Project Overview

The Royal National Orthopaedic Hospital (RNOH) is a National centre for surgical excellence in orthopaedics and undertakes world class research resulting in complex outputs. However, as with many research facilities, the existing tools and digital infrastructure to support such research are proving inadequate, particularly with the need to accommodate changes in governance requirements for medical translational research, coupled with the need to integrate with both with the institutional systems and research life cycle, and other systems such as those in the National Health Service and medical research councils (e.g. IRAS).

VRIC within JISC VRE programme

A previously funded JISC VRE project called CORE (collaborative Orthopaedic Research Environment) has explicitly tackled the above issues, and so the aim of this project is to take the CORE VRE, embed it into the RNOH, and integrate it both with the institutional systems and research life cycle, and with the national systems such as the National Health Service (NHS).

The integration of the CORE VRE will provide a set of services at RNOH to cover the four main areas of the research cycle, namely: The monitoring and governance of trials (experiment research administration); the trial protocols (experiment workflows); the publishing, dissemination and discussion on the results of trials in a repository; the discovery of information from the repository and other resources.

VRIC builds on the proof of concept Virtual Research Environment (VRE) developed in the first round of the VRE programme, the CORE VRE, which succeeded in its aims to develop a Web-based portal environment with Web services for: collation and analysis of clinical trial results; organisation of internal project discussions; and the production of appropriate outline documents based upon the requirements of conferences and journals selected for dissemination. The users were Orthopaedic surgeons, undertaking multi-centred clinical trials that needed to be managed and co-ordinated for a geographically dispersed set of researchers. The VRE also supports laboratory based clinicians to connect to the Grid using the OMII UK middleware. The user interface was co-designed with the end users. These Web services were designed to be generic and are being used in other JISC projects. For instance, the EFSCE (E-Framework Services for Course Evaluation) project is using the CORE dataset manager and statistical Web services.

Co-design strategy

In this project we will engage with the surgical community because they have to undertake what is arguably the most difficult of experiments: multi-centre double blind randomised controlled trials (RCT). In CORE the individual trials indicated when they had passed certain stages, so the work flow could be monitored. As part of the maintenance of CORE systems we developed a system for the director of research to monitor the individual trials and their progress.

During an interview in the first round of the VRE programme, a description of the cycle was given by one of the surgeons:

"Whilst it is possible to establish standard work practices (workflows) and protocols to ensure that ‘i’s are dotted and ‘t’s’ are crossed, the process for the management of the workflows is relatively flat and fragmented. Currently our virtual research environments employ a constrained workflow. We would prefer to work in collaborative research environments that allow us to share and learn from the work we do and also to use this work as a window on the future, predicting areas that should be researched and to ensure that the tools we develop are generic enough to respond to many different challenges. For example, predicting interdisciplinary work that needs to be explored so as to provide ‘ground breaking’ as well as ‘incremental’ research. E-Research offers the way to fuse the approaches of e Health and e Science, to develop virtual research environments (virtual workbenches) that build on the evolving bridges between the worlds of theory and practice."

It is essential that the CORE VRE integrates into the institutional structures. The tools will need to be available to staff anywhere with the organisation, as clinicians need to be able to enter the data during clinics and directors of research need to be able to monitor the trials. This will bring with it a number of inter-operability issues, as we move data between the VRE, the hospital systems (NHS), and the institutional systems.

Lessons to learn from

The CORE VRE used the JISC funded E-prints as its repository. However since the completion of the CORE VRE JISC has funded another VRE, myExperiment, that may be better suited to storage of trials and their results. Similarly the FAROES Learning Box repository has used Web 2.0 tools for sharing of learning material. myExperiment is a collaborative environment where scientists can safely publish their workflows, share them with groups and find the workflows of others. Workflows, other digital objects and collections - called Packs - can now be swapped, sorted and searched like photos and videos on the Web. And unlike Facebook or MySpace, myExperiment fully understands the needs of the researcher. myExperiment makes it easy for the next generation of scientists to contribute to a pool of scientific workflows, build communities, and form relationships. It enables scientists to share, reuse and repurpose workflows and reduce time-to-experiment, share expertise, and avoid reinvention. It is the ease with which scientists can share their experiments that is of interest to this project. Lessons learnt from the myExperiment and FAROES projects will be integrated into the CORE VRE.

Research lifecycle in the RNOH

For the community of Orthopaedic surgeons, there are three tightly coupled areas of focus: research, clinical practice, and education (in the form of continuing professional development and training of the next generation of surgeons). In this project, our user community will be heavily involved in co-design and co-deployment of the tool set, and in particular the front end of the workbench will be user focused. Therefore the underlying infrastructure will be designed in such a way that it adapts easily to different applications, e.g., via customisable user profiles.

To aid the understanding of how the system will be used, we outline a typical ‘research cycle’ that includes the practice of a clinical specialist in orthopaedics (who may also be a Higher surgical trainee) and a basic scientist. The purpose of this is to identify time-essential information provision and interaction with pervasive technologies. The research responsibilities of a specialist registrar in orthopaedics can be divided into four main roles:

1. Resource discovery. Basic Scientists and Clinicians need to be fully aware of the current state of knowledge involving managing databases, searching, data preservation, curation, and access. This should be building on the local knowledge base as well as shared resources and national repositories.
2. Research administration. The process of writing bids involves much recycling and adaptation of concepts and materials to accommodate the scope of proposal calls, and needs collaborative effort, human resource management, and link up to institutional systems.
3. The experiment or research itself. Tools, workflows, and process are distinctly different per discipline and research area. In the clinical domain this may involve patients coming to specialist clinics for investigation, pre- and post-surgical intervention, and to answer concerns of the patients. During the clinic, the staff will assess wide-ranging cases that cover the entire spectrum of orthopaedic knowledge. Some of these patients will be participating in trials and hence staff will need to enter the data in to the VRE. Staff may need to include more complex media reflecting surgical interventions carried out. Specific and detailed knowledge of procedures can be described in the multimedia and workflows.
4. Publishing. Relating to IPR and repositories, this closes the cycle back to resource discovery. Staff participate in an educational program as well as dissemination of results at National and International meetings, requiring them to locate information, keep up to date on issues in the field, and learn across disciplines.

Many departments in a university will undertake trials involving humans and therefore need to undergo some form of ethical clearance. This may be as simple as giving out questionnaires or interviews, albeit in expedited reviews. It is therefore essential that there is a good governance procedure in place to monitor the research process and tools developed to support this.