can increase patient engagement. This can happen by designing highly accessible, mobile technology to:

  • Improve patient participation, motivation, and adherence
  • Increase ability to meet recruitment goals, budget, and completion timelines
  • Enable new designs that better target populations and/or more closely align with real-world use

HTCPhoneI’d like to introduce our upcoming product, OpenClinica Participate, a tool tightly integrated with OpenClinica for engaging patients and collecting data directly from study participants.

If you took our recent survey, you got a glimpse of what your forms for patient-reported outcomes could look like in OpenClinica Participate. Driven by a powerful forms engine based on proven open-source technology, the participant forms are simple, dynamic, mobile-focused, and platform-independent.

But it’s about a lot more than mobile-friendly forms. Patient expectations are rising while trial participation is shrinking. Clinical trials need to engage ‘Subjects’ as ‘Participants’ — by recruiting and retaining through real-time engagement and meeting the ‘anytime, anywhere’ expectations of a mobile, smartphone enabled world. It starts with an intuitive, action-oriented dashboard. Participants are greeted with a simple interface that motivates and focuses them on what they need to do today. The layout is responsive and knows whether you are using your phone, a tablet, or a traditional browser. Communication with the participant can occur through multiple channels — via the dashboard, through SMS, or via email, with options to help you make sure the right balance is struck between security and accessibility.

Participate_OCUILast, and perhaps most important, Participate is tightly integrated with the OpenClinica EDC platform. The Participate solution allows you to design your study and forms using the OpenClinica study build tools you already know, while seamlessly capturing all your clinical and participant-reported outcomes in a single database. You can build skip patterns, repeats, and other logic into your participant forms just as you do with traditional OpenClinica CRFs, using the same rules engine. You can use scheduling rules to identify the next time participant feedback is required. As data is submitted by study participants, their activities become part of the same audit trail that tracks what your clinical users do. The data they submit can immediately be reviewed and extracted along with CRF data from other sources.

Participate is extremely easy to adopt. As a modular add-on to your hosted OpenClinica Enterprise instance, it can be activated for any new study from within your study build screen. Forms are powered by the widely used open source enketo-express library and all editions of OpenClinica will support the widely-used OpenRosa API to let you run Enketo, ODK Collect, or any of a number of OpenRosa-compliant data capture clients. Participate utilizes a cloud-based Software-as-a-Service (SaaS) delivery model, so there is no costly and delay-inducing software deployment to worry about.


Visit the OpenClinica Participate Website