If paper is the sand in the gears of the 21st century clinical trial, money may be the wettest form of that sand. Getting funds to patients and investigators in an auditable, documented, transparent manner is no small thing. Generating a single paper check is easy. Generating hundreds or thousands of them is a numbing and risk-laden chore—especially in a climate of heightened scrutiny of the industry's financial relationships with investigators.

So we suspect Greenphire has a bright future. The Philadelphia firm is dedicated to speeding money to patients and investigators. The Greenphire technology can be integrated with all of the major types of clinical computer systems. The company's ClinCard product has been developed to significantly reduce the payment-related work burden on investigative sites and sponsors at the same time.

That's easy to say and hard to do. Greenphire straddles the distance between the modern credit-card systems of the banking industry and the Victorian paper flow of modern clinical trials. An electronic card, like a gift card, can simplify reimbursements for out-of-pocket expenses. The company allows a patient's incidental or transportation costs to be available after a 24-hour security delay. "There is a lot of flexibility and security," says Samuel Whitaker, founder and CEO. "It's beneficial for the patient because they get quicker access to the funds."

Problematic Paper

It was news to us, but there may be 10 million Americans, perhaps many more, without any bank account. There could be any number of reasons for "unbanked" or "underbanked" patients: employment status, homelessness, immigration status or financial illiteracy.

So while all sponsors may not recognize it, handing an unbanked patient a paper check is handing her a problem. In most cases, a modest face amount on the check will be nicked by at least 10 to 20 percent after the fees from a check-cashing establishment have been levied.

An electronic card, on the other hand, ensures that the patient receives the full amount. Unlike a traditional gift card, sponsors can replenish Greenphire cards with additional monies over the course of a trial. That can keep a patient invested and interested in participation. "The whole goal is to maintain engagement between you and the prospective patient to keep them involved in the process," says Whitaker.

Integrated Communications

Electronic payment is also preferable from a sponsor perspective. "They have a centralized audit trail as opposed to collecting data from sites," notes Whitaker. "It's just one less thing the site has to be worried about in terms of cash flow. There is no check tracking."


A Sample Greenphire Card

As the sites receive cards, they are worthless, much as an iTunes card is inert plastic until activated at a cash register. Except in Greenphire's case, the card is typically switched on 24 hours after a clinic visit or any other milestone or security check specified by the sponsor.

The Greenphire system can also handle other messaging and communication to patients, alerting them with a mobile phone text message that their card has been credited with money. The system can send patients institutional review board-approved messages to remind them about taking their medication, filling out their diaries or upcoming appointments. It's also nice to hear that in an era of difficult technology mashups, the communication and financial aspects of the Greenphire system are integrated from the start.

The system can be linked to an interactive voice response system to manage calls from patients interested in a particular trial. That allows additional small payments every time the patient moves forward another step.

Remind Me

The appearance of the card is entirely at the sponsor's discretion. The graphic design of each Greenphire card can be completely customized to the trial, providing a branding opportunity that can accompany the funds. Says Whitaker: "We like to call it a billboard in your wallet. You are reminded of your participation in the study. You might think, 'I need to fill out my diary tonight.' We try to make it stand out."

Greenphire sees itself as a service provider, and does not charge to put money on each card. Rather, its fees are flat and depend on the complexity of the trial. Two recent proposals were quoted at $13 and $40 per patient, respectively.

Due to the vagaries of banking law and credit card rules, the Greenphire cards should work if a U.S. patient brings them to Europe, but the company isn't allowed to issue them there.

The only obstacle to Greenphire's success, unfortunately, is that not all sponsors are fully aware of the costs and complications that paper-based payments bring. Our hope is that that will change. At a time when patients and physicians are hesitant about participating in biomedical research, even incremental advances like the ClinCard could have large effects.