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Streamlining Mid-Study Changes
                with Technology
How many studies have you seen

                   that   do not have a mid-study change?




Confidential – 2
zero

Confidential – 3
Completed protocols across all clinical trials incurred an
      average of   2.3 amendments
      Each required an average of     6.9 changes to the protocol
      Phase III studies required   8.5 changes per amendment

                        http://csdd.tufts.edu/news/complete_story/pr_ir_sep-oct_2011


Confidential – 4
and those numbers are growing…
                   Protocols are more complex

                   CRFs are larger

                   Clinical trials are lasting longer

                   Clinical trials are global



Confidential – 5
What’s the impact?




Confidential – 6
What’s the impact?

                   Time delays

                   Cost overruns

                   Regulatory risk




Confidential – 7
Why do these impacts occur?




Confidential – 8
Why do these impacts occur?

                     Design

                     Test
       Change
       Management    Approve

                     Deploy



Confidential – 9
Why do these impacts occur?


                     Staggered deployments due
                     to IRB approvals
        Deployment
        Challenges   Manual deployments are
                     subject to human error




Confidential – 10
Why do these impacts occur?

                     Moving data from Version 1
                     to Version 2
        Data
        Migrations   Site downtime

                     Lost data




Confidential – 11
Why do these impacts occur?

                       EDC

                       Coding
        Multi-system
        Impact         Randomization

                       CTMS



Confidential – 12
Factors that affect time, cost and risk

                        Change Management

        Mid-study       Deployment Challenges
        Change
        Challenges      Data Migrations

                        Multi-system Impact



Confidential – 13
What role should technology play?




Confidential – 14
What role should technology play?

                        Inclusion / Exclusion

                        Range checks
        Support Real-
        World Changes   Extension visits

                        …to name a few



Confidential – 15
What role should technology play?

                      Reduce cost

        Improve       Accelerate timelines
        Operations
                      Lower risk




Confidential – 16
How can technology
                    support real-world changes
                     and improve operations?



Confidential – 17
Overcoming challenges.
                          Change Management

    Does the tool support a process-oriented approach to
    change management?
                               Design


                                        Test


                                               Approve


                                                         Release


Confidential – 18
Overcoming challenges.
                          Change Management

    Does the tool produce supporting documents like blank
    CRFs and annotated CRFs?




Confidential – 19
Overcoming challenges.
                                          Change Management

    Does the tool identify what changed between study
    revisions so that you can support risk-based verification?
              Change          Version 1              Version 2



              1 – Age         Are you 18 or older?   Are you 17 or older?
              Question Text


              2–              35.0 < temp < 37.0     35.0 < temp < 37.3
              Temperature
              Edit Check
Confidential – 20
Overcoming challenges.
                           Change Management

    Can you easily and consistently move study revisions
    through separate design, test and approve environments?




             Design    Test       Approve       Release

                       Study Revision 2
Confidential – 21
Overcoming challenges.
                                  Deployment Challenges
    What utilities are in place to support the mid-study
    deployment process?
                    Change Type    Element              Utility
                    Add            Edit Check           Reconcile data
                    Remove         Edit Check           Reconcile data
                                   Question (All
                    Add                                 Update Questions
                                   Patients)
                                   Question (Specific
                    Add
                                   Patients)
                                                        Change answer
                    Update         Question Type
                                                        options
                    Remove         Question
Confidential – 22
                    Add            Form
Overcoming challenges.
                         Deployment Challenges
    Does the update cause downtime or data entry
    inaccessibility for the sites?




Confidential – 23
Overcoming challenges.
                           Data Migrations

    Use a tool that does not have to move data for mid-
    study change updates.

    If you have to move data in the tool, create a
    “checksum” script to ensure the data are safely
    transferred from one version to the next.




Confidential – 24
Overcoming challenges.
                            Multi-system Impact

    Don’t lose sight of today’s connected environments!

    If your EDC is connected with Coding, CTMS,
    Randomization, lower risk with a Change Assessment
    Checklist

    Is anything changing that might affect connections with
    other systems?


Confidential – 25
How can the process flow?




Confidential – 26
How can the process flow?
                            Design
    Identify the change (e.g. a simple edit-check update)

    Designer makes the change in the online development
    environment, reviews her work and flags the version for
    testing.




Confidential – 27
How can the process flow?
                            Test
    The tester loads the version, reviews the configuration
    difference report and is ensured only the temperate edit
    was modified (release classified as low risk).

    The tester runs tests, everything passes and they flag the
    version for UAT.




Confidential – 28
How can the process flow?
                           Approve
    Clinical reviews the modification and approves the
    version.




Confidential – 29
How can the process flow?
                            Deploy
    The project manager coordinates the deployment with
    the study team.

    A mid-study change utility is run to identify data that
    falls outside the updated normal range.

    The sites are never down.


Confidential – 30
In summary…




Confidential – 31
Mid-study changes happen

      Factors that create delays, add cost and risk include:
             Change management
             Deployment challenges
             Data migrations
             Multi-system impact

      Technology should
             Support real-world changes
             Improve operations

      Process-oriented technology appropriately applied can help
             Reduce cost
             Accelerate timelines
             Lower risk

Confidential – 32
®
from Concept to Cure!
                         ™
   with D ATATRAK ONE!




                         DATAT R A K International
                         Cleveland, Ohio
                         Bryan, Texas
                         Cary, North Carolina


                         888.677.DATA (3282) Toll Free
                         www.datatrak.net

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Streamlining Mid-Study Changes with Technology

  • 2. How many studies have you seen that do not have a mid-study change? Confidential – 2
  • 4. Completed protocols across all clinical trials incurred an average of 2.3 amendments Each required an average of 6.9 changes to the protocol Phase III studies required 8.5 changes per amendment http://csdd.tufts.edu/news/complete_story/pr_ir_sep-oct_2011 Confidential – 4
  • 5. and those numbers are growing… Protocols are more complex CRFs are larger Clinical trials are lasting longer Clinical trials are global Confidential – 5
  • 7. What’s the impact? Time delays Cost overruns Regulatory risk Confidential – 7
  • 8. Why do these impacts occur? Confidential – 8
  • 9. Why do these impacts occur? Design Test Change Management Approve Deploy Confidential – 9
  • 10. Why do these impacts occur? Staggered deployments due to IRB approvals Deployment Challenges Manual deployments are subject to human error Confidential – 10
  • 11. Why do these impacts occur? Moving data from Version 1 to Version 2 Data Migrations Site downtime Lost data Confidential – 11
  • 12. Why do these impacts occur? EDC Coding Multi-system Impact Randomization CTMS Confidential – 12
  • 13. Factors that affect time, cost and risk Change Management Mid-study Deployment Challenges Change Challenges Data Migrations Multi-system Impact Confidential – 13
  • 14. What role should technology play? Confidential – 14
  • 15. What role should technology play? Inclusion / Exclusion Range checks Support Real- World Changes Extension visits …to name a few Confidential – 15
  • 16. What role should technology play? Reduce cost Improve Accelerate timelines Operations Lower risk Confidential – 16
  • 17. How can technology support real-world changes and improve operations? Confidential – 17
  • 18. Overcoming challenges. Change Management Does the tool support a process-oriented approach to change management? Design Test Approve Release Confidential – 18
  • 19. Overcoming challenges. Change Management Does the tool produce supporting documents like blank CRFs and annotated CRFs? Confidential – 19
  • 20. Overcoming challenges. Change Management Does the tool identify what changed between study revisions so that you can support risk-based verification? Change Version 1 Version 2 1 – Age Are you 18 or older? Are you 17 or older? Question Text 2– 35.0 < temp < 37.0 35.0 < temp < 37.3 Temperature Edit Check Confidential – 20
  • 21. Overcoming challenges. Change Management Can you easily and consistently move study revisions through separate design, test and approve environments? Design Test Approve Release Study Revision 2 Confidential – 21
  • 22. Overcoming challenges. Deployment Challenges What utilities are in place to support the mid-study deployment process? Change Type Element Utility Add Edit Check Reconcile data Remove Edit Check Reconcile data Question (All Add Update Questions Patients) Question (Specific Add Patients) Change answer Update Question Type options Remove Question Confidential – 22 Add Form
  • 23. Overcoming challenges. Deployment Challenges Does the update cause downtime or data entry inaccessibility for the sites? Confidential – 23
  • 24. Overcoming challenges. Data Migrations Use a tool that does not have to move data for mid- study change updates. If you have to move data in the tool, create a “checksum” script to ensure the data are safely transferred from one version to the next. Confidential – 24
  • 25. Overcoming challenges. Multi-system Impact Don’t lose sight of today’s connected environments! If your EDC is connected with Coding, CTMS, Randomization, lower risk with a Change Assessment Checklist Is anything changing that might affect connections with other systems? Confidential – 25
  • 26. How can the process flow? Confidential – 26
  • 27. How can the process flow? Design Identify the change (e.g. a simple edit-check update) Designer makes the change in the online development environment, reviews her work and flags the version for testing. Confidential – 27
  • 28. How can the process flow? Test The tester loads the version, reviews the configuration difference report and is ensured only the temperate edit was modified (release classified as low risk). The tester runs tests, everything passes and they flag the version for UAT. Confidential – 28
  • 29. How can the process flow? Approve Clinical reviews the modification and approves the version. Confidential – 29
  • 30. How can the process flow? Deploy The project manager coordinates the deployment with the study team. A mid-study change utility is run to identify data that falls outside the updated normal range. The sites are never down. Confidential – 30
  • 32. Mid-study changes happen Factors that create delays, add cost and risk include: Change management Deployment challenges Data migrations Multi-system impact Technology should Support real-world changes Improve operations Process-oriented technology appropriately applied can help Reduce cost Accelerate timelines Lower risk Confidential – 32
  • 33. ® from Concept to Cure! ™ with D ATATRAK ONE! DATAT R A K International Cleveland, Ohio Bryan, Texas Cary, North Carolina 888.677.DATA (3282) Toll Free www.datatrak.net