August 16, 2019: Introducing the Digital Medicine Society (Andy Coravos, MBA, Jen Goldsack, MS, MBA)

Speakers

Andy Coravos
CEO, Elektra Labs
Fellow, Harvard-MIT Center for Regulatory Science
Co-founder, Digital Medicine Society (DiMe)

Jen Goldsack, MS, MBA
Interim Executive Director, DiMe
Portfolio, Strategy & Ops, HealthMode

Topic

Introducing the Digital Medicine Society

Keywords

Digital medicine; Mobile health; Digital technologies; Wearable health devices; Connected devices; Cybersecurity

Key Points

  • Digital medicine is a rapidly evolving field that is by nature multidisciplinary and introduces new considerations for the healthcare community.
  • The Digital Medicine Society (DiMe) sits at the intersection of two communities: healthcare and technology. The Society is helping to move the field of digital medicine forward by developing a common language for diverse stakeholders from engineers and ethicists to payers and providers.
  • The U.S. healthcare system has strong protections for patients’ biospecimens like blood or genomic data, but what about digital specimens?

Discussion Themes

Are digital medical technologies worthy of the trust we place in them?

Should there be a Hippocratic Oath for manufacturers, organizations, and individuals delivering care through connected medical devices?

Read more about the emerging field of digital medicine and learn more about the Digital Medicine Society (DiMe), the professional home for those who practice and develop products in the digital era of medicine.

Tags

#DigitalMedicine, #pctGR, @Collaboratory1, @_DiMeSociety

August 9, 2019: Open Science: Are we there yet? (Adrian Hernandez, MD)

Speaker

Adrian Hernandez, MD
Professor of Medicine
Vice Dean for Clinical Research
Duke University, School of Medicine

Topic

Open Science: Are We There Yet?

Keywords

Open science; Data sharing; Secondary analyses; Research collaboration

Key Points

  • Open science involves the responsible sharing of research data for the purpose of scientific advancement, integrity, and transparency.
  • Various stakeholders have made progress toward sharing clinical trial data, including:
  • Guiding principles of open science include appropriate access to research information; proper oversight with minimum barriers to data access; maintaining utility of data; an expectation that results of shared data will similarly be shared; and acknowledgment of those who contribute original data.
  • Despite efforts at supporting open science, no academic institution has an open science policy yet.

Discussion Themes

Open science remains an important goal to build trust and expand knowledge.

Data sharing is not a traditional measure of academic success. What incentives would need to change in order to support open science?

Tags

#OpenScience, #DataSharing, #pctGR, @Collaboratory1, @texhern

August 2, 2019: AI and the Future of Psychiatry (Murali Doraiswamy, MBBS)

Speaker

Murali Doraiswamy, MBBS
Professor of Psychiatry and Behavioral Sciences
Duke School of Medicine

Topic

AI and the Future of Psychiatry

Keywords

Artificial intelligence; Machine learning; Psychiatry; Ethical adoption of technologies; Mental health; Wearables; Mobile health

Key Points

  • There is growing evidence from randomized controlled trials of the efficacy of using digital tools in mental health diagnosis and treatment.
  • Could artificial intelligence (AI) and machine learning technologies be used to:
    • Reduce the stigma associated with mental health treatment?
    • Predict the risk for future suicide?
    • Detect Alzheimer’s years before diagnosis?
  • Categories of AI applications include low-risk apps that measure but do not diagnose, and apps used in diagnosis or treatment that must meet the same high standards of evidence as medications.
  • Clinicians still struggle with how to integrate patient data from wearable devices. AI technology might help if it could be used to synthesize the data into a risk profile for an individual.

Discussion Themes

What are the roles of stress, exercise, and sleep in mental health, and can autonomic data from wearables help explain the variance in mental health symptoms?

To develop evidence thresholds for AI, we need larger scale public-private partnerships as well as pragmatic trials addressing key clinical questions.

Read more from Dr. Doraiswamy in How to Use Technology Ethically to Increase Access to Mental Healthcare.
Tags

#AI, #pctGR, @Collaboratory1

July 26, 2019: Digital in Trials: Improving Participation and Enabling Novel Endpoints (Craig H. Lipset)

Speaker

Craig H. Lipset
Former Head of Clinical Innovation, Pfizer

Topic

Digital in Trials: Improving Participation and Enabling Novel Endpoints

Keywords

Digital tools; Clinical trials; Participant experience; Patient engagement; Clinical Trials Transformation Initiative

Key Points

  • To improve trial participation, start by understanding the user/consumer; ie, the trial participant and his or her trial experience.
  • Digital improvements in clinical trials can involve these incremental steps:
    • Study planning that is data-driven, crowdsourced, and informed by artificial intelligence
    • Patient engagement that implements electronic consent, flexibility in location, digital concierge support, and data ownership
    • Study conduct that integrates remote monitoring, digital biomarkers, and electronically sourced data
    • Analysis and reporting that is automated and includes dissemination to trial participants

Discussion Themes

Will digital tools in medicine development enable improvement, disruption, or displacement?

Digital tools in development focus on breaking down barriers to participation, using digital to improve existing measurement or enable new endpoints, and automating processes and tasks while improving quality.

Tags

#pctGR, @Collaboratory1

July 19, 2019: Misinformation as a Source of Complication for Clinical Trials (Brian Southwell, PhD)

Speaker

Brian Southwell, PhD
Senior Director, Science in the Public Sphere, RTI International
Duke-RTI Scholar, Duke Forge, Duke University

Topic

Misinformation as a Source of Complication for Clinical Trials

Keywords

Behavioral sciences; Health behavior; Health knowledge, attitudes, practice; Misinformation; Patient selection; Treatment refusal

Key Points

  • Both lack of information and misinformation likely reduce participation in clinical trials.
  • Many sources of misinformation engender distrust of treatment, including inaccurate online sources, questionable sources trying to sell products, some health education from advocacy organizations, and even conventional news sources.
  • It is important to understand misinformation, how it emerges, its consequences, and the unintended effects of correcting it.
  • Our needs for social connection and hope for the future make us vulnerable to medical misinformation.
  • Studies support the corrective potential of direct rebuttal and large-scale exposure to accurate information.
  • It is important for clinicians and researchers to monitor and understand patients’ information environments and to build and maintain trust between healthcare systems and patients.

Discussion Themes

Emerging literature on misinformation highlights our humanity. Our needs for social connection and hope for the future make us vulnerable to misinformation.

Correcting misinformation is difficult and requires understanding of human psychology and patients’ information environments, and promotion of the shared interests of patients and healthcare systems.

July 12, 2019: medRxiv: A Paradigm Shift in Disseminating Clinical and Public Health Research (Harlan Krumholz, MD, SM, Joseph Ross, MD, MHS)

Speakers

Harlan M. Krumholz, MD, SM
Harold H. Hines, Jr. Professor of Medicine and Public Health
Yale University

Joseph S. Ross, MD, MHS
Associate Professor of Medicine and Public Health
Yale University

Topic

medRxiv: A Paradigm Shift in Disseminating Clinical and Public Health Research

Keywords

Open science; Clinical research dissemination; Preprints; medRxiv preprint server

Key Points

  • medRxiv (med archive) is a server for health science preprints. It is a free service to the research community, managed in partnership with BMJ and Yale.
  • Benefits of preprints in medicine include early sharing of new information; enabling less “publishable” studies to be more readily available; and facilitating replication and reproducibility studies.
  • medRxiv submissions require:
    • Following ICMJE guidance, including author names, contact info, affiliation
    • Funding and competing interests statements
    • Statement of IRB or ethics committee approval
    • Study registration (ClinicalTrials.gov or other ICMJE approved registry for trials, PROSPERO for reviews) or link to protocol
    • Data sharing availability statement
    • EQUATOR Network reporting guidelines checklists
  • The medRxiv preprint server urges caution in using and reporting preprints, and includes language explaining that preprints are preliminary reports of work that have not been peer-reviewed, should not be relied on to guide clinical practice or health-related behaviors, and should not be reported in news media as established information.

Discussion Themes

Preprint servers do not replace, but rather complement, peer review.

Preprint has the potential for being a vehicle for high-quality but “negative” results. If we teach students that a negative result is also a good result, providing an avenue for us to walk-the-talk more easily via open communication seems largely positive despite the limitations.

Read more about medRxiv.

Tags

#pctGR, @Collaboratory1, @jsross119, @hmkyale

June 28, 2019: Moving Beyond Return of Research Results to Return of Value (Consuelo Wilkins, MD, MSCI)

Speaker

Consuelo H. Wilkins, MD, MSCI
Vice President for Health Equity, Vanderbilt University Medical Center
Executive Director, Meharry-Vanderbilt Alliance

Topic

Moving Beyond Return of Research Results to Return of Value

Keywords

Health outcomes; Research results; Patient preferences; Value of information

Key Points

  • In returning value to research participants, results are shared with added context, are prioritized by each participant, include specific suggestions for relevant actions, and incorporate participant recommendations and preferences.
  • Data captured for research purposes, including EHR data, vital signs, and genetic data, can be repurposed and reoriented for study participants.
  • Participants are more likely to trust research if results are returned—and they are more likely to participate again.

Discussion Themes

We need to return study results that are informed by participants, and we need to design approaches for accessing and understanding results that participants will want to use.

We should think carefully about risk mitigation when returning research results for which there is a clear next step or action for the participant.

Read more about understanding what information is valued by research participants in a recent article by Dr. Wilkins and colleagues in Health Affairs.

Tags

#pctGR, @Collaboratory1, @drchwilkins, @vumchealth

June 14, 2019: Good Clinical Practice Guidance and Pragmatic Trials: Balancing the Best of Both Worlds in the Learning Health System (Robert Mentz, MD)

Speaker

Robert J. Mentz, MD, FACC, FAHA, FHFSA
Associate Professor
Director, Duke Cooperative Cardiovascular Society
Associate Program Director, Duke Cardiovascular Disease Fellowship
Duke University Medical Center and Duke Clinical Research Institute

Topic

Good Clinical Practice Guidance and Pragmatic Trials: Balancing the Best of Both Worlds in the Learning Health System

Keywords

International Council for Harmonization (ICH); Good clinical practice (GCP); Learning health system; Pragmatic clinical trials; Institutional review board (IRB); Research oversight; Regulatory issues; Quality by design (QbD)

Key Points

  • Good clinical practice (GCP) guidance details the responsibilities, procedures, and recording that are necessary for appropriate trial conduct; for example, conducting the trial in accordance with an IRB-approved protocol with appropriate adverse event monitoring and reporting.
  • There is an urgent need to streamline randomized trials. Key obstacles are lack of transparency, lack of representativeness, and lack of evidence of competence.
  • In the United States, clinical investigators must abide by guidance from FDA, HHS, and ICH-GCP. Yet it is hard for investigators to keep track and to know how GCP applies to their study.
  • GCP as an overall construct is useful, but it does not deal well with issues particular to pragmatic trials or trials outside the FDA-regulated world.

Discussion Themes

With embedded pragmatic trials, informed consent is more nuanced. New considerations and approaches for consent have arisen since ICH GCP first came into effect.

Establishing quality by design will take time, effort, and educating IRBs to understand how QbD can be used to avoid errors in a trial and collect data that is fit-for-purpose.

It’s crucial that trials address an important question, answer that question reliably, and keep participants safe.

Read more about Dr. Mentz’s study of GCP and pragmatic trials.

Tags

#pctGR, @Collaboratory1, @RobMentz

June 7, 2019: In Dreams Begin Responsibilities: Data Science as a Service—Using AI to Risk Stratify a Medicare Population and Build a Culture (Erich Huang, MD, PhD)

Speaker

Erich S. Huang, MD, PhD
Co-Director, Duke Forge
Departments of Biostatistics & Bioinformatics and Surgery
Duke University School of Medicine

Topic

In Dreams Begin Responsibilities: Data Science as a Service—Using AI to Risk Stratify a Medicare Population and Build a Culture

Keywords

Data science; Data liquidity; Data standards; Machine learning; Duke Forge; Application programming interface; Artificial intelligence

Key Points

  • Duke Forge focuses on bringing the best methodological approaches to actionable data problems in health. It is motivated by a framework of value-based healthcare to address societal inequities in health.
  • Essential components to building a data science culture include clinical subject matter expertise, quantitative and methodological expertise, and software architecture and engineering expertise, along with interoperable tools and applications.
  • Like freight shipping containers, health-relevant data needs standardized containers that make any type of data easy to pack, grab, combine, and move around. The aim should be to build a “data liquidity ecosystem” equivalent to freighters, cranes, trains, and trucks that facilitate the logistics of health data transport.

Discussion Themes

If we’re trying to build an ecosystem, then the electronic health record (EHR) platform needs to be evaluated by whether it is truly participatory in this ecosystem. If not, then its deficiencies must be remediated.

The faster we can move to the cloud and use building blocks that “snap” together, the faster we can get answers. We want to be building applications instead of infrastructure.

Algorithms don’t have ethics; some have hidden biases. Algorithms need to be scrutinized and tested for such biases. They also must be secured so they cannot be manipulated.

Read more about Duke Forge and check out articles on the blog.

Tags

#pctGR, @Collaboratory1, @DukeForge

May 31, 2019: Adapting Clinical Trial Design to Meet the Needs of Learning Health Systems (Harriette Van Spall, MD, MPH)

Speaker

Harriette G.C. Van Spall, MD, MPH, FRCPC
Associate Professor of Medicine
Department of Medicine, Division of Cardiology
Department of Health Research Methods, Evidence, and Impact
McMaster University
Population Health Research Institute

Topic

Adapting Clinical Trial Design to Meet the Needs of Learning Health Systems

Keywords

Learning health system; Pragmatic clinical trial; Patient-Centered Care Transitions in Heart Failure (PACT-HF); Heart failure; Stepped-wedge cluster trial

Key Points

  • Characteristics of a learning health system include:
    • Possessing a culture of knowledge and quality improvement
    • Encouraging research innovation by embedding research into clinical practice and generating knowledge at the point of care
    • Harnessing data from electronic health records and claims/administrative databases
    • Fostering trust between research and clinical teams
    • Engaging patients, clinicians, and key stakeholders
  • The Patient-Centered Care Transitions in Heart Failure (PACT-HF) trial evaluated the effectiveness of a group of transitional care services in patients hospitalized for HF within a publicly funded healthcare system.
  • Challenges of a learning health system include integrating care, intervention, and communications across silos; streamlining workflow; preventing “contamination” of usual care; and the limited interoperability of EHRs and slow updates to claims/administrative datasets.

Discussion Themes

Efficacy in explanatory randomized clinical trials (RCTs) does not equate to effectiveness in real-world settings.

Decisions about implementation of an intervention are not made “live”; you must wait until the study has ended, all the data are available for analysis, and analysis is complete before you can inform decision-maker partners about the risks and benefits of the intervention.

Read more about the PACT-HF study and results in JAMA Network (Van Spall et al. 2019)

Tags

#pctGR, @Collaboratory1