Mats Sundgren

Electronic health records: new opportunities for clinical research

Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.

Using electronic health records for clinical research

OBJECTIVES To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. METHODS The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. RESULTS An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. CONCLUSIONS Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies.

Multiple fiber-optic dual-beam UV/Vis system with application to dissolution testing

A system for fiber-optic probing in dissolution testing of solid pharmaceutical formulations has been constructed. The system is based on an imaging spectrometer and a charged coupled device (CCD) detector and includes 12 fiber-optic probes with a novel dual-path design. UV light was produced by a small arc deuterium lamp illuminating an optical fiber bundle. Twelve fiber-optic dipping probes were constructed with a reflection geometry. A 5 mm diameter lens was used to achieve a parallel light beam. The light passed back and forth through the flow-through cuvette defined by a sapphire window and a coated aluminium mirror. The mirror was cut in half and each segment was tilted and set at different distances from the window to obtain two separate paths with different lengths. Two receiver fibers were used for each probe to collect the transmitted light. The 24 receiver fibers from the 12 probes were bunched to a linear bundle and fed to an imaging spectrometer and the corresponding spectra were detected with a 512 x 512 pixel cooled CCD detector. The sampling interval was typically a few seconds for all probes. A software package was developed for data recording and on-line analysis. The program includes tools for multi-component analysis. The system was tested for different tablet formulations. Prednisone 50 mg tablets, normally used for control tests of dissolution baths, were followed for 3 h. Secondly, an extended release low dosage tablet was followed for 7 h resulting in a linear dissolution profile. Finally, a combination tablet containing two active drugs was tested for 60 min profiles. In the latter case, separate dissolution curves for the two active components were obtained. Future work will mainly focus on further development of the multi-component capability of the system.

Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project

INTRODUCTION The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. MATERIALS AND METHODS A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. RESULTS Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. CONCLUSIONS The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond.

Creativity as connectivity: a rhizome model of creativity

The knowledge-management literature has been weak on theorising the notion of creativity. This paper is an attempt to conceptualise creativity as the series of connections in what French philosopher Gilles Deleuze calls a rhizome; a horizontal network structure wherein all nodes can be connected to one another. This argument is illustrated by the new drug development activities in the pharmaceutical industry. New drugs are developed in four major phases: Discovery (Phase 0) and Development (Phases 1, 2 and 3). In the earlier phases of Discovery and Development, pharmaceutical researchers make connections between various entities and events in order to produce a new candidate drug. All these connections are made in a single plane producing lines of thought that eventually enable the new drug to be registered. The rhizome model of creativity helps to ground the notion of creativity in a coherent ontological and epistemological model and to demystify creative processes. Thus the rhizome is a viable analytical instrument for creativity studies.

The European Institute for Innovation through Health Data

The European Institute for Innovation through Health Data (i~HD, www.i‐hd.eu) has been formed as one of the key sustainable entities arising from the Electronic Health Records for Clinical Research (IMI‐JU‐115189) and SemanticHealthNet (FP7‐288408) projects, in collaboration with several other European projects and initiatives supported by the European Commission. i~HD is a European not‐for‐profit body, registered in Belgium through Royal Assent. i~HD has been established to tackle areas of challenge in the successful scaling up of innovations that critically rely on high‐quality and interoperable health data. It will specifically address obstacles and opportunities to using health data by collating, developing, and promoting best practices in information governance and in semantic interoperability. It will help to sustain and propagate the results of health information and communication technology (ICT) research that enables better use of health data, assessing and optimizing their novel value wherever possible. i~HD has been formed after wide consultation and engagement of many stakeholders to develop methods, solutions, and services that can help to maximize the value obtained by all stakeholders from health data. It will support innovations in health maintenance, health care delivery, and knowledge discovery while ensuring compliance with all legal prerequisites, especially regarding the insurance of patients privacy protection. It is bringing multiple stakeholder groups together so as to ensure that future solutions serve their collective needs and can be readily adopted affordably and at scale.

Business analysis for a sustainable, multi-stakeholder ecosystem for leveraging the Electronic Health Records for Clinical Research (EHR4CR) platform in Europe

INTRODUCTION The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. MATERIALS AND METHODS Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. RESULTS A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service providers viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. CONCLUSIONS By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR solutions appears profitable and sustainable in Europe, with a growth potential depending on the rates of market and hospital adoption.

Intuition and Creativity

This chapter will address the human faculty of cognition. In management studies and organization theory, managers and co-workers’ cognitive capabilities have been a source of investigation since the end of the Second World War when Herbert Simon introduced the behavioural theory of decision making. In Simon’s theory, decision making in organizations is determined by what Herbert Simon (1957) calls the bounded rationality of managers and other decision makers. This insight has significant implications for the functioning of organizations. For instance, rather than being concerned with optimal solutions to problems, organizations are merely satisficing their decisions, reaching ‘good enough’ decisions given the degree of ambiguity and chance in a certain situation. Simon’s research programme has been a major source of influence in management studies and organization theory after the Second World War. When speaking of creativity, the notion of intuitive thinking is what is of interest in this chapter. As a subset of cognition, intuition remains one of the least exploited cognitive faculties of human beings in the management literature. Moreover, the role of intuition receives little attention in the literature on organizational creativity. This chapter describes a study of the role of intuition and its implications for organizational creativity within pharmaceutical research.

Assessing the Financial Impact of Reusing Electronic Health Records Data for Clinical Research: Results from the EHR4CR European Project

Background: The new technological platform developed by the Electronic Health Records for Clinical Research (EHR4CR) European research project (2011-2016) has been specially designed to enable the trustworthy reuse of health data contained in hospital-based electronic health records (EHR) for enhancing and speeding up clinical research scenarios. In particular, protocol feasibility assessments, patient identification for recruitment, and clinical data exchange for study conduct, in accordance with data privacy, ethical and legal requirements. The objective of our study was to assess the financial impact of adopting these advanced solutions compared to current practices, from the perspective of the primary sponsors of clinical trials in Europe. Methods: Considering a scalable implementation of EHR4CR solutions in up to 5-10% of Phase II, III and IV clinical trials to be commercially sponsored in Europe over 5 years, two potential market sizes were defined. The first has a European initial scope (i.e., for European clinical trials only), and the second has a European subsequent broader scope (also including European arms of global studies). Based on expert opinions, the EHR4CR initial scope target market was estimated to be 30% of the broader scope. Direct costs to clinical research sponsors were estimated under current practices, and with the EHR4CR platform. Uncertainty was managed using 100,000 Monte Carlo simulations. Results: Compared to current practices, the potential average 5-year savings with EHR4CR solutions for Phase II, III and IV commercially sponsored clinical trials in Europe were estimated at €175.5 m for the European initial scope market, and at €585.3 m for the European broader scope market. These results were confirmed by robust probabilistic sensitivity analyses. Conclusions: Compared to current practices, EHR4CR solutions appear cost-saving for primary sponsors of clinical trials. These results suggest that the potential for savings would increase with a broader adoption of EHR4CR solutions in Europe, and beyond.

Venturing into the bioeconomy: Professional Ideologies, Identity and Innovation

This book reports empirical material from three case studies in the pharmaceutical industry, the biotechnology industry and the domain of academic research. New technoscientific frameworks that have not yet translated into new therapies, in the future, may play a more central role in the late-modern society.This book reports empirical material from three case studies in the pharmaceutical industry, the biotechnology industry and the domain of academic research. New technoscientific frameworks that have not yet translated into new therapies, in the future, may play a more central role in the late-modern society.