Big Data Technologies Penetrate Patient Recruitment and Enrollment: Interview with TrialReach

TrialReach is a patient recruitment/enrollment technology and service that uses machine learning algorithms, in combination with patient networks to get eligible patients to the right trials.  While at IIR’s 24^th Annual Partnerships in Clinical Trials Event, I had the opportunity to interview Tom Krohn, Chief Development Officer, at TrialReach.  Krohn will describe the technology’s transition from Eli Lilly, and how the TrialReach Platform functions.

How and Why did Eli Lilly Establish a Partnership With TrialReach?

When at Lilly, we designed a technology platform to syndicate clinical trial content to patients.  It was part of our open innovation efforts and included an open “API” – an internet style interface to the clinicaltrials.gov data.  Our goal was to make it easier for patients to find and understand trials.  We did this by enabling others to creatively use our API to serve their end-users.  This included Lilly partners,  patient advocacy groups, technology companies and even our competitors.  While we had success, it became clear we needed to move to enhanced content, especially bringing order to trial eligibility criteria.  Did you know there are more than 1000 ways to say the patient can’t be pregnant in clinicaltrials.gov?!  Imagine being a patient or caregiver and trying to sort through hundreds of trials, one-by-one.  I don’t think it is going too far to say this is a disaster for patients.  I know – I live and breath this stuff - and I still find it hard to sift through the information when I’m asked to assist someone in finding a trial.

We have also heard from patients that they want more simplified, non-scientific summaries of the trials.  Sponsors do a good job of communicating their scientific design – but it is challenging for patients to understand.  They want simplified, lay summaries of the study overview.

To expand into scaled content, we faced constraints at Lilly; Lilly wasn’t able to take the risk of being an industry platform.  Lilly is in the drug development business, not industry platform business.  So we evaluated many options and chose TrialReach last fall given their aligned business model and complementary capabilities to our platform. The technology platform, along with continued support of the Patient to Trials consortium, are now integrated with TrailReach’s platform.  We’re bringing machine learning technology and search workflows to structure all eligibility and create a clinical trial matching service that is available freely for all patients.

How Does TrialReach Provide Patient Access to Studies?

We are aware of the challenges of driving patient traffic to a sponsor’s clinical trial recruitment websites; recruitment tends to be low through those channels.  TrialReach maximizes reach through pre-established partnerships with health information websites, patient advocacy groups and social media channels such as blogger networks.  We currently have 10’s of millions of monthly reach, and will soon be well above 100 million.  We are an internet scale company – for clinical trials.

Through our experience with social media and online advertising, we have learned how to target patients based on engagement tracking.  On health information websites, for instance, we advertise and prescreen patients through the TrialReach technology.  It’s one thing to have a click, it’s a very different thing to have an engagement level through to consent, so we model profiles of patients in specific diseases who are likely to consent, and we do targeted marketing through those platforms.  With patient advocacy groups, we do not want bias flowing through to their patients, so we allow them to use our API directly or embed our widget on their websites; this multi-trial prescreen approach allows patients to find a matching clinical trial through TrialReach – regardless of sponsor.

Can You Describe TrialReach’s Approach to Patient Matching?

The biggest challenge in online recruitment is how to find and enroll patients that meet a clinical trial’s eligibility criteria; a general diabetes advertisement isn’t going to recruit eligible patients.  Additionally, many online clinical trial outreach efforts are not patient friendly; the information you see on www.clinicaltrials.gov is not patient friendly.  And yet, ct.gov still receives 112 million page views per month!

TrialReach’s approach to solving these issues involves culling data from www.clinicaltrials.gov and using statistical, probability and machine learning algorithms – combined with human curation for quality control - to guide patients through a patient friendly prefeasibility questionnaire.  The prefeasibility questionnaire automatically turns complicated medical terms into easy to understand verbiage for patients, and can either be optimized based on the eligibility criteria for a single study (i.e., via health information websites), or in a drilldown fashion based on aggregated study eligibility criteria (i.e., via TrialReach’s new web widget through patient advocacy groups).  In turn, from a single study standpoint, this process targets eligible patients, whereas from a multi-trial perspective, patients are able to drill down from hundreds of trials to a few they are eligible for in their area. 

We launched a beta version for the diabetes therapeutic area with something like 780 recruiting studies in the US.  All of the eligibility is structured, and the user interface experience presents patients with questions that are automatically generated from eligibility criteria and helps them work their way through hundreds of studies, find and present the relevant and eligible ones.  It’s a pre-screener for hundreds of studies instead of a single study.  We will be launching therapeutic specific questionnaires for Alzheimer’s next, and we have a parallel stream for cancer (first one being lung cancer).  Our goal is to have ALL US recruiting studies in ALL therapeutic areas available through this model within a year.  It is a big goal, but patients are waiting.

Can you Describe TrialReach’s Referral Management Service?

TrialReach’s referral management service is a premium service available to sponsors.  Combined with our outreach campaign capability, our referral management service is a patient engagement service that intervenes with patients that are interested in a clinical trial; we walk eligible patients through the prescreening, screening and enrollment process.  This service brings in a validation level; we verify that the patient says who they are, we do some checking, as much as we can, we help them connect to the site, and we work with sites to make sure they pick up the patient.   There is a lot of attrition in patient recruitment; TrialReach’s Referral Management Service reduces attrition through engagement.

Another benefit of this service includes the fact that we can track the patient all the way through the recruitment and enrollment funnel.  By handholding patients through the funnel, we can identify areas where patients tend to fall out (i.e., recruitment, screening, consenting, etc.).  By understanding where patients fall out, we can assist the Sponsor by identifying bottlenecks in the recruitment and enrollment process.

Does TrialReach Offer Free Services?

TrialReach offers multiple free services.  All of our services are free for patients and organizations serving patients such as advocacy groups or bloggers.  Our goal is to serve patients at scale and believe strongly in helping patients more easily find, understand and engage in clinical trials.

For sponsors we also offer free services including ability to augment their studies with patient friendly summaries and additional study design facts that matter to patients. For example, during the study, is there a lung biopsy? Is there an MRI?  How many visits are required, and how long is the treatment?   We don’t change the original content, you can still see both, but, we strive to help patients get the answers they have about a study.  I like to say that we are separating Informed from Consent.  While one needs to be informed to consent, one doesn’t have to consent to be informed.  We want to remove the challenges and friction for patients to engage in clinical research before they have to travel to the site.

When the study team augments the content by doing a simplified summary and approves it, it toggles a switch to make it available in our network.  In our multi-trial pre-screener, we’ve heard from patients that they want the easy to understand studies at the top of the result list.   This positioning is helpful for patient engagement and enables early sponsor adopters to have their studies listed at the top of the search results list.  This augmentation capability is free to all sponsors and has also seen some traction with academic institutions; it’s free and generates exposure to their trials. 

For TrialReach, this augmented content service allows us to grow our networks and expand the reach of sponsor studies to more patients.  It’s a win-win.

In the end, it is about serving patients well.  We believe this is a paradigm shift for the industry and have much to offer both patients and sponsors.