Approaches for linking form instance changes to individuals

The technical aspects are slightly above my pay grade but I do agree that a flexible system that can do more than (whilst facilitating) collecting a user ID is preferable if implementable.

Re-reading your original post:

4.9.3 Any change or correction to a CRF should be dated, initialed, and explained (if necessary)...

An audit log would accomplish dated via its timestamp. You could probably argue that all changes made between the audit log's 'sign-in' and 'sign-out' are effectively initialed [or worst case, you'd add the userid explicitly to each change entry]. But I dont really see any reasonable way to start inserting user comments into the (background) audit log, as necessary to explain potentially every change! I think that might to almost require a parallel form (ie option 4) and hence would pretty much rule out using an audit log, right?

I think you see why I've changed my mind a few times about this already. :sweat_smile:

I do think a generic way to link forms could address this and a lot of other use cases in an elegant way from a form design perspective. From an analysis perspective, until there's some kind of server support, it would mean joining the value change info from the audit log to one of these secondary forms. Definitely doable but much less convenient than having everything in one place.

Also, I wrote "This might best be done in a client-specific way" in my original post but I think I had a weak moment of laziness (forgive me, @martijnr). That would really be a missed opportunity. It would be such a useful feature that it should be portable. So I take that back.

My sense is that these corrections wouldn't happen all that often and that the comments wouldn't be all that long. I'm imagining something like "inverted 9 to 6" or "verified sensor reading" or something like that. Plenty of studies use paper margins for this which can be cramped. Really, there is no limit to what could be stored in the audit log and it would be plenty comfortable to read in a spreadsheet program.

Just to throw something crazy out there...

Instead of pushing back an external attachment containing the (selective) change log info captured with the form, would it be possible to submit an XML result containing both the primary and a secondary instance (!)? In this case, this secondary instance would record changes made to whatever was tagged in the primary instance as requiring change logging (ie date,userid,description). Benefit of having this in an external instance is that it may make it susceptible to being handed via our existing XForm functionality (as you state: "We have this wonderful, flexible tool for defining data capture (XForms) and it feels unfortunate to go completely outside of that.")

Any controls/fields requiring these changes logs would be tagged with xforms-value-changed, this could fire a client-specific UI popup to capture optional description, userid (signature, text initial, fingerprint, iris scan widget...) which would then be inserted the necessary data into the secondary instance, possibly using the equivalent element names and group hierarchy. Thus not polluting the original primary instance with a lot of audit info, but (somehow? TBD?) still allowing us to specify and capture the necessary audit data within the confines of our existing XForm framework.

And the whole she-bang would be submitted back as potentially one XML blob, containing both a primary and this secondary instance. Or the submit process could strip out this secondary instance and submit it as an external XML attachment.

Like I said, 'crazy'... :slight_smile:

[I guess this is a bit like Option 4 (secondary instance vs linked form), with a smattering of Option 5 (XForms events) thrown in]

form our med dptmt:

" also think option 2 is the most promising.

The important thing for an audit trail is that for each data point changed the following is captured (in addition to the original entry):

  • ID of person making the change
  • change made
  • date of change made
  • reason for change (not sure this is possible with option 2, though)

If a data point is changed 3 times, this should be visible in the audit trail.

In a typical clinical trial, electronic CRFs usually have the option to put questions to individual data points (with ID, date/time), e.g. when a study monitor finds that a data point is not reflected in the source document (e.g. by a transcription error) he flags this in the CRF. This form is then sent back to the investigator who in turn replies to the monitor's comment and makes the appropriate corrections (again with ID and data / time). So in the audit trail we clearly see why a change was made, by whom and when. If ODK is to be used for regulatory clinical trials, this is something that the system should be able to do. Note also that there are normally not that many data changes."...

PS: waiting for a second opinion from med dptmt data manager, that is the expert of the electronic data capturing tool we use for Clinical trials.

2 Likes

Very thorough options! I'm going to absorb these options for a bit, but wanted to quickly point out that when reading this, I'm realizing OpenClinica (clinical trial software) has built something very similar on top of Enketo (i.e. ODK XForms). Audit trail, comments, reason-for-change (and a lot more). There is some magic involved, and the form format extensions we used would not pass muster for our generic specification (stored as stringified JSON in a single XML node per question), but maybe some elements are of use. It is built on top of a basic comment feature in Enketo, which I think would pass muster spec-wise (I didn't get it into the ODK spec though tried). FYI, see this XLSForm (it can be tested on http://opendatakit.org/xlsform/)

2 Likes

Option 2 is nice because it's going into the audit log where we've started to put these things. Also, it's relatively fast to do.

I like it because you can imagine getting this dialog at the question level instead of the form level and that'd better satisfy the requirement. That workflow would be something like this:

  • On first launch, you enter the username/id. Maybe we auto-fill this if you have the username question.
  • On second launch, if you change a question, you confirm username and enter a short reason for change. Timestamp and the change itself are already in the log and the dialog keeps the previous entered information to speed up entry.

Yes, this narrows the type of data you can collect, but:

  • Systems with CRF support get this same narrow set of data and everyone is fine with it.
  • We can't even use fingerprints in Collect outside the audit. There isn't widely available hardware so why let this be a blocker?
  • Signatures are pretty large images. This could be fixed, I suppose.

To me, the big negative is that if we go down this road, Enketo won't have this feature, but Enketo (and thus Central at some point) could support it with relatively little work. Of course, we have to convince @martijnr, but he's less fanatical than he's ever been :laughing:!

2 Likes

This is an important point, which may preclude certain options (eg I think it could be difficult to accomplish using a parallel form/secondary instance/per XML element metadata). If each and every change must logged - even undoing an edit and setting a field's value back to its original during the same session, this rather implies a continuous change event log, ie audit lot.

I'm starting to warm up more to a specialized feature linked to the audit log (option 2) with all the arguments made here. It sounds like "for each change made on form re-entry, gather an alphanumeric user identifier and free text comment" is a very common requirement and narrowly addressing that case in a way that is easy for form designers would provide a lot of value. We could write a spec that describes what pieces of information need to be gathered from the user, when the user is required to enter them, and where in the audit log they get written to. Clients could choose an appropriate presentation.

If we had existing full-featured XForms engines to work with, there would be lots of interesting options but we don't and the XForms-y solutions I've come up with are either a ton of work for little marginal user benefit, not a great user experience, a bit of a hack, or a combination of the former.

Agreed the specs for for and the comment appearance look good. When those comments are used to track reasons for change, is there something that forces the comments to be filled in? Is user identity tracked based on who is logged in to a server?

I do think that for our users, separating the form data that and the audit metadata is valuable. It's not always the same people who analyze the two and working with XML is generally a higher technical bar. All that to say, if something like the for bind attribute were used for this purpose, I think the servers would have to do additional steps to extract the audit information. Given server fragmentation, I would say that's less than ideal.

Similarly, regarding the form design side, @martijnr wrote

That doesn't feel particularly more flexible than a single attribute that magically requires comments on all fields.

What I'm most nervous about are follow-on requirements like coded (rather than free-form) reasons for change.

@Xiphware asked "If each and every change must logged - even undoing an edit and setting a field's value back to its original during the same session"

Several levels of answer here.

  1. the audit function @LN @yanokwa built does this already (for example answer question, swipe forward, swipe back change answer).

This is actually a level of detail BEYOND what redcap actually does.
On the other hand it is an accurate reflection of what should ideally happen (i.e Redcap misses some timepoints where ideally you would have audit data).

  1. The key here therefore is not tracking the changes (which the newly done audit log does) or when they were made (again already done) but the WHY and the WHO

  2. In general what the main user wants to export is the FINAL data values.
    The audit log is so one can go back if requested and see what changes etc but is not routinely looked at per se as part of analysis

1 Like

second feedback:

"Option 2 looks most promising. In addition to that, for clinical trials I would like to add that:

  • It is absolutely key that there is user verification with password when entering data (whether initial entry or changing data). Otherwise you cannot trust the name that is assigned to the action in the audit trail. The audit trail is used in clinical trials to prove no one had access to the data that should not have had access to the data, that only trained and qualified personnel has entered data, to check if data has been entered according to a logical time frame (done to detect errors and/or fraud).

  • It would be ideal if you can set reason for change as mandatory at a question level when building the CRF. Because if it is optional, you will still need to check if reasons for change are being given, which leads to extra work. "

I could see easily standard responses (aka select one) being/becoming a high priority fairly quickly. Having to type the same change reason in repeatedly gets annoying quickly. That is, @dr_michaelmarks' "...but the WHY".

1 Like

I agree with @aurdipas, that user information ideally comes from the credentials used to retrieve the form, and not from a user-entered field (and OpenClinica maintains sessions to add user info automatically).

I'm fine with option 2 as well.

FYI, to share how Reasons For Change (RFC) are done in OpenClinica. First of all there are special views that require RFCs and others that don't have them at all. I believe it's related to the role of the user and the stage of the review process. This is probably easier to do with webforms than with a mobile app. For the views that require this, we automatically add an input field at the bottom of the page for each field the user changes. These fields are separate from the form. The fields have to be filled in before page-flipping or submission is allowed. There is an option to fill in all of the fields together with one reason or add reasons for individual questions.

Could you post example of how these look in an XForm (XML?) definition? Or is this tagging accomplished entirely outside the form definition?

I'm thinking

<bind ... jr:rfc-prompt="what is your favorite color" jr:rfc-required='true()'... /bind>

to trigger popup when filling in form... Or perhaps better in the control definition itself?

The control for a 'comment' (called discrepancy note in OpenClinica) is defined as in the XLSForm/XForm as I posted above (so just the for attribute and an appearance). The RFC functionality is built on top of that discrepancy note question and has no associated XForm syntax (it's defined by the view that the backend UI launches for that user) but it shares the data structure (stringified JSON for OpenClinica) of the discrepancy note and is shown in its history (which the user can view within the form). RFC is always required for them.

Not sure how helpful that all is though, because that was designed long before any audit functionality was added to the spec, and I'm not advocating for it. The only advantage of their approach is that you can query that comment data (e.g. it has different statuses and they have a custom comment-status() XPath function that can inspect the status of that JSON data). This means they can use it inside constraint and required expressions in XPath. E.g. a question can be required only if it doesn't have a comment or a constraint can include the clause that a value can exceed a limit if it has an 'updated' or 'new' comment.

Though the use by OpenClinica may be useful to see how far clinical trial requirements could go (I think it's way beyond what a generic client such as Enketo or ODK Collect should handle, for sure). Hence none of that specialized stuff has made into the core Enketo. We just made the core Enketo very extensible to facilitate such domain-specific customizations.

1 Like

As I understand it, the workflow that @dr_michaelmarks and @chrissyhroberts have described is entirely offline and so there is no entity to authenticate against. The idea would be that someone fills out data on their device and then either reviews it and makes edits later or hands it to someone else for review and editing. It's the same as the paper case where initials have to be relied on. This would be a bit better because you could at least know exactly whose device submitted the data.

In an ideal world, I think Enketo could be used for online edits to extend that workflow. I'm imagining it could have a way to use server auth for this feature. For example, when a user is logged in to Central and launches a submission for edit, Central would pass on some kind of client token/hash that would automatically be used as the user identifier for this feature. I'd see that as a future extension on this spec -- something like if the session (virtual secondary instance) has a user identifier, use that.

You mean for all questions, right? My evolving sense of option 2 is that it would be something like a single audit attribute (e.g. odk:track-change-reasons) that lets the client know to prompt for user identifier and change reason every single time a field is changed from a blank value to a non-blank value. The audit log would get two new columns (e.g. editor-id and change-reason) that would get populated. Editing or saving of the form would be blocked until editor identification and change reason were populated.

Basically this.

That would be very convenient and can be client-specific.

1 Like

Will there be daycare services at the convening?... :wink:

Well, first time we could use the login information (username), then if someone edit has to enter his/her user before editing. (Of course no authentication, all offline as paper based).
A bit more of restriction can be added validating the user editing against a csv media file with the list of users "authorized" for editing (?).

Yes. And I like your approach :slight_smile:

1 Like

Great progress people!

It's all about enhancing electronic data collection by making is verifiable, have an effective audit trails thus credible/authentic data.

@yanokwa, see how to make a signature feature work. In my view, it could be the most tamper-proof.

Paul

Just a minor point but we per se don't need an actual "signature" - an alphanumeric identifier would be fine (that's what Redcap records for example) and the file size of saving a JPG, or in the case of an audit trail multiple JPGs each time a change is made, would be problematic on many places we use ODK.

1 Like