Feature|Articles|September 29, 2026

Real-World Evidence Is Moving Upstream: Is the Data Infrastructure Ready?

RWE is finding a role earlier in drug development than ever before, but the data quality, integration, and organizational alignment required to make it regulatory-grade are still catching up to the ambition.

The conversation about real-world evidence (RWE) in clinical development has shifted. For years it was a post-market story, a tool for long-term safety surveillance and label expansion once a drug was already approved. That is no longer where the interesting work is happening. Real-world evidence is moving upstream, into trial design, into external control arms, into regulatory submissions, and in some cases into the evidentiary packages that support approval itself. The question is whether the infrastructure sponsors have built is ready for what that actually requires.

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Real-time clinical trials require standardized digital data capture at the point of care through scaled eSource-EDC-EHR integration, but progress stalls because competing standards lack regulatory enforcement and one-off system integrations cannot scale beyond single studies without industry-wide alignment and legal clarity on data ownership.