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Technology & Best Practices
for Recruitment
Nariman A. Nasser, Director
UCSF Participant Recruitment Service
SOCIAL MEDIA & EMERGING
TECHNOLOGIES
Technology and Best Practices for Recruitment
What is
 Social Media?
The use of web-based and
mobile technologies to turn
   communication into
   interactive dialogue
1. Collaborative projects
2. Blogs and Microblogs
3. Content communities
4. Social networking sites
5. Virtual game worlds
6. Virtual communities



Kaplan and Haenlein, Business Horizons, 2010
The Power of Social Media

• Recommendations by family/peers are more
  influential
• Reach wide number of motivated/interested
  individuals in a short time
• Encourages empowerment and proactive behavior
• Able to communicate in real-time
• Ideal for AE reporting and post-marketing
  surveillance (FDA/NIH Safety Reporting Portal)
Clinical Trials Networking Sites
The Unwieldy Power of Social Media
• Unless social media is used for real-time
  communication it is no different than a
  traditional media advertisement
• Real-time communication in the context of
  clinical trials recruiting must be carefully
  moderated
• FDA regulations are not conducive to brevity,
  no guidance to date (Novartis widget incident
  failed to communicate risk information,
  implies superiority)
Emerging Technologies

• Electronic personal health records (Google
  Health, HealthVault)
• Research volunteer registries (Volunteers for
  Health, ResearchMatch.org, TrialX)
• Electronic communication methods (text
  messaging, emailing health professionals,
  online screening tools)
• Telemedicine
TEXT MESSAGING FOR
RECRUITMENT
Mobile phones are changing the way people
   interact with the world around them
                 MOBILE FACTS                                                         POTENTIAL
           5.5 billion Global Subscribers*                         Mobile devices are now practically ubiquitous

   Penetration rates >80%* in most countries                    Worldwide Tool - large metropolitan areas to rural
          (US = 285M subs or 91%)                                              developing world

         Mobile Phone within arms reach                                Mobile is the most effective and natural
     of average users for 19 hours per day †                           way to maintain contact with clinical trial
                                                                                     participants
   Mobile phone users read messages within
            15 minutes of receipt†                                      Mobile communications are immediate,
                                                                               verifiable and actionable

            Mobile phone users respond
                within 60 minutes†                                       Clinical trial participants will use their
                                                                         mobile phones to provide information
   Average mobile phone users send/receive
                                                                                      to clinical sites
   4x as many text messages as voice calls†


•* Merrill Lynch Q3-2009/CTIA 2010 † Nielsen Q4-2008/10 ‡ Luth Research 2009.
Teens text, and so do their parents


                           parents text twice as
                            much as they call
SMS Recruitment – Data points

70% prefer to inquire via text message
90% response rate = highly engaged
Significant ROI
  3 months traditional method followed by 3 months with text messaging
     • Cost per Response decreased by 15%
     • Cost per Referral decreased by 32%
     • ROI > 650%



 OmniScience Mobile
100%
                 80%
                 60%                           Call
                 40%                           Center
                 20%                           Text
                  0%                           Messaging




                       Day 1

                               Day 2

                                       Day 3
      60% of those who use SMS are referred
“I contacted a subject who responded by text message and it
went great! She is scheduled for a visit within the week.” study
coordinator within 2 hours of receipt


“…it was very easy to maneuver.” anonymous patient
SMS for Recruitment
Technology and Best Practices for Recruitment
How NOT to Run an SMS Campaign
MOBILE APPS FOR
RECRUITMENT & RETENTION
Mobile Apps for Recruitment Have Limitations
• Limited Reach
   – Smartphones only
   – Used by only 36% of US mobile subscribers / 14% international subscribers

• Expensive
   – software app must support all major platforms: iOS, Android, Windows, RIM,
     Nokia
   – significant cost for development & maintenance

• Highly Inefficient as Direct Response option – Promotional
  materials driving traffic to an app there are too many steps:
   1.   Go to your phone’s app store
   2.   Find our app
   3.   Download it
   4.   Figure out where the app is on your phone
   5.   Click on the app to learn more about this study
Reference Apps Don’t Really Generate Referrals
Clinical Trials Mobile app




Who will take the time to find this app and use it to search
                     for clinical trials?
QR CODES
The Good and the Bad


• Inexpensive
• Only work for smartphone users
• Few have incorporated QR scanning into behavior
• Execution is tricky
   – You can’t remember a QR code and ‘text’ it later
   – Challenging for outdoor advertising



                            21
The Ugly



• No cell signal in NYC
  subway


• Creative design blocks
  code
Other Technologies

VOLUNTEER REGISTRIES &
RECRUITMENT PROTOCOLS
San Francisco General Hospital
              Recruitment Pilot

• Investigators want to extend their reach
• 1 year pilot program for 10 studies
  – 24/7 staffed phone line
  – Weekly craigslist posting
  – Outgoing calls to follow-up as needed

• Outcomes
  – 692 volunteers (validated unique)
  – 25% contacted for screening visits
  – BMI was most beneficial data field for search criteria
Airway Clinical Research Center
                 Asthma Recruitment Database

    • Local disease-
      specific database
    • Used as recruitment
      protocol/registry
        – Characterize asthma
          severity
        – Recruit for current studies
          real-time
        – Register for contact
          regarding future studies –
          already prequalified




•UCSF Airway Clinical Research Center (ACRC)
Recruitment Trends by County

                                               San Francisco   52%
                                               Alameda         16%
                                               San Mateo       11%
                                               Contra Costa    7%
                                               Santa Clara     4%
                                               Marin           3%
                                               Sonoma          2%
                                               Solano          1%
•UCSF Airway Clinical Research Center (ACRC)
BEST PRACTICES
Performing Initial Analyses

Study Design
   Site-specific protocols for study-specific and SOC
    procedures
   Placebo arms, excessive inclusion/exclusion criteria

Site-specific
   Staff resources
   Location(s): accessibility, interoperability, features /
    disadvantages

Competing Trials
Planning & Budgeting



Screen Failure Rate


Budget for the unexpected
  Design revisions
  Increased production & shipping costs over time
  Protocol revisions impacting recruiting
   methods/materials
Technology and Best Practices for Recruitment
Implementing the Plan

Staged approach       Communication Plan
                          Sponsor/Site Staff
Multiple
                          Primary contacts
 simultaneous
                          Secondary contacts
 advertising efforts
Plan on changing      Identify screening
 your plan – analyze    appointment
 relatively often       schedule workflow,
                        tools and conflicts
Ensuring High-Quality Participants

 Start by casting a wide net
           Think about a wide number of things or people when choosing the
                              thing or person you want*




 Don’t skip the prescreening step


 Ask the right questions at the right stage of
  the recruitment process
*Idioms by The Free Dictionary
Monitoring Progress



Set realistic expectations up front
Identify benchmarks for success/failure
Simple tracking tools go a long way
Receiving logs & reports is not enough –
 they have to mean something and be
 actionable
THE UCSF PARTICIPANT
RECRUITMENT SERVICE
Create a centralized service to facilitate the enrollment of research
              participants into UCSF clinical studies
       Assume a large part of the burden of recruitment efforts


       Provide expertise in recruitment materials development


       Ensure materials meet regulatory guidelines and requirements


       Offer an economy of scale for many recruitment activities


       Use established vendor relationships


       Increase the volume of high quality volunteers


       Facilitate a wider catchment and more robust networks
Recruitment Analysis and Planning

Robust recruitment plan
  Analysis of recruitment landscape
     Protocol complexities, procedures, SOC
     Competing studies
     Geographic/demographic population
     Marketing & Outreach methodologies
  Suggested strategies
  Timelines
  Budgets for suggested strategies
Cohort ID and Direct Mail

Identify cohorts from inpatient medical
 records (UCare and ThREDS)
  ICD-9 codes
  Demographics

CHR modification
Coordinate data extract services from ARS
Print and mail direct mail letters to cohort
Recruitment Materials Toolkit
Technology and Best Practices for Recruitment
Future Services/Resources

Recruitment Plan Implementation
  Centralized call center, text messaging, online
   screeners
  Marketing & outreach
  Referral networks

Searchable database of actively recruiting
 studies – matching
Real-time recruitment from EMR
THANK YOU

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Technology and Best Practices for Recruitment

  • 1. Technology & Best Practices for Recruitment Nariman A. Nasser, Director UCSF Participant Recruitment Service
  • 2. SOCIAL MEDIA & EMERGING TECHNOLOGIES
  • 4. What is Social Media? The use of web-based and mobile technologies to turn communication into interactive dialogue 1. Collaborative projects 2. Blogs and Microblogs 3. Content communities 4. Social networking sites 5. Virtual game worlds 6. Virtual communities Kaplan and Haenlein, Business Horizons, 2010
  • 5. The Power of Social Media • Recommendations by family/peers are more influential • Reach wide number of motivated/interested individuals in a short time • Encourages empowerment and proactive behavior • Able to communicate in real-time • Ideal for AE reporting and post-marketing surveillance (FDA/NIH Safety Reporting Portal)
  • 7. The Unwieldy Power of Social Media • Unless social media is used for real-time communication it is no different than a traditional media advertisement • Real-time communication in the context of clinical trials recruiting must be carefully moderated • FDA regulations are not conducive to brevity, no guidance to date (Novartis widget incident failed to communicate risk information, implies superiority)
  • 8. Emerging Technologies • Electronic personal health records (Google Health, HealthVault) • Research volunteer registries (Volunteers for Health, ResearchMatch.org, TrialX) • Electronic communication methods (text messaging, emailing health professionals, online screening tools) • Telemedicine
  • 10. Mobile phones are changing the way people interact with the world around them MOBILE FACTS POTENTIAL 5.5 billion Global Subscribers* Mobile devices are now practically ubiquitous Penetration rates >80%* in most countries Worldwide Tool - large metropolitan areas to rural (US = 285M subs or 91%) developing world Mobile Phone within arms reach Mobile is the most effective and natural of average users for 19 hours per day † way to maintain contact with clinical trial participants Mobile phone users read messages within 15 minutes of receipt† Mobile communications are immediate, verifiable and actionable Mobile phone users respond within 60 minutes† Clinical trial participants will use their mobile phones to provide information Average mobile phone users send/receive to clinical sites 4x as many text messages as voice calls† •* Merrill Lynch Q3-2009/CTIA 2010 † Nielsen Q4-2008/10 ‡ Luth Research 2009.
  • 11. Teens text, and so do their parents parents text twice as much as they call
  • 12. SMS Recruitment – Data points 70% prefer to inquire via text message 90% response rate = highly engaged Significant ROI 3 months traditional method followed by 3 months with text messaging • Cost per Response decreased by 15% • Cost per Referral decreased by 32% • ROI > 650% OmniScience Mobile
  • 13. 100% 80% 60% Call 40% Center 20% Text 0% Messaging Day 1 Day 2 Day 3 60% of those who use SMS are referred “I contacted a subject who responded by text message and it went great! She is scheduled for a visit within the week.” study coordinator within 2 hours of receipt “…it was very easy to maneuver.” anonymous patient
  • 16. How NOT to Run an SMS Campaign
  • 18. Mobile Apps for Recruitment Have Limitations • Limited Reach – Smartphones only – Used by only 36% of US mobile subscribers / 14% international subscribers • Expensive – software app must support all major platforms: iOS, Android, Windows, RIM, Nokia – significant cost for development & maintenance • Highly Inefficient as Direct Response option – Promotional materials driving traffic to an app there are too many steps: 1. Go to your phone’s app store 2. Find our app 3. Download it 4. Figure out where the app is on your phone 5. Click on the app to learn more about this study
  • 19. Reference Apps Don’t Really Generate Referrals Clinical Trials Mobile app Who will take the time to find this app and use it to search for clinical trials?
  • 21. The Good and the Bad • Inexpensive • Only work for smartphone users • Few have incorporated QR scanning into behavior • Execution is tricky – You can’t remember a QR code and ‘text’ it later – Challenging for outdoor advertising 21
  • 22. The Ugly • No cell signal in NYC subway • Creative design blocks code
  • 23. Other Technologies VOLUNTEER REGISTRIES & RECRUITMENT PROTOCOLS
  • 24. San Francisco General Hospital Recruitment Pilot • Investigators want to extend their reach • 1 year pilot program for 10 studies – 24/7 staffed phone line – Weekly craigslist posting – Outgoing calls to follow-up as needed • Outcomes – 692 volunteers (validated unique) – 25% contacted for screening visits – BMI was most beneficial data field for search criteria
  • 25. Airway Clinical Research Center Asthma Recruitment Database • Local disease- specific database • Used as recruitment protocol/registry – Characterize asthma severity – Recruit for current studies real-time – Register for contact regarding future studies – already prequalified •UCSF Airway Clinical Research Center (ACRC)
  • 26. Recruitment Trends by County San Francisco 52% Alameda 16% San Mateo 11% Contra Costa 7% Santa Clara 4% Marin 3% Sonoma 2% Solano 1% •UCSF Airway Clinical Research Center (ACRC)
  • 28. Performing Initial Analyses Study Design  Site-specific protocols for study-specific and SOC procedures  Placebo arms, excessive inclusion/exclusion criteria Site-specific  Staff resources  Location(s): accessibility, interoperability, features / disadvantages Competing Trials
  • 29. Planning & Budgeting Screen Failure Rate Budget for the unexpected  Design revisions  Increased production & shipping costs over time  Protocol revisions impacting recruiting methods/materials
  • 31. Implementing the Plan Staged approach Communication Plan  Sponsor/Site Staff Multiple  Primary contacts simultaneous  Secondary contacts advertising efforts Plan on changing Identify screening your plan – analyze appointment relatively often schedule workflow, tools and conflicts
  • 32. Ensuring High-Quality Participants Start by casting a wide net Think about a wide number of things or people when choosing the thing or person you want* Don’t skip the prescreening step Ask the right questions at the right stage of the recruitment process *Idioms by The Free Dictionary
  • 33. Monitoring Progress Set realistic expectations up front Identify benchmarks for success/failure Simple tracking tools go a long way Receiving logs & reports is not enough – they have to mean something and be actionable
  • 35. Create a centralized service to facilitate the enrollment of research participants into UCSF clinical studies  Assume a large part of the burden of recruitment efforts  Provide expertise in recruitment materials development  Ensure materials meet regulatory guidelines and requirements  Offer an economy of scale for many recruitment activities  Use established vendor relationships  Increase the volume of high quality volunteers  Facilitate a wider catchment and more robust networks
  • 36. Recruitment Analysis and Planning Robust recruitment plan Analysis of recruitment landscape Protocol complexities, procedures, SOC Competing studies Geographic/demographic population Marketing & Outreach methodologies Suggested strategies Timelines Budgets for suggested strategies
  • 37. Cohort ID and Direct Mail Identify cohorts from inpatient medical records (UCare and ThREDS) ICD-9 codes Demographics CHR modification Coordinate data extract services from ARS Print and mail direct mail letters to cohort
  • 40. Future Services/Resources Recruitment Plan Implementation Centralized call center, text messaging, online screeners Marketing & outreach Referral networks Searchable database of actively recruiting studies – matching Real-time recruitment from EMR