Agile Development

What does everyone mean

when they say Agile development?

You may have heard the Knowledge team talk about booking work into a ‘Sprint’ or discussing it in the ‘product backlog meeting’, so I thought it would be a good idea to sit down for a few minutes and explain what it all is, and why we describe ourselves as an Agile development unit using Scrum framework.

Companies have long employed development practices like Prince2 or Waterfall to create systems, but I find this a little restrictive, particularly when working in IT where the landscape and requirements change frequently. Agile is a project management philosophy that priorities early and frequent increments, allowing for changes throughout. Scrum is the framework that guides us through this. Scrum defines how we identify the work needed, who does the work, how and when it will be released. Agile and Scrum are a perfect partnership here, allowing us to be creative, regularly release updates and continuously move forward in developing EDGE.

We are always on the lookout for great ideas for functionality, these ideas form a list that we refer to as a Product Backlog. We can’t build everything at once so we make sure the Product Backlog is prioritized and under constant review so when we do meet with development, we know exactly what we want to build, how it needs to work and what should be done first.

While most updates are released monthly, internally we work on a two-week development sprint. Having a two-week sprint means our developers have a pretty good idea of what they can complete in the timeframe and this work becomes our sprint goal. The Sprint goal is set between our Product Owner and the development team. We agree this as a team, everyone is involved in the decision and therefore committed to the goal. We don’t have a lot of rules in scrum but there is one big one: The sprint is a locked event – no interruptions. As you can guess, interrupting the team mid-way through throws off their focus, leaves them less time for their original work and mild chaos ensues. It is probably one of the most difficult things for us Knowledge officers to do, we are always asking for “just one quick change?”, “just one little import?”. Anyway, that’s the rule and we do our best to stick with it.

At the end of the sprint, we have meetings which are called Reviews and Retrospectives, in short this is our chance to look at what we have achieved, make sure we are happy with it and for us to think about the sprint itself. Did we do everything we could, is there anything we would change next time? It’s this part where you see Scrum and Agile ideas blending again, the aim is continuous improvement. We aren’t going to try to build Rome/EDGE 3 in a day, but with small changes, tweaks here and there, and open discussions, everything keeps moving in the right direction.

EDGE & UHS

EDGE & UHS collaborate

and win Team Excellence Award

We are delighted to share that we recently won a joint award along with The Research and Development (R&D) team at University Hospital Southampton (UHS), for Team Excellence in the Management of Clinical Data. This award follows our collaborative work with the team at UHS on developing an innovative approach to support remote monitoring during the coronavirus pandemic using our EDGE Programme.

We picked up the award at the ceremony hosted by the Association for Clinical Data Management (ACDM) on Monday 6 September 21, which was held in Manchester at the Innside hotel. The event was sponsored by another CIRU service, CORE, and showcased achievements in the management of clinical data and had over 100 delegates attend from across the country.

After a lot of time and dedication into this project, EDGE is now being successfully used at UHS for remote monitoring, allowing sponsors to access trial information remotely, limiting the need for them to visit the site in person. This was something that was proving a real issue at the start of the pandemic.

The team from UHS have led this innovation whilst working closely with some of our EDGE team members, and we are thrilled that they have had recognition of their hard work as well as recognition for what has been a successful collaboration between both teams.

Kim Lee, Senior Q&A Lead at the NIHR Southampton Clinical Research Facility (CRF), UHS, led on ensuring effective governance and information security for the project. Herself and colleagues overcome many hurdles and challenges through a very long process.

Following the outcome of the award Kim has shared this comment:

“We are thrilled to have won this award, it is testament to the determination and hard work of the team over the pandemic.”

For more information check out the September 2020 CRN Wessex article looking at the process that the R&D team went through to create the tool.

Research Innovation & Collaboration

Research Innovation & collaboration

450 miles apart

Stevie and Mat might be 450 miles apart, but that hasn’t stopped them on their collaborative journey to making research finance easier and more efficient through the utilisation of the EDGE Research Management Programme. So, sit back, grab a coffee and read on to discover more about their voyage to finance made easy.

Stevie, EDGE Database Manager from NHS Lothian and South East Scottish CRN, and Mat Davis, Research Information Manager from University Hospitals Dorset NHS FT, began working together following Mat’s discovery of Stevie’s finance import tool that he found within the EDGE support section. He explained this as ‘a godsend’ and that it was exactly what he wanted to do. Mat soon made contact with Stevie which kicked off their collaboration over emails and phone calls.

Then at the EDGE Conference 2020 they were able to meet in person where Stevie, Super User and regular speaker at the EDGE Conference (and EDGE Advocate of the Year 2019), gave a successful presentation sharing his finance import tool for EDGE. Mat was just one of the many EDGE users at the conference who was interested in Stevie’s finance tools and knew straight away that an automated approach would be much more beneficial and that him and Stevie were both working towards the same goal.

Soon after the EDGE Conference Stevie and Mat took to MS Teams to work together on advancing the finance tools further. They combined their skills and knowledge leading to an updated Cost Template Import Tool, which can convert a standard NIHR Costing Template into full breakdown EDGE cost templates in less than a minute, retaining all the detail of the original template. Doing the same manually takes many hours. Their new Finance Tracker Tool takes a standard EDGE finance report and breaks it down to a granular level of detail using the analysis codes created by the import tool, displaying visit numbers, visit names, procedures and investigations, departments etc. in an easy to read format. Not forgetting, their handy EDGE Assistant Tool, a web browser extension they created to help with the EDGE Finance Process. The EDGE Assistant Tool can quickly fill in multiple dates at once, convert cost template items to income items, helps associate additional/itemised costs with existing visits, and helps identify missed or repeated patient visits.

These innovative tools speed up the research finance process, and assist with invoicing, finance activity tracking, and finance management, including supporting additional departments with finance such as Pharmacy. Stevie and Mat were keen to share their tools with the EDGE community in a recent EDGE Advance webinar, which gained over 120 attendees from across the country.

Following this, the pair are now assisting other members of the EDGE community, helping them get these tools off the ground and in place at their organisations. They have future plans to continue working together to develop further new ideas for utilising EDGE. Not only have the duo created true innovative work they have become great friends and are true examples of what the EDGE Programme is all about: collaboration.

I know that I can speak on behalf of the whole team here at EDGE – we really do thank them for their hard work and dedication into this, as well as appreciate the help and guidance they provide to the EDGE community.

To finish, here’s a quote from the both Stevie and Mat:

“The collaborative experience of working together has been incredibly rewarding and instrumental in the development of finance tools for use with EDGE, which we believe will really help the community. We would encourage everyone to share their experiences and processes with colleagues in other organisations.”

— Stevie Barre, NHS Lothian & South East SCRN & Mat Davis, University Hospitals Dorset NHS FT

EDGE International

A year with

EDGE International

It has been an eventful 15 months for everyone to say the least. I could say more but it would only go to repeat what has been said already by so many. Although Covid has dominated every facet of our working lives, there are still many achievements we can talk about. I felt now would be a good time to write a post to share some of the stories from the last year of the EDGE International groups, a little bit of a ‘Christmas Round Robin’ if you will, but in June!

Our colleagues in Canada have been working with the C17 network, a collaborative group of paediatric haematology, oncology, and stem cell transplant program centres, to implement EDGE into their programme of work. Early to join have been the Hospital for Sick Kids in Toronto and Montreal Children’s Hospital and more recently Stollery Children Hospital and Alberta Children Hospital. This now brings the total number of Canadian Centres using EDGE to 34 which has come about through a lot of hard work and dedication from our partners out there. With the remote monitoring case study now available (see previous blog post) Canada is exploring how this can be used across the regional network groups.

In New Zealand, we have also welcomed the Starship Children’s Hospital in Auckland to the programme along with their colleagues in Blood and Cancer at ADHB and the University of Auckland. All are looking at how EDGE can break down siloed working and bring together common systems and standards across their region with other district health boards keeping a close eye on how EDGE will evolve across the region.

Our most recent newcomer to the group is the CTRU at K. J. Somaiya Hospital and Research centre in Mumbai, India who started their training in early May and are getting ready to run with EDGE. This is a really exciting new group for the EDGE team to be working with and the CTRU have some great plans ahead.

In combination with our exploratory projects and Pilots in South Africa, Brazil, Sri Lanka, and Australia we now have a whopping 3000 international research studies being run through EDGE which is phenomenal.

While the international groups joining EDGE continue to grow a big thanks should be extended from our Team at CIRU to yours! The generosity of our subscriber base in the UK and Canada to share their experience, hard work, learning, and achievements with our new international colleagues must not go unacknowledged. The willingness to collaborate and share to help those starting from scratch is what the EDGE programme is best known for. In the absence of a 2021 EDGE Conference and the ability to gather in person, our subscribers have embraced working together online. A community of like-minded friends looking to help one another achieve a common goal. Thank You.

EDGE & Remote Monitoring

EDGE & remote monitoring

during the pandemic

Since the beginning of the pandemic monitoring of clinical trials has become difficult, with many workarounds being found to manage it remotely, whether that is sending redacted source data via email, or holding it up in front of the monitor in a Zoom meeting.

Kim Lee, Felicity Gibbons and Mikayala King from University Hospital Southampton (UHS) raised this with us and together we looked at solutions to use EDGE to solve the challenge and the impacts on privacy, risk and how to mitigate these.

Through a lot of hard work, especially by the UHS team they found a solution that worked with monitors to access the documentation through EDGE as a secure portal. Following this we have recently implemented a new browser PDF function (released this month) to support this process, ensuring that monitors can view the source data on EDGE without downloading it to their work device.

Monitoring in person on site is a costly and time consuming activity, for both site staff and the monitors, with a lot of travel costs involved. Remote monitoring is in its infancy still with regulatory and technological issues to be resolved, however we are working with groups to look at how this can be managed effectively to ensure that both the monitor and staff at site can carry this out in the most efficient way possible.

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