The 'Swivel Chair' Problem Slowing Down Clinical Trials
By John Oncea, Chief Editor, Clinical Tech Leader
Ask Kiley McGlauchlen what the biggest unsolved technology problem in clinical research is, and she doesn’t hesitate. She has a name for it: the swivel chair.
“The coordinator has to pull the data out of the electronic medical record and swivel their chair over to the EDC – the sponsor’s electronic data capture system – and manually enter it,” said McGlauchlen, Director of Clinical Research at Blessing Health System in Quincy, IL. “It’s just transcription. You’re taking it from one place and putting it somewhere else.”
It’s a small phrase for a large, structural problem: despite years of industry conversation about interoperability, there is effectively none between the systems site staff use to treat patients and the systems sponsors use to collect trial data.
Why Nothing Talks To Anything
The disconnect isn’t a technical oversight so much as a market structure problem. Sponsors choose their own electronic data capture platform for each trial – McGlauchlen named REDCap, Medidata, Oracle’s Inform, and Medrio among the options she’s encountered, alongside homegrown systems – and sites have no say in the choice. “None of the vendors that the sponsors choose work with our system,” she said. “They are standalone.” With no incentive for any single EDC vendor to build integrations with every hospital EMR, and no standard for sites to build toward, coordinators are left doing the connective work by hand, trial by trial.
That manual burden shows up in small but telling ways. McGlauchlen described one protocol requiring three blood pressure readings, five minutes apart, with the first discarded and the remaining two averaged; a calculation and a set of timestamps that had to be documented on paper because there was no standard EMR field built for that exact sequence. Multiply that kind of protocol-specific quirk across dozens of active trials, and the paperwork adds up fast.
A more absurd version of the same problem surfaces in imaging. For oncology trials requiring routine CT scans, Blessing uploads DICOM image files to a sponsor’s third-party imaging vendor for independent tumor measurement. The upload portal, she said, times out after three minutes of inactivity, meaning a coordinator has to sit and wiggle the mouse every few minutes for up to twenty minutes while a large imaging file transfers, just to keep the session from expiring. “This is not a good system,” she said. “It needs to be better. It needs to be faster.”
What Would Actually Fix It
McGlauchlen’s proposed fix isn’t a specific piece of software: it’s standardization further upstream. If the industry agreed on a consistent, realistic set of data elements to collect across trials, she argues, EMR-to-EDC integration would finally become achievable, because vendors would be building toward a common target instead of hundreds of trial-specific variations. “If we could standardize the data elements we’re collecting across trials, we’d be so much closer to real integration between the EMR and the EDC,” she said. The payoff, in her view, isn’t just efficiency: it’s faster safety reporting and fewer transcription errors, the kind that comes from a coordinator mistyping a date or transposing two digits under time pressure.
She traces some of that friction back even further, to how protocols get written in the first place. McGlauchlen estimates that roughly 45 percent of protocol amendments are avoidable, the result of requirements that could have been caught early if sponsors brought site staff into the conversation during the draft stage, rather than after a protocol is finalized. “Let us help you help us,” she said.
Vendor selection compounds the problem. Sponsors sometimes choose the least expensive vendor for a given service, McGlauchlen said, and sites – and patients – absorb the consequences of that choice. Sites frequently don’t even learn which vendor has been selected until close to a trial’s site initiation visit, sometimes as little as two weeks before go-live. Working through a CRO adds another layer of friction: McGlauchlen described a recurring pattern where accountability gets diffused between sponsor and CRO, leaving sites without a clear line back to whoever can actually resolve an issue.
None of this has led her to turn down a trial over technology complexity or vendor count on its own: she’ll price the added coordination into the study budget instead. The one thing that will make her walk away is a budget that doesn’t work financially. But the swivel chair remains, in her framing, the industry’s most persistent and least discussed technology failure. “Sponsors in the industry need to understand,” she said, “that they ask for too much.”