Streamlined Ethics Review

CTO’s streamlined research ethics review program makes clinical trials more efficient and cost-effective by enabling a single ethics review for multi-site studies. Through our online Ontario-built platform, CTO Stream, we’ve transformed how research ethics review is done in Ontario. CTO Stream, enables all research sites participating in a multi-site research study to undergo a single ethics review rather than separately applying to their local research ethics boards. This reduces the time and labour required to obtain research ethics approval.

CTO Stream

High-quality ethical review is critical to protecting the rights and welfare of people participating in clinical research studies. Up until 2015, each hospital or research site in Ontario participating in a study typically acquired its own local review, spending significant time and public resources on an inefficient process duplicated across participating sites. Developed in partnership with Infonetica Ltd, CTO Stream is a web-based platform that has transformed how research ethics review is done in Ontario, enabling a single ethics review for multiple research sites participating on the same study.
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Single REB Application

If you have a multi-site study, the ethics review will be done by one CTO Qualified REB.

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Standardized Forms

Sites will use the same ethics application forms and standardized consent form templates.

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Fast & Efficient

Getting ethics approval for additional sites is quicker and more efficient.

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CTO Qualified REB

All reviews are conducted by a CTO Qualified REB, ensuring the highest ethical standards are maintained.

CTO Stream By the Numbers

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CTO Stream users

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research studies

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applications for research ethics approval received

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in estimated cost savings to Ontario

How it Works

Working with REBs and institutions across the province, CTO has built a system that allows one Research Ethics Board (REB) to oversee the ethical conduct of research occurring at multiple sites in Ontario. All reviews are conducted by a CTO Qualified REB, ensuring the highest ethical standards are maintained.


Provincial Initial/CHEER Initial Application (PIA)

One research team will submit the provincial, study-wide application on behalf of all sites in Ontario through CTO Stream.


Centre Initial Application (CIA)

Once the Provincial application is approved by the designated REB of Record, each site submits the Centre Initial Application to the REB of Record. These abbreviated Centre applications are submitted through CTO Stream and reviewed by the same REB which approved the study provincially.


Participant Materials

Once provincially-approved, all non-consent participant materials (i.e. posters, wallet cards, diaries, etc.) are ready for use by all sites (allowing for administrative changes) minimizing the need for re-submission and re-review by the REB.


Post-Approval Submissions

During the course of the research, study-wide changes, amendments, documents etc. are submitted at the provincial level, and approved/acknowledged simultaneously for all sites. Sites are responsible for site-specific submissions pertaining to changes or events occurring at their own research site.



There is a single ethics expiry date for the study and all research sites in CTO Stream.
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REB Qualification Program

With CTO Stream, all ethics reviews are conducted by a CTO Qualified REB, ensuring the highest ethical standards are maintained. Obtaining CTO REB Qualification allows institutions and REBs to feel confident delegating ethics review and oversight to one other.