Episode 12: Jeffrey Smyth, E-Source: the good, the bad and the ugly
Jeffrey Smyth is the VP/COO for MOORE Clinical Research in Tampa, Florida. He has held the position since 2011 and has a Master’s in Healthcare Administration.
Jeffrey and MOORE Clinical Research have recently implemented an e-source solution across their company. This episode discusses the challenges, rewards and issues involved with implementing e-source.
+ Full Episode Transcript
Intro: Hello, and welcome to Episode 12 of Note to File podcast collection of interviews, best practices and candid commentary for clinical research sites. Our guest today is Jeffrey Smyth. He's the VP and COO for more clinical research located in Tampa, Florida. He's been there since 2011. He also holds a Master's degree in healthcare administration. In this episode, we discuss E-source, uh, the good, the bad, the ugly and everything in between. Enjoy. All right, Jeff, Thanks so much for coming on today. I know we've gone back and forth on scheduling a little bit, so I do apologize, but welcome and thank you for coming on.
Jeff: Thank you, Brad. Nice to be here with you talking and would love to share all the information that I have.
Brad: Yeah, I appreciate that. I know that, uh, you want to talk and we were sort of scheduled to talk here a little about E-source, E-Reg and sort of what that brings to the table for sites. And, uh, but I kinda want to start, uh, tell me a little bit about what you're doing right now and maybe even go all the way back to where you started. I like to kind of hear people's origin stories about clinical research. So if you wouldn't mind telling us a bit about your background and kind of where you're at now.
Jeff: Okay. Like, you know, many other people have said I didn't start in research. I just landed in research. About nine years ago, I started, um, in healthcare about 30 years ago, working in a hospital, I worked in two hospitals in my career in radiology and I was a radiology director up until 2011. I moved to Tampa, Florida, and I started working in research, more clinical research. And I started as the director of operations and then was promoted to the VP chief operating officer and have been working in research for the past nine years. Um, so it's been a very interesting journey for me. And what I like about it is I bring all of the operational ideas and initiatives that we had in the hospital environment. And I try and apply them to the research environment. And a lot of them can be, uh, very easily. So in keeping with, you know, the electronic initiatives that are out there in the industry now, especially, you know, everybody pays attention to it once a pandemic hits. But we were actually looking at many of these before COVID-19 so, um, and actually to rewind 10 years ago, before I left the hospital, I was working out, we had a lot of electronic paperless initiatives in progress, uh, electronic medical records system and all the other things that go along with that in the Hospital environment. So, and I know I've mentioned this to you before, once I started in working in research, it was like going back in time and really not using much, uh, software or electronic devices or because everything was on paper and it was, um, it was a little disappointing, but I got used to it. And, um, what I really have not liked about paper for so long is it costs money. It costs sites, extra money to use paper. That's, you know, one of the things that I've been thinking about the last nine years and luckily, um, I would say about seven years ago, we, um, looked into, uh, using a CTMS and I really pushed our site in that direction. We were at that time only using software to book appointments, everything else was on paper. And, uh, I wanted us to be able to use the subject's information. I had been reading about databases and how important they were in clinical research. And we had information and a software system for appointments. And I wanted to put that into a larger scale platform so that as we were getting busier and busier with trials, that we were going to build this database that was going to help us recruit patients in the future. So that's where all of this really started. And so we landed with real time CTMS and way back. And we've been with them since, and we've, you know, we are very happy customers of theirs and now we're using all of their platforms, everything that they offer, we are using them. And we are trying to gain efficiencies with everything that these software items can provide to a site. So I'm a big proponent of all of this stuff. And, you know, what's funny is along the way, along your journey, there are so many people and research and, you know, Sponsors, CRO's, Monitors that are so hesitant to get away from paper. And so hesitant for things to be, you know, stored in a system and maintained electronically. We've had to overcome a lot of that fear and talk through these things and show people how these things can work and how we meet the regulation and how they're HIPAA compliant and, and that sort of thing. So it's, it's truly been a journey, but, uh, we are very happy with where we are now.
Brad: Sure. And that's something I'm particularly interested in hearing about. So, you know, we use real time at our organization previously. We, we switched over to using Creo, which I really like, and I like the E-source system and I I've always considered myself, you know, I want to be ahead and be doing the next thing, which is, I think everyone using E-source and whatnot. And I've been hesitant just because of my fear of slow adoption from the sponsor. Uh, not to, not to mention, you mean having to train some of my investigators is, you know, presents its own issues at times as well. Um, so I'm, I'm really curious to hear a little bit about how well it's being adopted by the sponsors that you're dealing with. And then, you know, if does it require a, you know, convincing or most of them pretty like, okay, this is good. We're starting to see this now or we're good to go. What, what's your experience been like thus far?
Jeff: Um, well, if I may, let's back up about a year and a half. We started using real times irregulatory system, um, about a year and a half ago because we saw the potential for efficiencies with how these regulatory documents are signed and transferred and stored and shared. And it just made total sense to get away from a paper binder that had a lot of redundant information in it and to be able to store all of that electronically because, you know, you there's so many head-scratching moments for a site because a lot of these documents are being emailed to the site, but yet we were printing them and putting them in a paper binder. So it made no sense whatsoever. So
Brad: We're just adding another step to the process for, for no good reason,
Jeff: Absolutely adding another step. Another side note, we have always had a closed, shared network at our company and we have an IT service. They created a shared network and we were storing a lot of documents on our close network. And it's now become our redundancy because we don't put anything directly into the CTMS. We upload it to our shared network and then we put it into the CTMS and, uh, it's secure. And we view that as our redundant system for the CTMS, that's just, what's worked best for us.
Brad: So is that a, uh, is that a dedicated position or is that just done by the same coordinator who, who uploads it just for my own interest is how do you structure that?
Jeff: It's really, it depends on what the documents are and who really is the owner of that document. It could be, the director could be the coordinator. It really depends on their job function, but everybody essentially, who is on the study, they have access to that. And they, you know, if they received the document, they can say that and then upload it. So I think that depends on your organization and what, and what works best for you.
Brad: Sure, sure.
Jeff: So, yeah, I'm using E-reg was the first step. And, you know, there were conversations about that. You know, obviously the first thing is you have to show them, you know, your, your records and your SOP for using it. The, you know, the statements that, you know, it's 21 CFR, part 11 compliant, it's HIPAA compliant, it's all of these things so that they feel comfortable about it. What I love about real time is it is so intuitive. It is so easy for a monitor and inspect or to log in and to review the information that's very intuitive step by step kind of process to where it doesn't take a lot of training, you know, in order to use the system. It's, it's not very difficult at all. That's what we liked. We had to have some robust communication with some, uh, partners, and, but we didn't have anybody really pushed back on us. And I think E-reg was, you know, we were joining and E-reg at a time when, uh, doing that as well. And so we were kind of doing it at the right time. So we've been really successful with that this year, uh, realtime, um, release their E-source platform. We were, we've been thinking about it, looking into it and then really what promoted that was COVID-19 and the idea that, you know, monitors needed remote monitoring, and we needed a secure way of doing that instead of just emailing documents back and forth. So we started using that and, uh, it has been, we, we believe we have been very successful with that so far. Now we're only in our second month of using the system, but, um, the investigators like it, we have iPads and some of them like to use an iPad for data entry. Some of them would rather have a laptop and use it. Uh, what we like about it so far is we can see where it's gonna reduce a lot of queries. It's going to reduce a lot of minor protocol deviations, uh, because of, um, you know, writing or whatever was written on the paper was written incorrectly, or, you know, human error, some sort of misspelling of a word or somebody signs in the wrong place, or, you know, anything that can happen in source documents. And we can see where it brings a lot of integrity to the data because the data is so much cleaner and the way that you build the source, it becomes a very intuitive for the person who is capturing the source, uh, enter those data points correctly at the time that the patient is there contemporaneously. It's it really, I think, drives value in the data that we're providing to the sponsor.
Brad: Sure. Yeah, no, that's a fair point. Do you have a, somebody on your team or on your staff that builds the source into real time, or is that a service that they offer as a CTMS?
Jeff: They provide that service and they'll do that too, you know, for you, I believe with new customers, they will, you know, do a build or two, for you. And, uh, until you're comfortable doing that, um, our, we have a site manager who really is our lead coordinator, who is also, you know, our compliance person who is, uh, it's her duty to, you know, build source, but the CRCs that she works with, they do that as well. And it's really, if you think about it, just like with paper source, you want the coordinators involved in that because they're the ones completing the visits. You know, they learn the protocol, they learn the nuances of the protocol and how everything is different. And, um, so it's been a very satisfying for them to be involved and actually, um, you know, they have told me that, you know, uh, they've, I think they're on their third or fourth study building and E-source. And they, they really enjoy the process because I think a lot of coordinators would agree that when you build source, that is the time that you really are learning about the protocols so that you can adhere to the protocol moving forward with the visits and the expectations and working with the physician and the nurse practitioner and just making sure everything is captured the way it's intended to.
Brad: Yeah, that's a fair plan. I mean, at that point, you really have to go over, you're going through everything with a fine tooth comb to make sure that you're going to capture every data point that the protocol requires. So, yeah, I think just the act of building to source does make you more familiar with the protocol. You're a lot more prepared going into your visits. So that's, that's a really good point and something that, you know, as a site, you definitely wouldn't want to have your coordinator involved in and to go even backwards a little more. Is this something that you guys have figured out a way to offset the costs through amendments on your budgets with sponsors or have you guys kind of broached that issue yet?
Jeff: I think there's a few things about that that, you know, are obviously they're going to be ongoing for us as we, you know, continue down our pipeline of work. And as we negotiate new contracts, it's definitely going to be an item on the table. Um, because there's a few things to consider, especially from the CRO standpoint, you know, and, and especially now for a lot of sites who are having remote monitoring visits with E-source, you can argue that monitor visits can be reduced. You know, I'm, I'm sure no one is comfortable with not having any monitor visits, but what we have suggested to a few companies that we're working with is, maybe just have, you know, if you want to have an SIV, WebEx, you, the first monitoring visit after the first few subjects are enrolled, maybe they come onsite and they speak with the investigator. They look at the source, they look at the drug, they do those things, those formalities that they need to do. And then maybe several of the interim monitoring visits in between are done remotely. And then maybe they come back onsite at close out and, you know, they packaged the drug and they do all the other formalities that they need to do. And they do it that way. So if you're reducing the number of monitoring visits, you're reducing your travel costs. And so if you're reducing your travel costs, why not partner with the site in order to make that?
Brad: Yeah, no, that's, that's another great point. Yeah. You're technically, yeah. You're saving them money in the long, I mean, not in the long run and immediately you're saving them money by saving on travel for their, their monitors. I mean, and let's face it if you work at a site and you're doing remote monitoring visits right now without the E-source, it's terrible. It's awful to have to redact redact so much. Source facts are not facts, but hopefully not facts, but in some cases I scan everything. It's awful. And we're having to do some of that now, so I can understand it saves everybody time and money, but that's a fair point. I never considered the idea of a potentially being able to get the CRO to back off of their monitoring schedule a little bit, but it would make sense and they could do it anytime. It's all always there for them to go in and start doing source data verification, if you're granting them access.
Jeff: Right. And we we've been promoting this since we were on E rag a year and a half ago, the documents are there. You can, you can access them anytime before your visit or whenever you would like to, you know, and ongoing throughout the trial. You know, you don't have to come here. You don't have to wait on an email it's there, you can go in and, and view it at any time. So, you know, I would, I would argue another thing that CRO's would need to think about is how this is going to help their pool of CRA's. I mean, one would need to kind of consider, do I need as many CRA's, if all of my sites are using E-source, it seems like the productivity of CRS would, could be increased because they're decreasing all the travel time.
Brad: Yeah. You also might be able to be on to be able to put a tampon, some of that turnaround and burn on the CRA's. Cause you know, almost everyone I talk to is, Oh, feels like they're, they travel too much. They spend too much time on the road. So yeah, if you could take some of the burden of travel off of them, then they also might save money just by retaining their employees at a higher rate.
Jeff: Absolutely. You know, and, and add more value to their work. And you know, I, I know you've said this before and we've encountered the same thing. Maybe some of the new CRA's enjoy the travel. Maybe they do, but people CRA's who have been in the business for, you know, more than a couple of years, I think they're all tired of it. And um, but you know, it's a part of the job and what's expected of them, but you know, it just seems like this would provide so much more job satisfaction for them.
Brad: Yeah, no, I think that's true. And again, you're going to maybe open yourself up to better talent. Who's doesn't want to travel all the time, uh, since that's requirement of the job, if it's not so much a requirement of the job anymore, then you can, again, you open up your pool of good CRA applicants at that point. Uh, but yeah, I, I've almost never hear from a CRA who's excited to keep traveling or who hasn't had additional sites dumped on them in a different part of the country. So they've had to add to their itinerary now. Uh, so yeah, that's, that's actually interesting. And it also makes me curious why CRO's haven't, uh, really taken on the burden of E-source or if that's something else that's going to come down the road, uh, why wouldn't they provide, uh, an E-source platform to sites directly as opposed to the burden and cost being on the site?
Jeff: I see that and you know, I don't, I'm not sure, I'm not sure that I would agree with that. And, um, I kind of see the other side of it. I mean, I understand why they would think that, but as a site, I would not want different E-reg systems from different CRO's. I would not want different E- source platforms. I mean, it's bad enough with all the EDC platforms that we have that, you know, I, I feel like the site would want more consistency on their end. I see the argument that the CRS would make that, you know, they would equally have different systems to use.
Brad: Yeah, that's a fair point.
Jeff: I know one CRO that we worked very closely with, we were the first site that's using E-source. They have other sites that use you rag, but we're the first one that's been on E-source. So, you know, they've been very accommodating. They've been very gracious and, and everything, but you know, now that you say that, I wonder how they're going to feel when although their sites are on E-source and using different vendors and sort of thing
Brad: Right, right. Well, Hey, I had considered a nice, a way to turn the tables cause there's nothing worse than having 50 different logins for EDCs and E-Pro systems and, you know, uploading images somewhere. So at least this is our chance to make them have to log into different systems. Some, take some small satisfaction in that,
Jeff: You know, something else from a contracting point of view. Um, you know, and, and a lot of sites do this with their contracting. They work in, uh, funds for archival and storage. Well, when you're on E-source, you can use that money or whatever you're used to negotiating and use that to go towards your East source funding as well. So
Brad: Yeah, which I'm going to, I'm going to guess, I'm going to guess that that's, you know, if well, negotiated, you're still gonna see, you're probably gonna come out ahead. Uh, if you just bundle those costs and call it a, I mean, you can leave them as archiving costs or you could move them around and bundle them as your, you know, E-source E-reg costs. But ultimately it seems like something that you cover your cost and probably come out ahead at the end of the day.
Jeff: Right. And you know, I would, I would sell this to anybody I was negotiating with. I mean, the data is available in real time. It's accessible. Anytime the quality of the data is much higher. Uh, there's no issue with legibility. We think that the value is there because there are less mistakes, there's going to be less queries. And one thing from the site point of view or all the efficiencies that we have seen from not having paper and those things, I mean, there's so many things associated with paper that sites will discover, you know, as far it could be with space within the office, bookcases that were used to house binders, you, you're not going to need them. You know, we've had book carts in our offices to put cart charts on, to take to the monitor room and that sort of thing, or just to be working on, we don't need those. The space thing is huge, especially for small offices. It's, it's really big. And this is also another initiative that we started this year was we wanted to centralize our EDC. We wanted to have, you know, one person or however many individuals doing all the EDC for all three of our offices. And E-source has made that so much easier because you're not moving the source data around, you know, to one location or to another location. It is accessible from every location and it's, everything is sped up because the person who's doing the EDC after we have a QC process that we've implemented and after the QC process is done and the EDC is done, we see a quicker turnaround time in that as well. So there's other value in,
Brad: Well, I mean, right, even those employees can be at home. It can be anywhere. I assume, you know, if as long as, as long as they can log into real time and the EDC, then there's really no, no barrier other than an internet connection. Uh, so that's, I like that. I very much liked the idea of, you know, centralizing what you can and what makes sense. So that's a something I've thought about too. I think that's a really smart move to try to keep that as, as centralized as possible. Cause again, you just create, let your coordinator go, you know, churn and burn through their patients, collect their data, you know, in a, in a high quality way, of course, but it takes some of that data entry burden away from them at that.
Jeff: Another thing that, uh, is, is true is you don't have misfiled source. You know, I know people's, you know, put source of notebooks, some, put them in those, you know, cardboard, medical record files, and sometimes those can get misfiled and, you know, the moment when you're looking for something and all the blood is lost from your face, because you can't find it. And you know, honestly, you know, every site has gone through this, if they would just be honest, everybody has lost something at some point and you know, the good thing about it is it it's eventually found.
Brad: Sure.
Jeff: Um, but with the, these electronic things, you're not going to lose it like that. That's just not going to happen. So all the time and energy placed into that.
Brad: Yeah. That's a fair point. Again, a lot of the error possibility of error just yet it's taken away at that point. Cause yeah. It's yeah, you're right. We've a, you know, there's a piece of paper stuck to the back of another piece of paper that's filed somewhere else and that's not even a possibility.
Jeff: Yeah. We would call that a code red, you know, and everybody, everybody would stop what they were doing and tear the office apart and until it was located.
Brad: So how about the, uh, SOP process for, uh, you know, implementing these systems? Did you find any, I assume that's a pretty much like everything else in clinical research. So, so sort of an ongoing, evolving process as you really figure out, you know, you've got an idea of how things work and then, uh, then you figure out how things really work, which is a kind of how, you know, same way it works when you get a new protocol. Uh, what was the SOP development, uh, how has that process been or did you guys use, uh, any kind of outside help with that or did it realtime, help provide some guidance? Maybe
Jeff: Real time was, uh, very helpful. They did provide the information we needed for, um, the system and how the system, you know, is set up designed, secure, verified, and that sort of thing. They provided us with a lot of really good documentation. Uh we've we've had some, uh, what we believe to be some really good SOP of, for quite some time now. And, uh, knowing we had gone through the E-reg implementation and now the E-source implementation, we, we knew that this was just going to be a process for our SOPs and that we were just going to need to update them as we went along. It wasn't going to be possible to not update them because as we were going through the process, the CRO's and the sponsors are wanting to see our SOP's and how we're, you know, delivering this, how we're complying and all of this. So it's just, um, you know, it's a work in progress and we've updated a couple of them a few times now. And, um, we just know that with this, that we're going to continue to see some process change within our office. And we're going to have to update that as we move along. So it's fluid, but, uh, we keep that up and center and ready, uh, because we want the sponsors and the CRO's to feel good about what we're doing. And we're very, we're one of the sites we're very transparent. If they want to see our SOP, we send them, we, we want them to trust us and to feel good about what we're doing here.
Brad: Yeah. And that's a, I think that will definitely serve you best in the long run, you know, to be, to be that transparent and to be that fluid. I mean, I think it's, uh, one of the benefits of not necessarily working within a large, large institution or a very bureaucratic institution, as you know, oftentimes hospitals and universities can be. I mean, a lot of those sites that I know they're still working on Excel spreadsheets rather than "E" anything, you know, they're still hand entering any data into Excel spreadsheet. So, you know, it really gives you the opportunity to, to evolve, to be progressive and to sort of make any changes and correct course as you go. So I, I love that. I think if you're going to successfully implement a system like this, you, you almost have to be that way. Uh, and then lastly, I'm sort of interested to know about the training process for your staff and for your investigators even. So has that, you know, provided any challenges or is it, did you find that to be a relatively intuitive process for your, for your staff?
Jeff: You know, I think, you know, we're like most other sites and companies, and as far as people go with software and electronics and, you know, younger people catch onto it so much more easily, we have used computers and self different softwares for other functions for a long time now. So I feel like for the most part, 90% of the staff caught on to it immediately. Uh, there is some training, but it's basic and it's, you know, very easily attained some of the investigators, you know, the, the staff, our approaches, we just work with them. The coordinators work with them even while they're seeing patients, you know, they have the iPad or the laptop in there. They help them enter data and transcribe for them and, uh, just provide as much support, uh, with them as they can. But, you know, our investigators are, you know, they're computer literate. They seem to adapt, uh, I would say better than I thought that they would, a couple of them really grabbed hold of it and really ran with it. So we're, we've been very happy with everybody's performance on the system so far.
Brad: Sure. No, that's good to hear. And I know that can be a, I mean, just depending on what your staff and investigators look like that can, could present some challenges. So I'm glad to hear it's gone, gone smoothly for you. I know we, my previous job, we did implement some E-reg, uh, towards the end of my time there a couple of years back, and I was concerned about adoption and training across the system. So, uh, I guess you guys are, are you guys a series of standalone sites or more than one standalone site?
Jeff: We're a, a multispecialty site. We, we have three sites in the Tampa area and, um, we operate all three sites. We have, uh, three MDs, one nurse practitioner and a, we have six coordinators and, uh, we have a business office staff, which includes, uh, a couple of dedicated recruiters. Um, so we, you know, we're a high functioning site, excellent staff. So, but yeah,
Brad: Sure, you kind of know what you've got there. So that that's, I think the point I was trying to make too, is that, you know, you've got your arms around your staff and you, you kinda know each, each person's level of capability, which I think is again, there is a learning curve, you know, there's, there's plenty of people who have issues just with the EDCs that we use now. So that's a, again, just an interesting little aspect of the East source and E-reg that I'm always just looking to see how well adopted and how well, how intuitive it is for people to use. So that's good to hear that you guys have taken to it pretty easily,
Jeff: Right. I would say that, um, you know, we, we have about 20 employees overall. I mean, we see ourselves as a medium size site. Some other people think we're larger, you know, but I guess it's all relative to what you're doing or how many studies you're doing. But, um, you know, I feel like in this day and time, uh, everybody wants, you know, to be as efficient and as effective in their jobs as they can be. Our coordinators have been nothing but supportive in moving in this direction and they've really wrapped their arms around this. And, um, they are happy with the process. They are, they don't want to do anything with paper. We have a couple of studies, obviously that are still on paper because we're not fully on the source. We just started a couple of months ago. So we still have to move through that process. And there's, there's a couple that are still on paper, but, you know, they, they just enjoy working with the software so much. So from an employer's standpoint, I'm very happy with, uh, their satisfaction.
Brad: Oh, that's awesome. I said, it's good to have everybody on the same page. I personally, uh, imagine a world with no more binders and no more sticky notes. So that's a, it's a very comforting thought. And I hope that we, that we all get there.
Jeff: Yeah. I also too, I mean, there's, there's so many things that, you know, are so beneficial for sites and, you know, we understand it can be scary and there is an element of uncertainty for some people, but like us, we, you know, we did our research, we did a really good planning process. And, you know, at some point you just have to jump into it and start doing it. And any software system is only as good as you use it. And you really got to jump in and start using it so that you can see the full potential that these things have for you and how it can affect your business.
Brad: Yeah. And I think that's a really, again, a really astute point is that these systems can be great or they can be terrible. It really depends on how well you use them and how much you use them. And we kind of talked a little bit about that before we started that I'm really convinced that the more you use the system and the more you integrate all the different elements, the more powerful it becomes and the easier it becomes to use. And I think that's a it's important point too. I I've often tried to just sort of dip my toe in the water with, you know, these new systems. And that's great to an extent, but you really don't see the full value until you start integrating all the different aspects and then put it all together, you know, in the bigger, the bigger scheme of things.
Jeff: Absolutely. And you know, two other components realtime has is a reloadable debit card and a text feature that you can text and communicate with subjects directly through the CTMS. And so when you're talking about retention and retention is huge, you know, recruitment is one thing. Retention is the other side of the coin and is huge. And we want all of our subjects when they enter a study, we want them to remain opted in for all text messages. We, you know, we push them, we ask them, we have want them. We communicate that over and over to them to try. And because we want all of our appointments confirmed, we want them engaged in what they're doing. And because, I mean, that's just the beginning because when you have a subject in a study, you want them, obviously there's more important things that they need to be focused on using the medication, doing their diary, entries, all of those things. And it starts with how you set the tone for the communication during the study. And so we see a lot of value in that. The other thing is a lot of subjects, you know, they come and they do a study and they're getting the benefit of the medication. And they're getting the benefit of seeing a doctor and seeing a nurse practitioner and, um, the healthcare associated with that. But they're also, you know, you're paying them and the reloadable debit card is an excellent feature because we, you give them one at the beginning of the study, they can keep it for many studies afterward. And it pro it gives the site a lot of flexibility. And our goal is to pay everybody on the same day as their visit. And we want to show them that we are interested in them that we're trustworthy and that if we say we're going to pay him, we're going to pay him. And there should be no questions about that. So we feel those debit cards have really added a lot of value and it really helped our retention in the study. So,
Brad: Yeah, and I would definitely echo that. We did the same thing. Maybe six months ago, we added a debit card system. And I think it's, you know, not putting people through the hassle of having to go cash, a check or jump through any extra hoops. You just give them the card at the beginning and reload it. And, you know, sometimes it's not a significant amount of money, but it's, it's the, even that alone is enough to help them, you know, get a meal or get down the road and their vehicle make it to your, to all their appointments. And, uh, I think it really does. It shows a lot more, a lot more attention to the, to the patient. And it's a little more, I dunno, to go back to what you said. I think it does help significantly with, with retention. So that's a sort of a hidden value for sure.
Jeff: Right. And also, I mean, I don't, I'm sure there's a lot of other sites who were issuing checks to all their subjects, but, you know, we've, you know, had some difficulties with that because, you know, we have had some patients who have taken our checks and, you know, deposit them electronically and then try and deposit them in, in person and, you know, taking our routing number and pay, try to pay their bills with it and, you know, stuff like that. So, I mean, there, you know, there's all kinds of things out there in the world today. And I think these debit cards only help protect the site as well.
Brad: Yeah, for sure. And we've had patients who don't have bank accounts, they don't have checking accounts even. So, you know, that puts them at a, you know, behind the eight ball. If you hand them a check and they say, well, what do I, what do I do with this? Well, you know, you don't, you can avoid that conversation all together by, by handing them a reloadable visa card and then they're on their way. So yeah, I think that's, uh, again, just sort of a, an extra little cherry on top to help, you know, Hey show the patients that you're, you know, your professional that you're serving them. And at the same time, uh, you know, it's easier for you. You're not having to cut checks, you know, you just load it up in the system and you're good to go,
Jeff: Who writes checks anymore. Right.
Brad: Right. I know. Well, it's just another one of those funny things about clinical research, you know, we should be out here on the cutting edge and you know, probably a lot of sites are writing checks. You know, I know that if I'm in the grocery store by inline and I see somebody in front of me writing a check, I'm like, Oh dude, come on. Really? We're writing checks now, but you know, but it's not, it's not uncommon for someone to hand out a check.
Jeff: Yeah. And on an, on a side note, waiting on a check from a CRO, how about that?
Brad: Oh, no. Don't, that's another, I think that's another podcast so we can, we can do that next time. Absolutely. Well, I do. I want to thank you so much for coming on. We probably have more, we could cover a few would like to please come back. We can talk some more about this. Uh, where can people find you online?
Jeff: That would be great. I'm on LinkedIn and, um, more clinical research [inaudible] dot com. And we have a Facebook page as well, and I'm easily accessible. So if anybody who's listening to the podcast has, you know, questions about moving into E-reg or E-source or questions about realtime CTMS. I'm happy to help if they want to reach out to me and connect. Um, I'd be, I'd be happy to help that. I think it's, you know, one of the most beneficial things a site can do right now.
Brad: Very good. Yeah. Please do reach out to Jeff. Uh, you know, my hope is that this does become, you know, an outlet where sites can all share information with each other. And as a result, they're going offline and talking and, uh, sort of sharing their best practices with each other. So I'll make sure we link you in our show notes on the website. And again, I want to thank you so much for coming on and, uh, we'll talk to you again soon.
Jeff: Thank you, Brad.
Outro: As always Thank you so much for listening. You can check out full episode transcripts, show notes and contact information on our website. Notetofilepodcast.com. Thanks again.