ACRES-Greg-Koski-20140426
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Enhancing
Safety,
Quality
and
Efficiency
in
Medicines
Development
and
Health
Research
through
Systems
Solu>ons
Transla(ng
Principles
to
Performance—
Crea(ng
a
Global
System
to
Promote
Responsible
Conduct
of
Human
Research
by
Physicians
Greg
Koski,
PhD,
MD
President
and
Chief
Execu(ve
Officer,
Co-‐Founder
Medicines
Development:
A
Complex
Enterprise
under
Intense
Environmental
Pressures
In
a
rapidly
changing
environment,
the
ability
to
survive
is
determined
by
the
ability
to
adapt!
l Medicines
development
has
been
almost
en(rely
proprietary
and
conducted
largely
in
corporate
silos,
an
approach
fraught
with
inefficiency
l Clinical
trials
are
not
“global”—they
are
interna(onal
l “Harmoniza(on”
is
simply
a
nice
way
to
say
“failure
to
standardize”
l Public
respect
for
the
endeavor
has
plummeted
and
par(cipa(on
is
low
l One
cannot
keep
doing
things
the
same
way
and
expect
different
results
Current
Situa(on
in
a
Nutshell
l Medical
research
involving
human
subjects
must
be
conducted
only
by
individuals
with
the
appropriate
ethics
and
scien(fic
educa(on,
training
and
qualifica(ons.
l Research
on
pa(ents
or
healthy
volunteers
requires
the
supervision
of
a
competent
and
appropriately
qualified
physician
or
other
health
care
professional.
Principles
for
Physicians
Engaged
in
Clinical
Research
Declaration of: Helsinki, 2013
l There
are
minimal
formal
professional
training
requirements
for
physician
inves(gators.
l Most
“physician
inves(gators”
do
only
one
clinical
trial
during
their
career.
l Ethical
lapses
and
scandals
have
tarnished
respect
for
and
confidence
in
the
research
enterprise
at
all
levels.
l The
stage
is
set
and
the
(me
is
right
for
fundamental
systemic
change!
But,
in
reality….
“For
too
long,
the
industry
has
failed
to
recognize
the
importance
and
value
of
well-‐established,
sustainable,
high-‐
performing
research
sites.
They
are
a
resource
that
we
have
undervalued.
Now
is
the
(me
for
us
to
take
a
more
systemic
approach
that
promotes
site
produc(vity
and
sustainability…”
-‐-‐Briggs
Morrison,
MD
Vice-‐President
for
Global
Medicines
Development
and
Chief
Medical
Officer,
AstraZeneca
Member
of
the
ACRES
Board
of
Directors
Sites
MaZer!
Change
Management—
It
takes
a
crisis!
“The
current
approach
to
drug
development
is
inefficient,
ineffec(ve
and
unsustainable.”
Consensus
DIA
Europe,
2010
A
mul(-‐sector
alliance
of
like-‐minded
organiza(ons
working
collabora(vely
to
build
a
shared
Global
System
for
Clinical
Research
What
is
ACRES?
An
Integra(ve
System
– Examples
of
an
integra(ve
system
are
charitable
organiza(ons
or
business
endeavors
where
individuals
ban
together
to
accomplish
some
common
desired
objec(ve
or
goal.
– “Where
you
and
I
do
something
together
because
of
what
we
both
want
to
accomplish.”
– The
greatest
leverage
is
found
in
integra(ve
systems,
where
all
the
individuals
are
mo(vated
by
what
they
are
endeavoring
to
create.
hZp://www.systemswiki.org/index.php?(tle=Systems_Classifica(ons
What
is
ACRES?
A
neutral,
not-‐for-‐profit
organiza3on
opera3ng
in
the
public
interest
– a
“home”
for
collabora(on
among
Stakeholder
Alliances
– an
“incubator”
for
innova(on
– an
“adapter”
of
successful
models
and
prac(ces
from
other
highly-‐regulated
and
complex
research-‐focused
industries
– a
“coordinator”
for
mul(-‐stakeholder
ac(vi(es
– an
“integrator”
for
complex
cross-‐cuang
ini(a(ves
A
Transforma(ve
Mul(-‐Sector
Alliance
ACRES—through
and
with
its
allies—is
working
to
build
an
shared
global
system
that:
– Leverages
stakeholder
collabora(on,
innova(on
and
investment
to
implement
change
– Promotes
and
improves
the
use
of
exis(ng
tools,
policies
and
processes
rather
than
re-‐inven(ng
,
– Facilitates
and
streamlines
clinical
research
while
improving
safety
and
quality
– Reduces
waste,
redundancy
and
inefficiency
in
the
clinical
trials
process
– Responds
fairly
to
the
world’s
health
needs
What
are
ACRES
goals?
• The
Alliance
for
Clinical
Research
Excellence
&
Safety
is
working
to:
– posi(vely
align
ethics,
scien(fic
integrity
and
good
business
prac(ces
– provide
appropriate
opportuni(es
and
incen(ves
to
further
the
mission
of
medicines
and
device
development
globally
– to
ensure
that
clinical
trials
are
conducted
in
a
safer,
scien(fically
sound,
socially
responsible
and
ethical
manner
that
rewards
all
par(cipants
and
stakeholders,
including
pa(ents,
everywhere
Ini(al
projects
are
underway
in
each
of
four
opera(onal
domains
where
cri(cal
processes
for
research
sites,
sponsors,
CROs,
regulatory
authori(es,
ethics
commiZees,
and
research
subjects
intersect
to
achieve
“clean
data”
with
greater
efficiency,
safety
and
interoperability
-‐-‐
at
the
points
where
change
is
most
needed.
ACRES
Founda(on
Ini(a(ves
Execu(ve
Office
Ongoing
Global
Ini(a(ves
l Promoting professionalism, performance and
sustainability through compentency-based education,
training, and accreditation.
l Driving creation and adoption of standards and
metrics through effective implementation of a shared
technology infrastructure and informatics
l Fostering more effective and efficient ethical and
regulatory oversight through standardization,
innovation, collaboration, and stakeholder
engagement
l Building an enterprise-wide culture that embraces
safety as its highest priority and most valued asset
Each
ACRES
ini(a(ve
is
intended
to
leverage
investments
for
the
mutual
benefits
of
all
stakeholders
–
like-‐minded
organiza(ons
and
individuals
driven
by
principles
of
inclusivity,
integra(on,
integrity
and
innova(on
to
achieve
effec(ve
implementa(on
with
close
aZen(on
to
elimina(ng
waste,
mi(ga(ng
risk
and
learning
from
varia(on,
while
enhancing
responsible
ethical
conduct
of
research
and
professionalism.
ACRES
Alliance
Approach
to
Ini(a(ves
Opportunities for Collaboration
l The WMA and ACRES share common beliefs that clinical
research is highly-valuable and that it must be done in a
responsible manner by well-trained, qualified investigators
and research teams within an ethical framework and with
effective oversight:
u Competency-based guidelines for education and
training for physician investigators during graduate and
post-graduate medical education.
u Pathways to professionalism for clinical investigators
through professional certification as part of a program
for global accreditation to recognize and reward
excellence in clinical research.
Fundamental
Elements
of
an
Enterprise
System
“A
system
is
an
en>ty
that
maintains
its
existence
through
the
mutual
interac>on
of
its
parts
to
achieve
a
specific
goal
or
goals.”
Richard
Wright
Drug
development
is
far
behind
other
industries
in
the
applica>on
of
a
system
approach
to
standardize
and
integrate
mission
cri>cal
processes.
Systems
Thinking!
Current
Drug
Development
Process
from
a
Systems
Perspec(ve
In
it’s
(me,
it
performed
adequately…
The
(mes
and
the
environment
have
changed
!
Other
industries
can
help
us
envision
a
beZer
future
for
Drug
Development:
– Informa(on
Technology
– Transporta(on
– Communica(ons
– Shipping
Successful
Systems
Models
Do
Exist
The
Systems-‐Focused
Intelligent
Organiza(on
Systems
Thinking:
The
Global
Air
Transport
System
Current
Drug
Development
Process
from
a
Systems
Perspec(ve
No
maZer
how
much
we
(nker
with
the
parts,
what
we
are
leg
with
has
limited
ability
to
perform
adequately
in
today’s
demanding
environment!
Systemic
change
is
necessary….
How
do
we
get
there…?
Systems
Thinking!
“For
too
long,
the
industry
has
failed
to
recognize
the
importance
and
value
of
well-‐established,
sustainable,
high-‐
performing
research
sites.
They
are
a
resource
that
we
have
undervalued.
Now
is
the
(me
for
us
to
take
a
more
systemic
approach
that
promotes
site
produc(vity
and
sustainability…”
-‐-‐Briggs
Morrison,
MD
Vice-‐President
for
Global
Medicines
Development
and
Chief
Medical
Officer,
AstraZeneca
Member
of
the
ACRES
Board
of
Directors
Sites
MaZer!
We
cannot
achieve
effec(ve
solu(ons
using
the
same
tools,
processes
and
thinking
that
created
the
current
ineffec(ve
approach…
Benefits
of
a
Systems
Approach
• Drive
and
reward
standardiza(on
• Drive
regulatory
simplifica(on
and
compliance
• Promote
and
value
professionalism
• Enhances
performance
– Increase
efficiency
– Reduce
redundancy
• Promote
and
enhance
safety
• Reduce
costs
and
(me-‐to-‐approval
• Promote
investment
in
sustainable
clinical
research
capacity
in
emerging
na(ons
and
markets
• Align
ethics
and
good
business
prac(ces
• Increase
transparency
and
improve
public
trust
All
stakeholders
across
all
sectors
of
the
enterprise
must
embrace
systems
thinking
and
collaborate
for
their
mutual
benefit…
Network
Systems
Architectures
ACRES
Collabora(ve
Informa(on
Technology
Infrastructure
l Web-‐enabled,
“cloud-‐based”
integrated
informa(on
system
with
a
shared
virtual
data
warehouse
and
knowledge
engines
l System
support/facilita(on
of
all
opera(ons
– Point-‐of-‐entry
EDC
and
CTMS,
including
AE
repor(ng
and
performance
dashboard/metrics
– SOP
driven
con(nuous
compliance/quality
control
– Shared
data-‐base
for
trial
ini(a(on
and
support
– Remote
risk-‐based
quality
management,
safety
and
performance
monitoring—
“site
op(cs”
Asia
Latin America
Europe
North America Africa and
Middle East
ACRES
Executive
Office
ACRES Global Headquarters and
Regional Coordinating Centers
ACRES
National
Co-‐Development
Affiliates
Research Sites, Investigators
and Ethics Committees
Professional Organizations
and Academia
National Government Offices
and Oversight Agencies
ACRES
National
Affiliate
An
Integrated
Global
Network
ACRES
Value
Proposi(on
Urgent
Challenges
– Educa(on
and
training
– Trial
complexity
– Site
selec(on
– Performance
– Monitoring
– Data
management
– Pharmacovigilance
– Regulatory
compliance
– Delays
and
redundancy
– Time
to
market
– Ethical
review
– Misconduct
– Public
confidence
– Economic
pressures
– Global
dispari(es
More
effec>ve
applica>on
(redirec>on)
of
exis>ng
resources
to
build
a
sustainable,
shared
“system
infrastructure”
will
provide
a
handsome
return
on
investment,
economically
and
socially.
Current
es3mates
of
waste
due
to
inefficiency
and
redundancy
in
the
clinical
trials
process
is
approximately
30%
An
effec3ve
system
could
realize
annual
savings
in
excess
of
10
Billion
Euro
Why
ACRES?
• “Construc(ve
transforma(on”
• Unique
global
integrated
systems
approach
– Comprehensive
– Inclusive
• Solu(on
oriented-‐-‐implementa(on
focused
– Established
plan
– Coherent
strategy
• Mul(-‐sector
exper(se,
credibility
and
collabora(on
– Experience
– Capability
– Leadership
hZp://www.acresglobal.net
-‐-‐building
a
global
collabora>ve
ecosystem
for
clinical
research,
together!