The Stanford Cancer Institute Clinical Trials Office (SCI-CTO) has developed an electronic medical record (EMR) integrated tool that helps clinicians locate relevant cancer clinical trials for patients in real time. Recently published results show it is producing faster referrals, a surge in screening requests, and a cultural shift toward viewing trials as a standard option in cancer care.
Clinical trials do more than test whether new drugs are safe and effective. They drive progress in cancer treatment by refining existing therapies, uncovering better drug combinations, and pushing science forward. Every breakthrough in cancer care, from targeted therapies to immunotherapy, has been made possible through clinical trials. None of it would be possible without trial participants. Yet fewer than 10% of cancer patients enroll in trials, and that number is a clear barrier to progress.
Lead author and Stanford Cancer Institute member Nam Bui, MD, clinical associate professor of medicine, states, “We've had clinical trials that had to close or results delayed because the accrual numbers were too low. Every second that we can't get patients on trial is time wasted that could be beneficial for scientific discovery.”
Gaps
There is a fundamental knowledge gap between trials that are enrolling new patients and the doctors who need to find the right trials for their patients. The national federal trial database, clinicaltrials.gov, is bloated, overwhelming, and challenging to navigate.
“Before the internet, we used the Dewey Decimal System in the library,” says Bui. “Now we have Google. You can search ‘restaurant near me’ or ‘when was the Constitution written’ and get answers instantly. That kind of tool doesn’t exist for clinical trials. Clinicaltrials.gov is informational, but it is not built to match patients to studies.”
Even when a doctor finds an applicable trial in the database, their patient may not be eligible. Eligibility involves combing through medical records, reviewing scans, and checking treatment history. All of that is done manually, and it takes time. Doctors often must email the trial site directly, just to ask if their patient qualifies.
“They may not get back to you quickly,” Bui says. “And with cancer patients, you can’t wait weeks or months to find out if someone is eligible.”
In cancer care, time matters. The disease doesn’t wait, and neither can patients.
The vision
The Stanford Cancer Institute runs an extensive portfolio of cancer trials, yet leadership saw room for improvement. The vision: bring cancer clinical trial screening to the point of care and eliminate barriers hindering patient referrals, including retyping patient information, switching browsers, and lengthy email chains delaying referrals. If clinicians could find relevant trials directly within the electronic medical record and trigger a formal review with a single click, referrals would be faster and more frequent.
In partnership with the software company XpertDox, Stanford customized the cloud-based platform XpertScreen to streamline patient clinical trial matching within its EMR platform. Building the tool came with technical challenges, one of the biggest being integration. The team had to determine how to extract patients’ clinical data from the EMR, feed it into the matching platform, and connect it with Stanford’s separate trial database.
"We spent years aligning data structures and building secure interfaces to make this level of integration possible. Our goal was to give clinicians instant access to trial information and patient matching, without adding complexity to their workflow,” said Agnes Nika, SCI-CTO director of research services.
The result is a tool designed to be part of the standard clinical workflow. With a single click, it pulls key patient data, including age, diagnosis, prior treatments, and mutational status, and cross-references against Stanford’s real-time inventory of open-to-accrual trials to generate a list of potentially eligible trials, ranked by relevance. Clinicians can then select one or more trials and send a screening request to the study team, asking them to assess the patient’s eligibility.
The shift
To change clinician behavior and make clinical trial screening a routine part of cancer care, the SCI-CTO took a multifaceted approach: educational outreach, a well-timed smart nudge, and one-click access within the EMR.
Before XpertScreen was implemented into the EMR, targeted outreach was conducted to help clinicians understand how to use and incorporate the tool into their workflow.
A key feature of the tool is the smart nudge integrated directly into the system. Bui explains, “When a doctor creates a new treatment plan, it asks, ‘Have you considered clinical trials?’ and provides an internal link to automatically screen the patient, all without leaving the EMR.”
The nudge mattered. Placing the prompt at the exact moment treatment decisions are made turned trial consideration from an afterthought into a default step.
The tool’s one-click design further streamlines referrals, making initiating trial screenings fast, simple, and painless.
As the workflow became more embedded, referral activity followed, reflecting a clear shift in clinician behavior. Screening requests increased more than tenfold over three years, from just 20 in the first year to 236 in the third. The percentage of platform visits that led to a referral also climbed steadily, from 21% in year one to 72% in year three.
When physicians can screen patients for trials without leaving the clinical medical systems, it becomes a new standard of care."
“Our goal is to offer a clinical trial to every patient. For busy providers, this means considering standard and investigational options as part of the everyday clinical workflow,” said Joel Neal, MD, PhD, senior author and SCI-CTO medical director. “When physicians can screen patients for trials without leaving the clinical medical systems, it becomes a new standard of care. This shift is critical because we want our patients to benefit from the best science available.”
Next step: Go bigger
SCI-CTO is thinking beyond its own walls.
“We’ve seen a fair number of patients who were screened actually enroll in trials, which is really promising,” Bui said. “This tool has proven that it’s effective. We just need to refine it and expand it.”
The SCI-CTO aims to expand the platform beyond Stanford and into the broader community, where many of the patients they hope to reach receive their care.
“There are hurdles in integrating healthcare systems and databases, but that’s our next step,” said Bui.
It's not easy to get different health systems to share data, but it’s necessary if trial access is to reach patients who aren’t already in Stanford’s network. At the same time, the SCI-CTO team is working to refine the algorithm so that it returns more accurate and relevant trial matches for each patient.
Stanford’s integrated trial-matching tool brings awareness and speed to a process that has long been too slow and disconnected from real-time care. When trial discovery becomes an ordinary part of each cancer visit, fewer promising therapies will stall, more patients will access cutting-edge options, and the distance between scientific discovery and standard care will shrink.
