3 (well 4) reasons to update your web browser

3 (well 4) reasons

to update your web browser

One of our key aims here at EDGE and The Clinical Informatics Research Unit, is to ensure that our users get the very best out of EDGE. One thing that can certainly help towards this and is something we try and encourage as much as possible, is ensuring that our users’ web browsers are kept up to date. “Why?” I hear you ask. Here are 3 (well 4) reasons why.  

1.)    Performance
Having an up to date browser means that EDGE will perform to the best of its ability – it is a web-based application after all. Especially in relation to its speed, which is of course very useful when you are needing to run those big reports with large amounts of data. Not only are old browsers much slower than the new ones, but they are also more likely to crash, which isn’t what anyone needs in their busy working day.

2.)    Display
Using an old browser can cause webpages to not appear how they should. For example, images may not be displayed and the display of content could be misaligned (definitely not what you want after all that data entry!)

3.)    Security
And, of course there is the security issue. Old browsers are much more prone to viruses, spyware and other threats, so it really is important to keep them up to date and your work secure.  

Oh, and there is one more reason why we recommend your web browser is updated. How could I forget? If you’re reading this and you’re one of our users of EDGE, then you should hopefully already know that we are working on a new version of EDGE, which we have been referring to as ‘EDGE 3’. In preparation of the launch next year, we are urging users to update their web browsers in order to get the best out of what EDGE 3 has to offer.

We also want to ensure that users are using one of the following up to date browsers: Microsoft Edge, Safari, Google Chrome, Mozilla Firefox or Opera. EDGE 3 will still operate on Internet Explorer 11, however this will come to end of life support from Microsoft on June 15th 2022. Therefore, we recommend that you switch to one of the other browsers mentioned above. We also recommend that users request help and support from their local IT team in updating their web browsers.

Hopefully this post has been useful in explaining why web browsers should be kept up to date, and that it encourages our users to check their browsers and update where necessary. If you do have any EDGE and browser compatibility questions, feel free to contact us.

Thank you for taking the time to read this post. And if you are an EDGE user, thank you for your continued cooperation and involvement with the EDGE programme.   

Saving & Improving Lives

Saving & improving lives:

the future of UK clinical research delivery

Yesterday the UK government and devolved administrations have published their vision: ‘To unleash the full potential of clinical research delivery to tackle health inequalities, bolster economic recovery and to improve the lives of people across the UK’.

The full document can be accessed here

The report has 5 key themes; Embed research in the NHS, make it patient centred, make it more streamlined and efficient, leverage digital tools and data and create a sustainable and support workforce. These themes will be supported through the newly formed UK Clinical Research RRG programme (Recovery, Resilience, Growth).

Underlying this report are 7 specific areas for action:

1.    Improving the speed and efficiency of study setup. This includes expediting costing, contracting and approvals.

2.    Building upon digital platforms to deliver clinical research.

3.    Increasing the use of innovative research designs.

4.    Aligning research programmes and processes with the needs of the UK health and care systems.

5.    Improving visibility and making research matter to the NHS.

6.    Making research  more  diverse  and  more  relevant  to  the whole UK.

7.    Strengthening public, patient and service user involvement in research.

If you have ever read Best Research for Best Health released by the DoH in 2006, Personalised Health and Care 2020 released by the DoH in 2014, or Improving the Health of the public by 2040 released by the Academy of Medical Sciences in 2016, you’ll see a running theme over the last 15 years of speeding up research, leveraging digital tools, using data effectively and building a skilled and resilient workforce.

Since joining the Clinical Informatics Research Unit in 2012 and working on research issues at both a national level as well as a local level, across multiple countries in the world, the UK still has a strong leading edge. Many of the practices developed in the UK are researched and copied to other countries to mimic the successful support and delivery structures that we have. This is something to be extremely proud of and is partly down to the vision delivered in the publications mentioned earlier that are then built upon over time by everyone involved in research.

To ensure we continue to attract the best research and best researchers to the UK we need to maintain tour competitive advantage, the thing that attracts those people to our shores. Most people use the Quality, Speed, Cost triangle to show that things can be delivered at either high quality, fast or cheap, but not all 3, each trading off with the others. However technology can help to shift this paradigm and reduce those trade off’s, not completely, but enough to allow a noticeable reduction in cost, with faster and higher quality outcomes. 

Peter Thiel, co-founder of PayPal and Palantir, says in his 2014 book Zero to One “As a good rule of thumb, proprietary technology must be at least 10 times better than its closest substitute in some important dimension to lead to a real monopolistic advantage.” Now I don’t think that from a national clinical research perspective any country can leverage a 10x improvement over all other countries, yet the small changes and improvements that we all make on a daily basis, whether off our own back or guided (or pushed) by the DoH vision all add up over the long term, making the UK an attractive place to deliver research.

So, if like me you’ve read the report, then digest it, think about it, work out the part you play, whether large or small and plan what changes you can make. To me, aligning what we are doing with EDGE and all our other research services ensures that we are, for want of a better expression, all pulling in the same direction.

Useful links:

https://www.gov.uk/government/publications/best-research-for-best-health-a-new-national-health-research-strategy

https://www.gov.uk/government/publications/personalised-health-and-care-2020

https://acmedsci.ac.uk/policy/policy-projects/health-of-the-public-in-2040

How close are we to Artificial Intelligence and Machine Learning being utilised in every day work?

AI is the current buzzword that we are all hearing on a daily basis, whether it is in a news article or at a conference, however understanding the implications of this technology, in the short, medium and long term is important to give it some context in relation to our daily work lives. Sarah Bennight, Director of Marketing at Stericycle Communication Solutions is quoted as saying ‘AI is everywhere. Every vendor seems to tout it, and every conference is filled with talk of everything AI. Folks tend to think that you throw in AI, and your paper gets published, your company gets funded, your product gets sold, and your customers’ interests get peaked. And therein lies the problem.

80% of Health executives agree that within the next 2 years, AI will work next to humans in their organisation, as a coworker, collaborator and trusted advisor, however 81% agree that organisations are not prepared to face the societal and liability issues that will require them to explain their AI-based actions and decisions, should issues arise (Accenture, Digital Health Tech Vision 2018).

To me, this sounds like ‘we know it’s coming, we just aren’t sure how we will handle it’, and that is probably true of many challenges we face on a daily basis. We have a vague idea of what is coming up in the near future, but it takes time and effort to dissect that into the day to day business of running an organisation.

One challenge that we have seen here in the Clinical Informatics Research Unit is around data quality, or often the lack of it. We have a team who work with hospitals to extract clinical data sets from Electronic Health Records and merge that with other datasets, in order to allow clinicians to link and query the information, for either research or audit purpose. A huge amount of time is invested in cleaning that data, identifying any outliers in it and addressing them. Even the question of ‘what is an outlier’ needs to be defined up front. Arm measurements can be recorded in CM’s, MM’s or inches (we’ve seen all 3). Alternatively some data points are clearly arbitrary, for example patients who are 1 cm tall and weigh 1 kg, the result of which can often be tracked back to the field being compulsory for someone to complete in the EHR, who doesn’t have that information to hand at the point of completion and just enters those values to reach the next page. Dr Sachin Jain, former CMIO at Merck and now CEO of CareMore Health explain to Forbes in January 2019 ‘The first thing we’ve learned is the importance of having outstanding data to actually base your Machine Learning on. In our own shop, we’ve been working on a few big projects, and we’ve had to spend most of the time just cleaning the data sets before you can even run the algorithm. That’s taken us years just to clean the datasets. I think people underestimate how little clean data there is out there, and how hard it is to clean and link the data.

Bias is another challenge inherent in machine learning. The algorithm will only be as good as the data model that it is trained on, and ensuring that is a big challenge. A worrying quote from Dr Dhruv Khullar in the New York Times said ‘In medicine, unchecked A.I. could create self-fulfilling prophesies that confirm our pre-existing biases, especially when used for conditions with complex trade-offs and high degrees of uncertainty. If, for example, poorer patients do worse after organ transplantation or after receiving chemotherapy for end-stage cancer, machine learning algorithms may conclude such patients are less likely to benefit from further treatment — and recommend against it.

Despite the challenges that lay ahead with AI and ML, the excitement surrounding it is unlikely to go away, and in the future, understanding the algorithms that govern decisions made by computers will be a core component of the governance of any organisation utilising them.

Certainly from an EDGE perspective, I think I am quite safe to say that we will monitor the developments in these technologies over time, and when, or most importantly if the time is right, implement them in a careful and considered manner.

In the meantime, if you want to have a play around with Machine Learning, there is an interesting model that you can use, provided by Microsoft, on the dataset of passengers on the fateful Titanic Voyage that can be found here

EDGE & the CPMS project

It was the 9th October 2015 when an email landed in my inbox inviting me to an initial teleconference with the NIHR Coordinating Centre. It was to discuss a proposed integration between EDGE and CPMS. My usual positive attitude kicked in and I thought ‘Hmmmm, that’ll be a nice project for a year or so, how complicated could it be’. Underestimation is a dangerous thing however, which I have learnt many times, usually when starting DIY projects in my house and telling my wife things like ‘the shower will be fixed in an hour or so’, only for it to still be in pieces on the floor a few days later. So as you can imagine, both to my surprise, and not to my surprise at the same time, 3 and a half years later this interface project is still in progress.

In my rather varied career history, I used to run critical incidents in the Kent Police Control Room, such as firearms incidents and large scale public order events which were constantly evolving and each had many moving parts to take into account. I’m therefore used to pressure and stress, aware of the need to dynamically risk assess the situation constantly, keep in mind the bigger picture whilst also trying to complete the task in hand. This has perhaps stood me in good stead for this integration project.

Despite this being the most complicated project that I have ever worked on, I believe it has actually delivered benefits beyond its original design. It has brought our team, the Clinical Research Networks and the Coordinating Centre around the table on an almost weekly basis, in turning building a very close working relationship with everyone involved and developing a much deeper understanding around how we each function. Although we haven’t been able to engage with every Trust in the integration work, we have always involved as many as possible in the conversations to ensure that everyone has a voice in the changes being made.

As Newton said, every action has an equal and opposite reaction, and this cannot be denied. The concentration of our workforce on delivering the CPMS integration has meant that other aspects of our teams work has had to play second fiddle, often meaning that engagement through platforms like ideascale has reduced, or the ability for our team to set up user groups around areas of special interest.

So on a positive note, we are currently in the throes of recruitment, meaning that soon we will be able to re-continue all of the engagement work that enables us to work alongside you all in understanding your business, your processes, your problems and your aspirations in order to deliver the best solutions possible in EDGE.

Update from Dave Osler

Well it is safe to say that the last few months have been somewhat eventful to say the least. The GDPR D-day has been and gone along with so much work happening across the NHS and academia to prepare for. It certainly feels like everyone has a better understanding of their data now and are more conscious about how it’s justified, where it’s stored, how long for, who the data controller is, alongside all the other stipulations and requirements of the regulations.

Clinical research data capture has for a long time been highly regulated and controlled due to the many other directives and frameworks under which we operate meaning that we should all have been in a fairly strong position to steer ourselves to GDPR compliance. As one University said to me ‘it’s not clinical research we are worried about so much, it’s research across other faculties’. This is where we come to realise that outside the sphere of clinical research, not all protocols include the basics such as a data management plan.

In line with our dedication to high quality research management, every member of the EDGE team from developers to account managers, Head of Operations to our directors PA have completed their GCP training alongside mandatory GDPR training.

We are starting to develop the next stage of the EDGE – CPMS interface called ‘SetStudySites’. This will transfer project sites from EDGE in order to create those site records on CPMS, therefore reducing the need to enter the same site data on 2 separate systems. This will lead us gradually towards our shared vision of a truly integrated research system.

My experience before joining CIRU

My experience within research has been relatively short but a varied one up to this point. I have gained unique experiences and have learnt much about research over the last 4 years. Not only is research an extremely rewarding practice to be a part of but our governments drive for the UK to lead in research for patient care and economic growth also makes for a gratified career prospect.

I first got into research after working for 9 years within many different Pharmacy departments at Southampton General Hospital. Being well aware the step up to a Pharmacy technician wasn’t for me, I knew it was time to take another route. At that time I took an opportunity within the Clinical Trials Pharmacy department as a Senior Clinical Trials Assistant. Dispensing trial drugs and accountability were key aspects of my day to day duties within that role as well as ensuring nurses received their prescription drugs on time for their patient’s appointments. Due to the importance of time windows within most CTIMP protocols, each dispensing item had a time limit from receiving the script to a final technician check. This could be very stressful at times when the pharmacy was extremely busy and as most prescriptions were not presented in advance this could not be predicted. Other essential tasks involved recouping costings from commercial studies by collating finance figures from site file accountability logs. This was very important as our department mostly relied on funding coming in from commercial trials.

After 6 months I was employed as a ‘Pharmacy Clinical Trials Co-ordinator’, an extremely rewarding role where I was solely responsible for over a million pounds worth of trial medication. Good relations and communication with PI’s, Co-Investigators and Nurses were pivotal for preparing CTIMP deliveries and prescriptions, enabling chemotherapy and other trial IVs to be made in the aseptic’s in time for patient’s appointments. As IVs all have various expiries (once made) it’s imperative my organisation skills were on point. Some medication can quickly expire, wasting thousands of pounds of stock while also holding up a treatment chair in a busy cancer clinic, in turn wasting pharmacy and research teams’ valuable time.

With a taste of research I felt it was the right time to move away from Pharmacy after 10 years and I joined the Lung Research team within the same hospital. A small team of 5 (Including myself), consisting of 2 senior nurses and 3 research assistants.

My time was split supporting senior nurses with administration duties such as updating trial site files and inputting data into ECRFs after patient visits, while the other half was assisting in coordinating 100,000 genomes project implementation into the trust. Along with this I also gained consent from patients for the TargetLung study. This would entail following patients through their standard of care journey, taking their bloods and processing bodily fluids in a lab for scientists to process. I would also collect tumour tissues from many different procedures in order to help researchers try and improve their knowledge of how the immune system works with lung diseases. As you can imagine this was an extremely insightful way of learning how laboratories, theatres and various departments work together in research.

With the above hands on experience of clinical trials on my side, it has assisted me a great deal as a Knowledge Officer at the Clinical Informatics Research Unit, in understanding what clinical research teams need to carry out their occupations effectively. The CIRU team has a great diversity of experience from all aspects of research departments which helps us solve problems and brainstorm issues efficiently with good understanding of our users. Naturally there are times when issues arise where we are not familiar, but good relationships with CRNs and the Trusts keeps the CIRU team up to date with current affairs which is helpful for running the EDGE programme.

Blog post written by Lee Pearce,
EDGE Knowledge Officer, CIRU
University of Southampton