How to Design Electronic Case Report Form (eCRF) Questions to Maximize Semantic Interoperability in Clinical Research

Case report forms (CRFs) are the instruments used by research organizations worldwide to collect information about patients and study participants with the purpose of answering specific questions, assessing the efficacy and safety of medical products, and in general improving prevention and treatment in health care. To obtain significant research results out of the collected data, CRFs should be designed following the recommendations issued by regulatory authorities. However, we believe that semantic interoperability in CRFs has not yet been properly addressed. Within an international consortium comprising several COVID-19 cohorts, we scrutinized the questions included in the different CRFs with the purpose of establishing semantic interoperability across the different study data elements so that data could be merged and jointly analyzed. We realized that similar concepts were structured very differently across the different CRFs, making it hard to find and match the information. Based on the experience acquired, we developed 5 guiding principles on how to design CRFs to support semantic interoperability and increase data quality while also facilitating the sharing of data. Our aim in this viewpoint is to provide general suggestions that, in our opinion, should support researchers in designing CRFs. We conclude by urging authorities to establish an international coordination board for standards and interoperable clinical study data with competence in clinical data, interoperability standards, and data protection as part of a preparedness plan for future pandemics or other health threats.