title: An eClinical trial system for cancer that integrates with clinical pathways and electronic medical records.
abstract: BACKGROUND
  Various information technologies currently are used to improve the efficiency of clinical trials. However, electronic medical records (EMRs) are not yet linked to the electronic data capture (EDC) system. Therefore, the data must be extracted from medical records and transcribed to the EDC system. Clinical pathways are planned process patterns that are used in routine clinical practice and are easily applicable to the medical care and evaluation defined in a trial protocol. However, few clinical pathways are intended to increase the efficiency of clinical trials.
  
  
  OBJECTIVE
  Our purpose is to describe the design and development of a new clinical trial process model that enables the primary use of EMRs in clinical trials by integrating clinical pathways and EMRs.
  
  
  METHODS
  We designed a new clinical trial model that uses EMR data directly in clinical trials and developed a system to follow this model. We applied the system to an investigator-initiated clinical trial and examined whether all data were extracted correctly. At the protocol development stage, our model measures endpoints based on clinical pathways with the same diagnosis. Next, medical record descriptions and the format of the statistical data are defined. According to these observations, screens for entry of data, which are used both in clinical practice and for study, are prepared into EMRs with an EMR template, and screens are prepared for data checks on our EMR retrieval system (ERS). In an actual trial, patients are registered and randomly assigned to a protocol treatment. The protocol treatment is executed according to clinical pathways, and the data are recorded to EMRs using EMR templates. The data are checked by a local data manager using reports created by the ERS. After edit checks and corrections, the data are extracted by the ERS, archived in portable document format (PDF) with an electronic signature, and transferred in comma-separated values (CSV) format to a coordinating centre. At the coordinating centre, the data are checked, integrated, and made available for a statistical analysis.
  
  
  RESULTS
  We verified that the data could be extracted correctly and found no unexpected problems.
  
  
  CONCLUSIONS
  To execute clinical trials in our system, the EMR template and efficient ERSs are required. Additionally, to execute multi-institutional clinical trials, it is necessary to create templates appropriate for EMRs at all participating sites and for the coordinating centre to validate local templates and procedures.
  
  
  CONCLUSIONS
  We proposed and pilot tested a new eClinical trial model. Because our model is integrated with routine documentation of clinical practice and clinical trials, redundant data entries were avoided and the burden on the investigator was minimised. The reengineering of the clinical trial process would facilitate the establishment of evidence in the future.
authors.affiliation: Department of Clinical Trial Design and Management, Translational Research Centre, Kyoto University Hospital, Kyoto, Japan. kyamamo@kuhp.kyoto-u.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Eriko
authors.initials: E
authors.lastname: Sumi
authors.forename: Takamichi
authors.initials: T
authors.lastname: Ishii
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Kohta
authors.initials: K
authors.lastname: Iguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yokode
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Fukushima
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D002985:Clinical Protocols; D017322:Clinical Trials, Phase II as Topic / Q000379:methods; D019091:Critical Pathways; D057286:Electronic Health Records; D015251:Epirubicin / Q000008:administration & dosage; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design
chemical_list: D000970:Antineoplastic Agents; D015251:Epirubicin; D002945:Cisplatin