Duplicate Tech, Not Technology, Is Burning Out Trial Sites

By John Oncea, Chief Editor, Clinical Tech Leader

It’s become a reflexive complaint in clinical research: technology is burning out the workforce. But when I asked Elisa Cascade, an industry advisor who has worked on both the sponsor and technology sides of clinical trials, on exactly where that burden comes from, she offered a sharper diagnosis than “too much tech.” The problem isn’t technology. It’s duplication.

“Site’s own technology alleviates site burden,” Cascade told me. The trouble starts when a site is forced to use a sponsor’s mandated system in addition to its own, doubling the effort for the same piece of information. Multiply that across dozens of studies and dozens of sponsors, and you get sites logging the same patient visit, the same lab value, the same consent record into system after system.

The Cost Of Entering Everything Twice

The stakes go beyond frustration. Cascade was direct about the downstream effect: double work “slows down enrollment and causes data errors, which then end up as audit findings.” In an industry where a single data-quality lapse in a regulatory filing can jeopardize an asset worth hundreds of millions of dollars, redundant data entry isn’t just an inconvenience; it’s a quality risk.

David Vulcano, CEO of the Association of Clinical Research Professionals and a longtime advocate for research sites, sees the same dynamic from the site’s side of the table, and he has data to back it up. During his time as president of the Society for Clinical Research Sites, survey data showed a growing number of sites pushing back on sponsor-mandated technology, and the sites that pushed back, he said, tended to be the more sophisticated, more successful ones. Smaller sites, lacking leverage, mostly “roll over to whatever the sponsor gives.”

An Absurd Comparison That Makes The Point

Vulcano’s clearest illustration of why this matters came from outside clinical research entirely. Imagine walking into an emergency room, he said, and being told the hospital needs 20 minutes to switch its medical records system because your insurer prefers a different one. “Ludicrous,” he called it, and yet that’s effectively what happens when a sponsor requires a site to abandon its own established systems for a study-specific platform.

His reasoning cuts against a common assumption that it is only the sponsors being difficult. Sponsors want uniformity because they’re trying to reduce variance at the level of a single study: every site doing the same visit the same way. But sites, he pointed out, aren’t running one study. They’re running 10, 20, sometimes 30 at once, and their goal is to reduce variance at the level of their own operations, not any one sponsor’s protocol.

“I build a Ford, a Ford, a Ford, a Ford, a Ford,” Vulcano said, “not a Ford, a Ford, Mercedes, Honda, Ford.” Both sides are optimizing for scale; they’re just optimizing at different levels of the system, and that mismatch, without the ability to feed each other’s dashboards and adhere to each other’s quality controls, is what produces duplicate work and process interruptions.

Why Sites Hesitate To Invest In Their Own Systems

There’s a reason more sites haven’t simply solved this themselves by standardizing on strong internal technology. According to Vulcano, the biggest reason sites hold back from investing in their own systems is fear: they invest in a platform, and then a sponsor won’t let them use it on a given study anyway. That fear becomes self-fulfilling – sites under-invest in their own infrastructure because they can’t be sure sponsors will respect it, which keeps the industry dependent on sponsor-mandated, duplicative systems.

He does see the incentives shifting. Sites that have been burned by juggling five different e-consent platforms are increasingly recognizing that consistent, site-owned technology reduces errors and cost. And sponsors, he said, are starting to notice: when a site’s own system can feed a sponsor’s dashboard without duplicate entry, adoption friction drops and sites become more willing to push back and win that argument.

What Would Actually Reduce The Burden

Neither Cascade nor Vulcano frames this as an argument for less technology. Both are emphatic that well-designed, site-owned technology reduces burden rather than adding to it. The fix isn’t fewer systems; it’s fewer redundant entries into the systems that already exist. That requires the sponsor side to accept a site’s existing technology stack wherever possible, and it requires the interoperability progress addressed in this series’ companion piece, The Real Reason Clinical Trial Systems Don’t Talk to Each Other, to actually reach the point of data flowing once, not five times, per patient encounter.

Until that happens, sites will keep absorbing the cost of an industry that has, as Cascade put it, largely agreed on the destination without agreeing on who pays to get there.