The future of clinical research is to move the trials outside of the “white tower” of academic medical centers and into the community.  Patients can be identified through the EHR after diagnosis in outpatient clinics and regional hospitals.  The EHR is “flagged” to ask if the doctor and patient want to enroll in an intervention trial of a new therapy and then a research coordinator remotely calls the patient and family for consent.  The patient is randomized to treatment A, B, C, vs placebo, and outcomes are monitored continuously by blinded artificial intelligence protocols that assess pre-specified efficacy outcomes in the electronic health care record, e.g., Which treatment is working better to improve organ function, survival, hospitalization, etc.?).  If one treatment is better than the other, the next patients are adaptively randomized in greater and greater proportions to the treatments that work, thus limiting the risk of a patient receiving a treatment that does not work.  Once a treatment is statistically superior, the trial is automatically stopped. 

• Examples include the REMAP-CAP clinical trials group which adaptively randomized patients with SARS-CoV2 in hundreds of regional hospitals and rapidly established the efficacy of hydrocortisone, anti-IL6, and heparinization, improving mortality during severe COVID-19 pneumonia.