# Improving eSource Site Start-Up Practices

## TL;DR

This paper explores ways to improve the setup of clinical trials using eSource software, which helps collect patient data more efficiently.

## Contribution

The study identifies key steps, challenges, and solutions for implementing eSource in clinical trial site start-ups.

## Key findings

- The most important challenges include identifying a site eSource champion and agreeing on an eSource approach.
- Top solutions involve using FHIR-standard electronic data and standardizing legal documents and readiness checklists.

## Abstract

eSource software that copies patient electronic health record data into a clinical trial electronic case report form holds promise for increasing data quality while reducing data collection, monitoring and source document verification costs. Integrating eSource into multicenter clinical trial start-up procedures could facilitate the use of eSource technologies in clinical trials.

We conducted a qualitative integrative analysis to identify eSource site start-up key steps, challenges that might occur in executing those steps, and potential solutions to those challenges. We then conducted a value analysis to determine the challenges and solutions with the greatest impacts for eSource implementation teams.

There were 16 workshop participants: 10 pharmaceutical sponsor, 3 academic site, and 1 eSource vendor representatives. Participants identified 36 Site Start-Up Key Steps, 11 Site Start-Up Challenges, and 14 Site Start-Up Solutions for eSource-enabled studies. Participants also identified 77 potential impacts of the Challenges upon the Site Start-Up Key Steps and 70 ways in which the Solutions might impact Site Start-Up Challenges. The most important Challenges were: (1) not being able to identify a site eSource champion and (2) not agreeing on an eSource approach. The most important Solutions were: (1) vendors accepting electronic data in the FHIR standard, (2) creating standard content for eSource-related legal documents, and (3) creating a common eSource site readiness checklist.

Site start-up for eSource-enabled multi-center clinical trials is a complex socio-technical problem. This study’s Start-Up Solutions provide a basic infrastructure for scalable eSource implementation.