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Published in: BMC Medical Research Methodology 1/2017

Open Access 01-12-2017 | Research article

Mobile electronic versus paper case report forms in clinical trials: a randomized controlled trial

Authors: Robert Fleischmann, Anne-Marie Decker, Antje Kraft, Knut Mai, Sein Schmidt

Published in: BMC Medical Research Methodology | Issue 1/2017

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Abstract

Background

Regulations, study design complexity and amounts of collected and shared data in clinical trials render efficient data handling procedures inevitable. Recent research suggests that electronic data capture can be key in this context but evidence is insufficient. This randomized controlled parallel group study tested the hypothesis that time efficiency is superior when electronic (eCRF) instead of paper case report forms (pCRF) are used for data collection. We additionally investigated predictors of time saving effects and data integrity.

Methods

This study was conducted on top of a clinical weight loss trial performed at a clinical research facility over six months. All study nurses and patients participating in the clinical trial were eligible to participate and randomly allocated to enter cross-sectional data obtained during routine visits either through pCRF or eCRF. A balanced randomization list was generated before enrolment commenced. 90 and 30 records were gathered for the time that 27 patients and 2 study nurses required to report 2025 and 2037 field values, respectively. The primary hypothesis, that eCRF use is faster than pCRF use, was tested by a two-tailed t-test. Analysis of variance and covariance were used to evaluate predictors of entry performance. Data integrity was evaluated by descriptive statistics.

Results

All randomized patients were included in the study (eCRF group n = 13, pCRF group n = 14). eCRF, as compared to pCRF, data collection was associated with significant time savings  across all conditions (8.29 ± 5.15 min vs. 10.54 ± 6.98 min, p = .047). This effect was not defined by participant type, i.e. patients or study nurses (F(1,112) = .15, p = .699), CRF length (F(2,112) = .49, p = .609) or patient age (Beta = .09, p = .534). Additional 5.16 ± 2.83 min per CRF were saved with eCRFs due to data transcription redundancy when patients answered questionnaires directly in eCRFs. Data integrity was superior in the eCRF condition (0 versus 3 data entry errors).

Conclusions

This is the first study to prove in direct comparison that using eCRFs instead of pCRFs increases time efficiency of data collection in clinical trials, irrespective of item quantity or patient age, and improves data quality.

Trial registration

Clinical Trials NCT02649907.
Literature
2.
go back to reference Jones CE, Munoz FM, Kochhar S, Vergnano S, Cutland CL, Steinhoff M, Black S, Heininger U, Bonhoeffer J, Heath PT. Guidance for the collection of case report form variables to assess safety in clinical trials of vaccines in pregnancy. Vaccine. 2016;34(49):6007–14.CrossRefPubMedPubMedCentral Jones CE, Munoz FM, Kochhar S, Vergnano S, Cutland CL, Steinhoff M, Black S, Heininger U, Bonhoeffer J, Heath PT. Guidance for the collection of case report form variables to assess safety in clinical trials of vaccines in pregnancy. Vaccine. 2016;34(49):6007–14.CrossRefPubMedPubMedCentral
3.
go back to reference Jha AK, Burke MF, DesRoches C, Joshi MS, Kralovec PD, Campbell EG, Buntin MB. Progress toward meaningful use: hospitals’ adoption of electronic health records. Am J Manag Care. 2011;17(12 Spec No.):SP117–24. Jha AK, Burke MF, DesRoches C, Joshi MS, Kralovec PD, Campbell EG, Buntin MB. Progress toward meaningful use: hospitals’ adoption of electronic health records. Am J Manag Care. 2011;17(12 Spec No.):SP117–24.
4.
go back to reference Holroyd-Leduc JM, Lorenzetti D, Straus SE, Sykes L, Quan H. The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence. J Am Med Inform Assoc. 2011;18(6):732–7.CrossRefPubMedPubMedCentral Holroyd-Leduc JM, Lorenzetti D, Straus SE, Sykes L, Quan H. The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence. J Am Med Inform Assoc. 2011;18(6):732–7.CrossRefPubMedPubMedCentral
5.
go back to reference Fleischmann R, Duhm J, Hupperts H, Brandt SA. Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study. J Neurol. 2015;262(3):532–40.CrossRefPubMed Fleischmann R, Duhm J, Hupperts H, Brandt SA. Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study. J Neurol. 2015;262(3):532–40.CrossRefPubMed
6.
go back to reference Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: Physicians’ perspective from a survey. JMIR mHealth uHealth. 2016;4(2):e70.CrossRefPubMedPubMedCentral Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: Physicians’ perspective from a survey. JMIR mHealth uHealth. 2016;4(2):e70.CrossRefPubMedPubMedCentral
7.
go back to reference Jones WS, Roe MT, Antman EM, Pletcher MJ, Harrington RA, Rothman RL, Oetgen WJ, Rao SV, Krucoff MW, Curtis LH, et al. The changing landscape of randomized clinical trials in cardiovascular disease. J Am Coll Cardiol. 2016;68(17):1898–907.CrossRefPubMed Jones WS, Roe MT, Antman EM, Pletcher MJ, Harrington RA, Rothman RL, Oetgen WJ, Rao SV, Krucoff MW, Curtis LH, et al. The changing landscape of randomized clinical trials in cardiovascular disease. J Am Coll Cardiol. 2016;68(17):1898–907.CrossRefPubMed
8.
go back to reference Welker JA. Implementation of electronic data capture systems: barriers and solutions. Contemp Clin Trials. 2007;28(3):329–36.CrossRefPubMed Welker JA. Implementation of electronic data capture systems: barriers and solutions. Contemp Clin Trials. 2007;28(3):329–36.CrossRefPubMed
9.
go back to reference Cleland J, Caldow J, Ryan D. A qualitative study of the attitudes of patients and staff to the use of mobile phone technology for recording and gathering asthma data. J Telemed Telecare. 2007;13(2):85–9.CrossRefPubMed Cleland J, Caldow J, Ryan D. A qualitative study of the attitudes of patients and staff to the use of mobile phone technology for recording and gathering asthma data. J Telemed Telecare. 2007;13(2):85–9.CrossRefPubMed
10.
go back to reference Borlawsky TB, Lele O, Jensen D, Hood NE, Wewers ME. Enabling distributed electronic research data collection for a rural Appalachian tobacco cessation study. J Am Med Inform Assoc. 2011;18(Suppl 1):i140–3.CrossRefPubMedPubMedCentral Borlawsky TB, Lele O, Jensen D, Hood NE, Wewers ME. Enabling distributed electronic research data collection for a rural Appalachian tobacco cessation study. J Am Med Inform Assoc. 2011;18(Suppl 1):i140–3.CrossRefPubMedPubMedCentral
11.
go back to reference Azad TD, Kalani M, Wolf T, Kearney A, Lee Y, Flannery L, Chen D, Berroya R, Eisenberg M, Park J, et al. Building an electronic health record integrated quality of life outcomes registry for spine surgery. J Neurosurg Spine. 2016;24(1):176–85.CrossRefPubMed Azad TD, Kalani M, Wolf T, Kearney A, Lee Y, Flannery L, Chen D, Berroya R, Eisenberg M, Park J, et al. Building an electronic health record integrated quality of life outcomes registry for spine surgery. J Neurosurg Spine. 2016;24(1):176–85.CrossRefPubMed
13.
go back to reference Bushnell DM, Martin ML, Parasuraman B. Electronic versus paper questionnaires: a further comparison in persons with asthma. J Asthma. 2003;40(7):751–62.CrossRefPubMed Bushnell DM, Martin ML, Parasuraman B. Electronic versus paper questionnaires: a further comparison in persons with asthma. J Asthma. 2003;40(7):751–62.CrossRefPubMed
14.
go back to reference Farnell DJ, Routledge J, Hannon R, Logue JP, Cowan RA, Wylie JP, Barraclough LH, Livsey JE, Swindell R, Davidson SE. Efficacy of data capture for patient-reported toxicity following radiotherapy for prostate or cervical cancer. Eur J Cancer. 2010;46(3):534–40.CrossRefPubMed Farnell DJ, Routledge J, Hannon R, Logue JP, Cowan RA, Wylie JP, Barraclough LH, Livsey JE, Swindell R, Davidson SE. Efficacy of data capture for patient-reported toxicity following radiotherapy for prostate or cervical cancer. Eur J Cancer. 2010;46(3):534–40.CrossRefPubMed
15.
go back to reference Jamison RN, Raymond SA, Levine JG, Slawsby EA, Nedeljkovic SS, Katz NP. Electronic diaries for monitoring chronic pain: 1-year validation study. Pain. 2001;91(3):277–85.CrossRefPubMed Jamison RN, Raymond SA, Levine JG, Slawsby EA, Nedeljkovic SS, Katz NP. Electronic diaries for monitoring chronic pain: 1-year validation study. Pain. 2001;91(3):277–85.CrossRefPubMed
16.
go back to reference Dupont A, Wheeler J, Herndon JE 2nd, Coan A, Zafar SY, Hood L, Patwardhan M, Shaw HS, Lyerly HK, Abernethy AP. Use of tablet personal computers for sensitive patient-reported information. J Support Oncol. 2009;7(3):91–7.PubMed Dupont A, Wheeler J, Herndon JE 2nd, Coan A, Zafar SY, Hood L, Patwardhan M, Shaw HS, Lyerly HK, Abernethy AP. Use of tablet personal computers for sensitive patient-reported information. J Support Oncol. 2009;7(3):91–7.PubMed
17.
go back to reference Haller G, Haller DM, Courvoisier DS, Lovis C. Handheld vs. laptop computers for electronic data collection in clinical research: a crossover randomized trial. J Am Med Inform Assoc. 2009;16(5):651–9.CrossRefPubMedPubMedCentral Haller G, Haller DM, Courvoisier DS, Lovis C. Handheld vs. laptop computers for electronic data collection in clinical research: a crossover randomized trial. J Am Med Inform Assoc. 2009;16(5):651–9.CrossRefPubMedPubMedCentral
18.
go back to reference Dillon DG, Pirie F, Rice S, Pomilla C, Sandhu MS, Motala AA, Young EH. African Partnership for Chronic Disease R: open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa. J Clin Epidemiol. 2014;67(12):1358–63.CrossRefPubMedPubMedCentral Dillon DG, Pirie F, Rice S, Pomilla C, Sandhu MS, Motala AA, Young EH. African Partnership for Chronic Disease R: open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa. J Clin Epidemiol. 2014;67(12):1358–63.CrossRefPubMedPubMedCentral
19.
go back to reference Nahm M, Shepherd J, Buzenberg A, Rostami R, Corcoran A, McCall J, Pietrobon R. Design and implementation of an institutional case report form library. Clin Trials. 2011;8(1):94–102.CrossRefPubMed Nahm M, Shepherd J, Buzenberg A, Rostami R, Corcoran A, McCall J, Pietrobon R. Design and implementation of an institutional case report form library. Clin Trials. 2011;8(1):94–102.CrossRefPubMed
20.
go back to reference Schweitzer M, Oberbichler S. Requirements for evidence-based templates in electronic case report forms. Stud Health Technol Inform. 2016;223:142–9.PubMed Schweitzer M, Oberbichler S. Requirements for evidence-based templates in electronic case report forms. Stud Health Technol Inform. 2016;223:142–9.PubMed
21.
go back to reference Njuguna HN, Caselton DL, Arunga GO, Emukule GO, Kinyanjui DK, Kalani RM, Kinkade C, Muthoka PM, Katz MA, Mott JA. A comparison of smartphones to paper-based questionnaires for routine influenza sentinel surveillance, Kenya, 2011–2012. BMC Med Inform Decis Making. 2014;14:107.CrossRef Njuguna HN, Caselton DL, Arunga GO, Emukule GO, Kinyanjui DK, Kalani RM, Kinkade C, Muthoka PM, Katz MA, Mott JA. A comparison of smartphones to paper-based questionnaires for routine influenza sentinel surveillance, Kenya, 2011–2012. BMC Med Inform Decis Making. 2014;14:107.CrossRef
22.
go back to reference Le Jeannic A, Quelen C, Alberti C, Durand-Zaleski I, CompaRec I. Comparison of two data collection processes in clinical studies: electronic and paper case report forms. BMC Med Res Methodol. 2014;14:7.CrossRefPubMedPubMedCentral Le Jeannic A, Quelen C, Alberti C, Durand-Zaleski I, CompaRec I. Comparison of two data collection processes in clinical studies: electronic and paper case report forms. BMC Med Res Methodol. 2014;14:7.CrossRefPubMedPubMedCentral
23.
go back to reference Pavlovic I, Kern T, Miklavcic D. Comparison of paper-based and electronic data collection process in clinical trials: costs simulation study. Contemp Clin Trials. 2009;30(4):300–16.CrossRefPubMed Pavlovic I, Kern T, Miklavcic D. Comparison of paper-based and electronic data collection process in clinical trials: costs simulation study. Contemp Clin Trials. 2009;30(4):300–16.CrossRefPubMed
24.
go back to reference Kinnula S, Renko M, Tapiainen T, Pokka T, Uhari M. Post-discharge follow-up of hospital-associated infections in paediatric patients with conventional questionnaires and electronic surveillance. J Hosp Infect. 2012;80(1):13–6.CrossRefPubMed Kinnula S, Renko M, Tapiainen T, Pokka T, Uhari M. Post-discharge follow-up of hospital-associated infections in paediatric patients with conventional questionnaires and electronic surveillance. J Hosp Infect. 2012;80(1):13–6.CrossRefPubMed
25.
go back to reference Campbell N, Ali F, Finlay AY, Salek SS. Equivalence of electronic and paper-based patient-reported outcome measures. Qual Life Res. 2015;24(8):1949–61.CrossRefPubMed Campbell N, Ali F, Finlay AY, Salek SS. Equivalence of electronic and paper-based patient-reported outcome measures. Qual Life Res. 2015;24(8):1949–61.CrossRefPubMed
26.
go back to reference Rorie DA, Flynn RWV, Grieve K, Doney A, Mackenzie I, MacDonald TM, et al. Electronic case report forms and electronic data capture within clinical trials and pharmacoepidemiology. British journal of clinical pharmacology. 2017;83(9):1880-95. Rorie DA, Flynn RWV, Grieve K, Doney A, Mackenzie I, MacDonald TM, et al. Electronic case report forms and electronic data capture within clinical trials and pharmacoepidemiology. British journal of clinical pharmacology. 2017;83(9):1880-95.
27.
go back to reference Eisenstein EL, Collins R, Cracknell BS, Podesta O, Reid ED, Sandercock P, Shakhov Y, Terrin ML, Sellers MA, Califf RM, et al. Sensible approaches for reducing clinical trial costs. Clin Trials. 2008;5(1):75–84.CrossRefPubMed Eisenstein EL, Collins R, Cracknell BS, Podesta O, Reid ED, Sandercock P, Shakhov Y, Terrin ML, Sellers MA, Califf RM, et al. Sensible approaches for reducing clinical trial costs. Clin Trials. 2008;5(1):75–84.CrossRefPubMed
28.
go back to reference World Medical A. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef World Medical A. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.CrossRef
29.
go back to reference Salaffi F, Gasparini S, Ciapetti A, Gutierrez M, Grassi W. Usability of an innovative and interactive electronic system for collection of patient-reported data in axial spondyloarthritis: comparison with the traditional paper-administered format. Rheumatology (Oxford). 2013;52(11):2062–70.CrossRef Salaffi F, Gasparini S, Ciapetti A, Gutierrez M, Grassi W. Usability of an innovative and interactive electronic system for collection of patient-reported data in axial spondyloarthritis: comparison with the traditional paper-administered format. Rheumatology (Oxford). 2013;52(11):2062–70.CrossRef
30.
go back to reference Walther B, Hossin S, Townend J, Abernethy N, Parker D, Jeffries D. Comparison of electronic data capture (EDC) with the standard data capture method for clinical trial data. PLoS One. 2011;6(9):e25348.CrossRefPubMedPubMedCentral Walther B, Hossin S, Townend J, Abernethy N, Parker D, Jeffries D. Comparison of electronic data capture (EDC) with the standard data capture method for clinical trial data. PLoS One. 2011;6(9):e25348.CrossRefPubMedPubMedCentral
31.
go back to reference Booth M. Assessment of physical activity: an international perspective. Res Q Exerc Sport. 2000;71(2 Suppl):S114–20.CrossRefPubMed Booth M. Assessment of physical activity: an international perspective. Res Q Exerc Sport. 2000;71(2 Suppl):S114–20.CrossRefPubMed
32.
go back to reference Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.CrossRefPubMedPubMedCentral Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.CrossRefPubMedPubMedCentral
33.
go back to reference Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythm. 2003;18(1):80–90.CrossRef Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythm. 2003;18(1):80–90.CrossRef
34.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
35.
go back to reference Ali S, Powers R, Beorse J, Noor A, Naureen F, Anjum N, Ishaq M, Aamir J, Anderson R. ODK scan: digitizing data collection and impacting data management processes in Pakistan’s tuberculosis control program. Futur Internet. 2016;8(4):51.CrossRef Ali S, Powers R, Beorse J, Noor A, Naureen F, Anjum N, Ishaq M, Aamir J, Anderson R. ODK scan: digitizing data collection and impacting data management processes in Pakistan’s tuberculosis control program. Futur Internet. 2016;8(4):51.CrossRef
37.
go back to reference Thriemer K, Ley B, Ame SM, Puri MK, Hashim R, Chang NY, Salim LA, Ochiai RL, Wierzba TF, Clemens JD, et al. Replacing paper data collection forms with electronic data entry in the field: findings from a study of community-acquired bloodstream infections in Pemba, Zanzibar. BMC Res Notes. 2012;5:113.CrossRefPubMedPubMedCentral Thriemer K, Ley B, Ame SM, Puri MK, Hashim R, Chang NY, Salim LA, Ochiai RL, Wierzba TF, Clemens JD, et al. Replacing paper data collection forms with electronic data entry in the field: findings from a study of community-acquired bloodstream infections in Pemba, Zanzibar. BMC Res Notes. 2012;5:113.CrossRefPubMedPubMedCentral
38.
go back to reference Robotham D, Satkunanathan S, Doughty L, Wykes T. Do we still have a digital divide in mental health? A five-year survey follow-up. J Med Internet Res. 2016;18(11):e309.CrossRefPubMedPubMedCentral Robotham D, Satkunanathan S, Doughty L, Wykes T. Do we still have a digital divide in mental health? A five-year survey follow-up. J Med Internet Res. 2016;18(11):e309.CrossRefPubMedPubMedCentral
39.
go back to reference Food and Drug Administration (FDA). Electronic source data in clinical investigations. In: Guidance for industry. Silver Spring: U.S. Department of Health and Human Services; 2013. p. 1–11. Food and Drug Administration (FDA). Electronic source data in clinical investigations. In: Guidance for industry. Silver Spring: U.S. Department of Health and Human Services; 2013. p. 1–11.
40.
go back to reference El Fadly A, Lucas N, Rance B, Verplancke P, Lastic PY, Daniel C. The REUSE project: EHR as single datasource for biomedical research. Stud Health Technol Inform. 2010;160(Pt 2):1324–8.PubMed El Fadly A, Lucas N, Rance B, Verplancke P, Lastic PY, Daniel C. The REUSE project: EHR as single datasource for biomedical research. Stud Health Technol Inform. 2010;160(Pt 2):1324–8.PubMed
Metadata
Title
Mobile electronic versus paper case report forms in clinical trials: a randomized controlled trial
Authors
Robert Fleischmann
Anne-Marie Decker
Antje Kraft
Knut Mai
Sein Schmidt
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2017
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-017-0429-y

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