Despite clear data quality and regulatory advantages, paper-based clinical outcome assessments persist due to cost asymmetry, trial complexity, startup timelines, and provider capability gaps, though hidden paper costs and loss of institutional knowledge often outweigh upfront electronic implementation expenses.
Sustainability should be central to clinical trial design and considerate of how digital tools such as electronic clinical outcomes assessments can help achieve this.
Exploring the different stages in the development of a digital measure, and the activities and steps key to achieving meaningful impact for patients.
The answer comes down to context of use—and knowing the motives for "missingness."
