Applying AI to Automate Workflows Without Disrupting Sites

In a recent video interview with Applied Clinical Trials, Kevin Williams, EVP and Chief Strategy Officer at Ledger Run, discussed how sponsors must rethink operational strategies in 2026 to better support clinical trial sites amid rising complexity. He explained why sourcing models, system design, and workflow automation must be evaluated together to reduce operational switching and site burden. Williams also outlined how sponsors can introduce new engagement tools without overwhelming sites, emphasizing neutrality-first adoption and consistency across processes. He explored how AI-enabled workflows can automate existing processes rather than impose new ones, and concluded by identifying the metrics sponsors and CROs should track to assess whether site support investments are improving performance, satisfaction, and long-term collaboration.

The below interview transcript was lightly edited for clarity.

ACT: How can AI-enabled workflows be designed to enhance site efficiency without disrupting established operations?

Williams: Yeah, good question. Everybody wants to talk about AI and what it’s doing for them. The interesting part of AI is that you need to use it to solve specific operational challenges.

We like to take a pragmatic approach to AI. We joke at the management level that we’re never going to be an AI company, because AI is an enabler. It’s not a company, and you have to solve real problems with it.

For us and similar organizations, that means finding the problems you want to solve and then using AI to solve them. When it comes to workflows, the workflow doesn’t necessarily have to be new—it could just be automated.

That’s the approach we’ve been taking. If you look at certain business processes today, what makes them burdensome isn’t necessarily the process itself, but all the manual steps involved. There might be hundreds of steps, with multiple people touching something to make it work.

If we can use AI or AI agents to automate those workflows, you can still run the same process, particularly as it relates to sites. I strongly believe in meeting sites where they are, not creating new processes and burden, but allowing them to function the way they do today in a more automated way.

That automation might initially be from the sponsor or CRO perspective, creating efficiencies that can ultimately be passed along to sites.

For me, the ideal scenario is a fully engineered, smart system where everyone logs in—sites, sponsors, CROs—and everything works seamlessly. But that’s not reality, especially for back-office clinical business operations.

We’re not competing with wearables or new ePRO devices. This is back-office work, and it requires more hand-holding to drive change. We can leverage modern technology like AI to assess and push that change, but not in a way that creates more burden for sites.