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Clinical trials cannot run without research sites and participants. Yet both can end up carrying significant costs while waiting to be reimbursed.
In this episode of Digital Health Off the Record, Edwin and Farrell explore the often-overlooked realities of payments in clinical trials. From site budgets that fail to capture the true workload to patient expenses that can become barriers to participation, they discuss why getting payments right is essential for sustainable and accessible research.
Building on previous conversations about site burden, patient-centred trial design and fragmented technology, they also consider whether digital payment tools are genuinely simplifying the process or creating another system for sites to manage.
In this episode, we cover:
Why timely and fair site payments matter - 00:51The hidden work that trial budgets can overlook - 03:02Payment delays and their impact on site cash flow - 14:37Patient reimbursement and barriers to participation - 19:12Technology, ethics and planning for long-term costs - 23:58 -
Patient centricity is not a new topic in clinical trials, but it is one the industry still needs to keep coming back to.
In this episode of Digital Health Off the Record, Farrell Healion and Edwin Cohen explore why incorporating patient voice earlier in study design can make a real difference to recruitment, retention and the overall patient experience.
We discuss how patient input can help reduce unnecessary burden, improve protocol design, support more meaningful inclusion criteria and make trials work better around real life. We also look at where digital health technologies, DCT capabilities, patient feedback tools and patient engagement roles can help - and where simply adding more technology risks creating the opposite effect.
As always, this is an honest conversation about what the industry is getting right, where we still fall short and how we can design better trials for patients, sites and sponsors.
In this episode, we cover:
Why patient voice matters for recruitment, retention and study success 00:25How earlier patient input can improve protocol design and reduce burden 03:50Designing trials around real-world patient needs, diversity and access 05:46The role of DCTs, digital tools and patient feedback in improving the trial experience 12:55Why patient centricity still struggles to stick in practice 21:10Balancing standardisation with meaningful flexibility in global trials 25:26 -
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eConsent has been discussed in clinical trials for years, but it still feels underused compared with other patient-facing technologies like eCOA.
In this episode of Digital Health Off the Record, Farrell and Edwin take a practical look at what eConsent really means, why it should be more than a PDF with an electronic signature, and how it can improve the consent experience for patients, sites and sponsors.
We discuss:
Why eConsent still has not reached its full potential (00:24)What eConsent should mean beyond a digital signature (01:17)How eConsent can improve patient understanding and accessibility (03:45)Why consent should be treated as a workflow, not just a document (05:17)The hidden value of optional consent, data use and sample traceability (07:24)Why consent forms remain too long, complex and difficult to manage (10:27)How digital workflows can support amendments, reconsent and oversight (19:20)Why digital consent is often held to a higher standard than paper (22:17)As with our previous discussions on eCOA and DCT-enabling technologies, the real opportunity is not simply to digitise an existing paper process. It is to rethink how clinical trial technology can make studies clearer, more accessible and easier to manage for everyone involved.
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eCOA has been part of clinical trials for decades, but it still has not reached its full potential.
In this episode of Digital Health Off the Record, Farrell and Edwin go back to basics on electronic clinical outcome assessments - what eCOA actually covers, how it differs from eDiaries and remote patient monitoring, and why it is about much more than just ePRO.
They also get into the practical side of eCOA implementation, including why paper still appears in study discussions, where hidden costs and data integrity risks come from, and how better planning can remove licensing, translations, submissions and device strategy from the critical path.
We cover:
What eCOA means across ePRO, ClinRO, ObsRO and PerfO [01:20]How eCOA can support primary and secondary endpoints [03:46]Why eDiaries and remote patient monitoring are related, but not the same thing [04:34]The history of eCOA and the move from paper to digital [06:17]The real cost comparison between paper and digital data capture [07:48]“Parking lot syndrome” and why timestamps matter [09:33]BYOD vs provisioned devices, including patient preference and reimbursement [11:10]Sustainability considerations for study devices [15:43]Why eCOA implementation often goes wrong [17:37]Why licensing, translations and submissions can delay study start-up [18:10]China-specific implementation considerations [21:00]Accessibility, caregiver support and assisted completion [23:53]Why paper introduces more risk than many teams realise [25:35]Ultimately, eCOA is not just a technology choice. It is an implementation, data quality and patient experience decision.
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AI is moving fast, but clinical trial regulation is still catching up.
In this episode of Digital Health Off the Record, Farrell and Edwin explore how AI fits within GCP today, even when it is not explicitly covered in ICH E6(R3).
They break down what is usable now, what is higher risk, and how to apply existing regulatory principles as guardrails for AI adoption in clinical trials.
What we cover:
EU AI Act - High-risk AI in patient safety and clinical decision making (03:30)Quick wins - Lower-risk operational AI and workflow efficiency (05:30)Agentic AI and the accountability challenge (07:00)Human oversight in SAE reporting and protocol deviations (08:30)RBQM and continuous monitoring opportunities (11:00)Synthetic data: what it is and where it fits (12:45)Digital twins and protocol simulation (18:30)Reducing control arms and improving recruitment (20:30)Data quality, model drift, and over-trust in AI outputs (22:30)Next episode, we dive into eCOA - covering implementation considerations, BYOD vs provisioned devices, translations, and licensing.
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ICH GCP E6(R3) is now coming into effect across key regions like the UK and Canada and has been in Europe for months - but what does it actually mean in practice?
In this episode of Digital Health Off the Record, Farrell Healion (OptiTrial) and Edwin Cohen (C&Flow) break down the shift from traditional trial thinking to a more modern, risk-based, and technology-enabled approach.
We explore:
Why R3 is more than just an update - it is a rethink of how trials are designedThe real impact of Risk-Based Quality Management and focusing on what truly mattersHow Digital Health Technologies are now expected, not optionalThe growing role and responsibility of sites when using their own technologyWhat participant centricity actually looks like beyond the buzzwordsWe also get into the practical realities:
Where does responsibility sit?
How do you assess site-owned systems?
And are we creating new burdens while trying to reduce others?R3 sets the direction - but the industry is still figuring out how to implement it.
If you are working in clinical trials, digital health, or study operations, this is a conversation you will want to be part of.
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Decentralized clinical trial technologies had their moment during COVID. But are we actually using them well today?
In Episode 4, Farrell Healion and Edwin Cohen break down where DCT really stands in 2026 - cutting through the narrative of fully remote trials to focus on what actually works in practice.
Because the goal was never to replace sites. It was to give patients more flexible ways to participate.
We cover:
- eCOA and why paper should no longer exist in 2026- eConsent - high potential, but still lagging in adoption
- Wearables and connected devices - where patients are driving innovation
- Telehealth as the simplest and most effective way to reduce burden
- The hidden costs of paper and delayed data
- Why hybrid models are the reality, not fully decentralized trials
- Global challenges - from data privacy to country-specific regulations
- Why most teams are not getting full value from the tech they deployDCT is not the challenge anymore. Implementation is.
If trials are meant to fit around patients’ lives, the same must be true for sites.
Candid takes, no buzzwords, straight talk.
Are DCT technologies reducing burden - or just shifting it somewhere else? Let us know.
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Everyone is talking about AI in clinical trials. But are we actually ready for it?
In Episode 3, Farrell Healion and Edwin Cohen go under the hood — cutting through the buzzwords to look at what AI adoption in clinical trials actually requires. Because the biggest barrier is not the technology. It is the 20 years of technical debt we are trying to build it on.
We cover:
ML, LLMs, and GenAI — what the difference actually means for clinical opsReal-world AI wins that are genuinely moving the needleWhat your organisation must have in place to succeedThe hard conversation: risks, ethics, and accountabilityAI is not coming for your job — it is coming for the 40% of your job you hate doing anyway. But only if the foundations are right.
Candid takes, no buzzwords, straight talk.
What is the biggest hurdle to AI adoption in your organisation — trust, data quality, or regulation? Let us know.
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In Episode 2 of Digital Health Off The Record, we turn the spotlight onto one of the biggest tensions in modern clinical trials: site burden.
Digital health technologies promise efficiency, better data, and improved patient experiences. But what does it actually feel like on the ground for sites? Are we reducing burden, or simply shifting it?
From device overload and fragmented systems to duplicate data entry and endless training refreshers, we unpack the operational reality facing site teams today. With studies now involving 20 plus systems on average, increasing datapoint complexity, and shrinking timelines to first patient in, something has to give.
We explore:
Why more technology does not automatically mean more efficiency
The hidden operational layer driving much of the burden
How data overload is affecting clinicians and study teams
It is not all bad news. Real time data, improved data integrity, decentralized models and better patient engagement are shifting the industry forward. But are we designing studies with a digital first mindset, or just layering innovation on top of legacy processes?
We also debate what “good” could look like. From cohesive site journey design and centralized training models to the potential of AI co-pilots and connected flows, what would actually make life easier for sites?
Expect candid reflections, practical examples and honest perspectives on what needs to change if we want digital health to deliver on its promise without overwhelming the people running our trials.
Let us know your experiences. Are digital tools reducing burden at your site, or adding to it?
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In our first episode of Digital Health Off The Record, we unpack the biggest themes and takeaways from SCOPE Summit 2026.
From Agentic AI and digital endpoints to implementation realities and inspection readiness, we share what was actually discussed in the rooms, not just what made the slides. Where is the industry genuinely progressing? Where is the hype running ahead of delivery? And what should sponsors, sites and technology partners be paying attention to next?
Expect candid reflections, practical insights and a few unfiltered opinions as we kick off the podcast and set the tone for the conversations to come.
