Enabling Cloud Computing In DCTs For Remote Data Capture, Monitoring, And More (Part One)

By Kannan Ramachandran, category specialist - Cloud Computing & Data Center, Beroe, Inc.

DCTs and hybrid trials are moving from contingency to capability. The differentiator is no longer the proliferation of apps or devices, and it is the cloud fabric that standardizes data capture at the edge, orchestrates streaming ingestion, and provides globally consistent operational oversight. Recent real-world DCT implementations have demonstrated large-scale use of wearables, telehealth, and cloud-based operational dashboards to reduce site visits and improve data continuity. Likewise, peer reviewed analyses from 2024–2025 show rapid sponsor adoption of remote monitoring technologies and cloud connected data pipelines, particularly in oncology and multiregional programs.

Yet this shift also amplifies operational and compliance risks, including latency across remote connections, fragmented audit trails across multiple vendors, and integration drift that can undermine inspection readiness. This article provides a pragmatic blueprint spanning workload placement, integration patterns, and governance by design to help sponsors scale hybrid and decentralized trial models safely and sustainably.

Why Cloud Infrastructure Has Become Essential For DCTs And Hybrid Trials

Following the pandemic, sponsors validated that decentralized elements such as eConsent, ePRO/eCOA, telehealth, wearables, and home health services can widen patient access, maintain trial continuity, and improve overall adherence. In 2024, an oncology-focused survey published in JAMA Network Open reported strong sponsor aspirations to expand remote-enabled capabilities and projected a multiyear growth curve across enabling technologies, with oncology adoption lagging but showing clear upward momentum.¹

In parallel, a 2026 analysis in PLOS Digital Health reviewed 1,370 U.S.-registered decentralized trials and documented a structural shift toward digitalized and cloud-enabled trial operations. The study highlighted increasing use of remote monitoring tools, digital ingestion workflows, and cloud-connected pipelines, underscoring the methodological foundations required to scale DCTs reliably.²

Implication: Hybrid trials and DCTs are no longer edge-case models or pandemic-driven exceptions. They now represent a deliberate strategic choice that depends heavily on resilient, auditable, and globally accessible cloud pipelines to support distributed participants, sites, and vendor ecosystems.

Evidence: Real-world DCT case roundups from 2025 demonstrate multi-therapy studies running continuous wearable-based monitoring, remote symptom reporting, telehealth touchpoints, and centralized cloud dashboards to reduce site visits and improve operational continuity across cardiology, oncology, respiratory disease, and immunology.³ Complementary 2025 platform guidance shows how Application Programming Interface first integration, involving eConsent, eCOA, EDC, and automated medical record retrieval, accelerates enrollment and improves data quality in cloud orchestrated environments.⁵

What Cloud Infrastructure Enables In Hybrid And Decentralized Trial Models

Cloud infrastructure enables hybrid and decentralized trials to function as cohesive, real-time operational systems rather than as fragmented digital touchpoints. By providing globally-distributed ingestion endpoints, centralized oversight, and scalable data orchestration, the cloud transforms remote interactions, such as ePRO/eCOA entries, wearable streams, and telehealth visits into reliable, inspection-ready trial data. Each core DCT workflow benefits from capabilities that simplify data capture, strengthen continuity, and reduce variability across regions.

A. Remote ePRO/eCOA With Real-Time Operational Visibility

Remote ePRO/eCOA allows participants, caregivers, and clinicians to capture symptom scores, patient reported outcomes, and assessments from mobile or web interfaces. Cloud endpoints buffer, validate, and synchronize submissions in near-real-time, enabling study teams to track compliance and data freshness across geographies. Evidence from 2024–2026 shows that sponsors increasingly view remote monitoring and cloud-based capture as foundational for oncology and multiregional trials, moving far beyond pandemic driven adoption.^1,2

Design practices that work:

To ensure remote ePRO/eCOA workflows perform reliably at scale, sponsors benefit from applying several proven architectural principles:

• Regional API gateways withContent Delivery Network (CDN) acceleration to reduce latency and minimize dropout across diverse connectivity environments
• Client-side telemetry (e.g., offline duration, retry patterns, sync failures) monitored against defined service level objectives (SLOs) for data freshness and reliability
• Automated nudges and escalation rules for missed reporting windows, reducing downstream reconciliation burden and preserving protocol adherence

These practices are strongly reinforced across sponsor adoption reports and DCT integration guidance.^1,5

B. Home Health And Wearable Devices: Continuous Streaming, Not Batch Uploads

Home health visits and wearable sensors generate continuous real-world data streams, vitals, activity metrics, glucose readings, spirometry, ECG strips, smart inhaler adherence, and nurse-captured measurements. Cloud streaming services (pub/sub, event hubs) absorb these variable workloads, maintain event order, and isolate corrupted payloads into dead letter queues. Real-world 2025 DCT rundowns highlight how cloud dashboards have enabled multi-therapy areas, including cardiology, respiratory disease, immunology, and oncology, to operate remote monitoring programs at scale.³ Likewise, the 2026 DCT landscape study confirms a significant uptick in digital ingestion patterns among registered DCTs.²

Design practices that work:

To maintain auditability and operational resilience across diverse device ecosystems, cloud-enabled trials typically adopt:

• data contracts per vendor/device, defining units, cadence, sampling expectations, and error handling logic
• immutable raw data landing zones, separated from curated/analytics layers to preserve regulatory traceability and support forensic reconstruction
• device heartbeat KPIs such as last seen timestamp, battery status, and firmware version to detect silent failures before they cascade into protocol deviations.

These design choices are supported across methodological analyses and real-world DCT operational documentation.^2,3,5

C. Multiregional Oversight: Converging Disparate Signals Into One Operational Truth

With sites, home health partners, vendors, labs, and imaging cores distributed across regions, cloud platforms enable operational teams to consolidate disparate data streams from EDC, CTMS, RTSM, eCOA, imaging repositories, and safety systems into unified operational data stores (ODS). This consolidation provides role-based dashboards for study managers, CRAs, data managers, and PV teams. Insights from 2024–2026 show that sponsors increasingly rely on cloud-enabled central monitoring for faster detection of operational risks and better cross-regional visibility.^1,2

Design practices that work:

To establish reliable oversight across multiple regions and vendors, sponsors apply the following cloud-native practices:

• Unified master data frameworks, harmonizing sites, roles, and user identities with single sign on (SSO) across platforms
• Lineage and time travel capabilities, allowing teams to reconstruct “as was” data sets, a key requirement for regulatory inspections
• Event-driven automations, such as automatically triggering RTSM inventory adjustments when site level thresholds fall below predefined limits

These operational patterns align with documented sponsor adoption trends and platform integration best practices.^1,2,5

Hybrid and decentralized clinical trials have moved well beyond experimental adoption and now rely on cloud infrastructure as their operational backbone. As this first part has shown, the cloud is what enables remote data capture, continuous wearable streaming, multiregional oversight, and reliable, inspection‑ready workflows across globally distributed participants and vendors. By standardizing ingestion, strengthening continuity, and providing near‑real‑time visibility, cloud‑native architectures address the core challenges that once limited DCT scalability.

At the same time, these capabilities introduce new operational and compliance considerations from latency and monitoring blind spots to fragmented audit trails and vendor drift, all of which become more pronounced as trials expand. Understanding these pitfalls is essential for sponsors aiming to run decentralized models at scale.

In Part 2, we shift from what cloud infrastructure enables to how sponsors can operationalize it safely and sustainably. We will explore integration patterns that reduce reconciliation burden, governance‑by‑design practices that embed compliance into every layer of the architecture, workload placement strategies, and operating models that ensure reliable execution without relying on spreadsheets. Together, these next sections provide a practical blueprint for organizations looking to mature their hybrid and decentralized trial capabilities.

References:

1. JAMA Network Open (April 2024): Remote Monitoring and Data Collection for Decentralized Clinical Trials — oncology sponsor adoption patterns and enabling technologies. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2817479
2. PLOS Digital Health (Jan 2026): Decentralized clinical trials: a comprehensive analysis of trends, technologies, and global challenges — analysis of 1,370 U.S. registered DCTs. https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001191
3. Real world DCT case roundup (2025): Real World Examples of Decentralized Clinical Trials Using Remote Monitoring — multi therapy DCTs using wearables, telemedicine, cloud dashboards. https://www.clinicalstudies.in/real-world-examples-of-decentralized-clinical-trials-using-remote-monitoring/
4. Applied Clinical Trials / UW CTI (2023–2024): Decentralized Clinical Trials: Being Audit Ready and Avoiding Pitfalls — common DCT audit findings, TMF/documentation gaps, vendor oversight expectations. https://uwclinicaltrials.org/2023/11/20/decentralized-clinical-trials-being-audit-ready-and-avoiding-pitfalls/
5. Castor (2025): Decentralized Clinical Trial Platforms in 2025: A Practical Guide for Clinical Operations — integration, eConsent/eCOA/EDC orchestration, medical records retrieval, API callbacks. https://www.castoredc.com/insight-briefs/decentralized-clinical-trial-platforms-in-2025-a-practical-guide-for-clinical-operations/
6. FDA/MHRA/Health Canada Workshop (Feb 2024): Clinical Trials with Decentralized Elements and GCP Inspections — inspection expectations and decentralized element definitions.

About The Author:

Kannan Ramachandran is a category specialist at Beroe Inc., a global procurement intelligence firm that partners with over 10,000 companies worldwide, including a majority of the Fortune 500. With deep expertise in cloud computing and data center infrastructure, Kannan advises enterprises on strategic sourcing, cost optimization, and digital transformation. His work is rooted in data-driven research and market intelligence, helping organizations make informed decisions in a rapidly evolving tech landscape.