The Integration Era Has Arrived — But Where’s the Integration?
By Sergio Armani, Founder & CEO, ACG-Clinical
The industry keeps talking about integration — but most of what we’ve seen are connections, not collaboration. That’s finally starting to change.
I recently attended Florence Research’s Revolution Summit, and the buzzword this year was clear: integration. Everyone’s talking about connected platforms, unified data layers, and “seamless collaboration” between sponsors, CROs, and sites.
Florence Healthcare: Integration in Action
Castor’s CEO, Derk Arts, MD, PhD, captured the sentiment perfectly in a LinkedIn post following the conference:
“Most ‘integrations’ today are still little more than SFTP uploads — data transfers without true interoperability — and AI will be absolutely useless if we don’t solve the primary problems we’ve been struggling with for the past 10 years.”
But let’s be honest — where’s the integration, really? For all the excitement, most of what we’re seeing isn’t integration at all. It’s interfaces. It’s systems that talk at each other, not with each other. It’s rebranded acquisitions stitched together with APIs and marketing language — while sites still fill out the same feasibility forms five different ways. That’s not transformation — that’s translation.
Still, something has shifted. For the first time in years, there’s real momentum behind the idea that technology should serve relationships, not just oversight. And that’s why I believe we’re at the start of something bigger — The Integration Era: an era where progress is measured not by how many tools a sponsor or CRO owns, but by how well those tools — and the teams behind them — actually work together.
The CRO Conundrum: Integration Tried, But Rarely Achieved
Before we celebrate this wave of collaboration, it’s worth acknowledging something important: CROs have been chasing this dream for years. IQVIA, PPD, ICON, Parexel, Syneos — all invested heavily in digital platforms meant to unify sites and sponsors. And yet, the friction persists.
Why? Because their systems were built to manage studies for the sponsor first and the sites second. That hierarchy — sponsor at the center, site as the spoke — created layers of oversight but very little empowerment.
Instead of collaboration, we got compliance. Instead of partnership, portals.
The result? Sites that feel managed, not supported — and technology that reinforces control, not connection.
Even with Thermo Fisher’s acquisition of Clario signaling another push toward operational convergence, the question remains: can these legacy players finally build solutions that work for everyone — sponsors, CROs, and sites alike?
Florence Healthcare: The New Model for Collaboration
At Research Revolution, what stood out wasn’t just Florence’s technology — it was the energy: rooms full of sites, sponsors, and CRO leaders actually engaging — debating, laughing, learning. Real optimism.
Florence isn’t positioning itself as another vendor with another tool. They’re positioning themselves as a connector — rethinking how sponsors and sites work together.
Their newest capabilities, announced alongside a partnership with AWS, mark a turning point. By leveraging AWS’s scalable cloud infrastructure, Florence is now connecting over 65,000 research sites and 600 sponsors in a shared, secure environment that finally feels integrated — not imposed.
“Florence was built to bring sponsors and sites into a shared operational space. First, we fully digitized startup to eliminate manual bottlenecks and paper workflows. Now, we’re using AI to enhance speed and augment intelligence across 65,000 study sites globally — arming sponsors with portfolio-wide operational visibility so they can anticipate trial risk, act on insights, and drive execution on the ground.”
— Ryan Jones, CEO, Florence Healthcare
The focus is no longer one-way document submission or portal logins. Florence’s platform lets sponsors and CROs collaborate inside the same workspace as sites — managing feasibility, startup, document workflows, and monitoring in a single connected system.
For sites, it means control and simplicity. For sponsors, visibility and compliance — without endless email trails or redundant uploads.
Florence isn’t trying to replace site processes; it’s amplifying them. By connecting eBinders, eISF, and eTMF in real time — and, through AWS, enabling scalability and interoperability — they’re showing what integration looks like when designed around the user, not the hierarchy.
AI and the Feasibility Frontier
Florence also announced AI-assisted workflows across the study lifecycle — from site identification and feasibility to startup and remote monitoring.
Sponsors will be able to search site profiles by therapeutic focus, geography, and performance criteria to select the right partners — and deliver protocol-specific feasibility surveys that actually matter. Sites, in turn, can use AI-driven workflows to accelerate completion with context-specific responses that highlight qualifications and operational strengths.
This matters because feasibility has long been a friction point — inconsistent forms, repetitive data requests, endless manual entry. Florence is using AI to turn that burden into a collaboration opportunity.
From Operations to Opportunity (for Sites)
What’s often overlooked is how this evolution supports the commercial side of site operations.
For independent sites, networks, health systems, and AMCs, faster and more intelligent feasibility workflows directly strengthen engagement with sponsors. When sites can auto-populate responses with verified operational data and contextual insights, they’re not just completing a form — they’re telling a stronger story about capability and capacity.
It reframes feasibility from a reactive administrative task into a proactive sales tool — one that spotlights operational readiness, differentiates performance, and builds sponsor confidence earlier in the cycle.
The approach extends beyond feasibility. AI is being applied to contract negotiation, document exchange, and remote monitoring, reducing administrative burden and improving oversight without constant site visits.
“We’re not just automating the trial conduct for speed. We’re creating a shared, AI-augmented experience between sponsors and sites to reduce manual work and increase capacity — one that’s more intelligent, scalable, and efficient.”
— Shankar Jagannathan, COO, Florence Healthcare
That’s The Integration Era in action — not just better systems, but smarter, shared workflows that move everyone forward together.
Top-Down vs. Bottom-Up: Who’s Winning the Integration Race?
The race toward true integration may come down to where you start.
Veeva is building top-down — extending Vault from sponsors into the site world (e.g., Site Connect, MyVeeva).
Florence is building bottom-up — starting with site workflows and inviting sponsors into environments that already work for the people doing the work.
Veeva’s advantage is scale — but its challenge is cultural.
Florence’s advantage is trust — earned by solving real site pain first.
Both approaches have merit; the company that meets in the middle — aligning usability with scale — will define integration in practice.
The New Wave of Innovators: Integration in Motion
A wave of innovators — from niche startups to platform integrators — is building the connective tissue this industry has been missing. This is what the Integration Era looks like in motion.
Inato: Transparency Meets Intelligence
Inato is reshaping site selection. Its marketplace model flips top-down selection, letting sites showcase performance, patient access, and therapeutic expertise directly to sponsors. The Sanofi partnership validated what sites hoped for: a fairer, data-driven way to be seen. With AI-assisted pre-screening and feasibility modeling, Inato is turning data into insight — helping sponsors identify high-performing, diverse sites faster. The challenge: most AI remains site-facing, and full sponsor interoperability is still emerging. Directionally, empowering sites through visibility and data is how collaboration begins.
Suvoda: Integration Through Unification
Post-merger with Greenphire, Suvoda is unifying IRT, eConsent, patient payments, and scheduling under a single data layer. The goal isn’t to replace every system but to make existing ones talk to each other. By connecting operational and financial workflows across sites and sponsors, Suvoda is closing a major blind spot: the disconnect between study operations and participant engagement.
RealTime Software Solutions: The Operational Integrator
RealTime is connecting CTMS, eReg, eSource, and recruitment into one ecosystem. The Devana Solutions acquisition pushes that vision further. Devana’s BD intelligence tracks site performance, pipeline, and sponsor relationships — allowing RealTime to link the front end of site growth (identifying and winning studies) to the back end of delivery (executing and managing them). That’s workflow integration from sales to science. With Devana and open APIs on the horizon, RealTime is positioning itself as the connective tissue between site operations and sponsor oversight.
Advarra: Big Moves in Site Enablement
Through acquisitions of Bio-Optronics (Clinical Conductor), Forte (OnCore), and Longboat, Advarra has assembled a broad site/sponsor enablement portfolio. Its Site Enablement Platform aims to unify CTMS, regulatory, and engagement under one roof. The strategy makes sense; the question is usability. Will it feel truly integrated or like connected tools? That answer will determine whether scale becomes real integration or just more infrastructure.
Castor: Open Architecture, Real Interoperability
Castor’s API-first platform connects EDC, eConsent, and DCT tools so sponsors and sites can work from a consistent, connected data layer. By bridging clinical and real-world data, Castor enables continuity between traditional and decentralized trials. Openness and flexibility make it one of the few solving integration through design, not acquisition.
Trailynx and Agnizant: The New Experimenters
Smaller but scrappy, Trailynx simplifies startup and document workflows with lightweight tools that reduce friction for both sites and sponsors. Agnizant works more behind the scenes — automating communication and data flow for CROs and sponsors, though its “site collaboration” layer still lives quietly inside broader automation products. The lesson: integration isn’t a size game; it’s an empathy game. Whoever listens best to end users wins.
TransCelerate: The Lesson We Can’t Ignore
TransCelerate’s Shared Investigator Platform had the right intention — simplify access, reduce duplication, enable transparency — but the wrong center of gravity. Sites never fully adopted it because it felt sponsor-led, not site-designed. Instead of removing friction, it added another layer. The reminder: integration can’t be mandated. It has to be earned.
Reality Check: Medidata, Veeva, and the Myth of End-to-End Integration
Medidata’s strength is control — but its ecosystem is largely closed.
Veeva’s strategy is openness — but success hinges on whether sites actually adopt their tools. If Veeva succeeds, it could redefine integration at scale. If not, it risks another closed loop — connected in theory, fragmented in practice.
AI: The Catalyst for Real Integration
AI doesn’t solve fragmentation — it amplifies it. When data lives in silos, AI can’t see the full picture. That’s why integration has to come first.
Imagine AI models that:
Predict which sites will meet enrollment goals based on historical performance and regional demographics
Auto-populate feasibility forms with verified operational data
Flag document discrepancies before a human monitor looks
AI isn’t the future of clinical research — integrated AI is. Intelligence without interoperability just creates faster silos. Integration turns AI from a tool into a teammate.
The ripple effect is commercial as much as operational. As AI-assisted, integrated workflows reduce friction across startup and monitoring, sites can reposition from “study recipients” to strategic partners. Integration doesn’t just streamline processes — it helps BD and leadership teams prove value with evidence, not anecdotes. That’s why the next phase of enablement won’t just be operational; it will be commercial integration — connecting insight, execution, and growth in one motion.
The Integration Era Is Just Beginning
We’re entering a phase defined not by more tools, but by better alignment. The organizations that win won’t be those shouting loudest about innovation; they’ll be the ones building bridges — between systems, between teams, and between the realities of site operations and the ambitions of sponsors.
The Integration Era has arrived. Let’s make it real.
As someone who’s watched this industry evolve from portals to partnerships, I respect Florence’s bottom-up approach to integration. Building around site realities — not just sponsor requirements — is a cultural shift in how collaboration can truly work. I’m looking forward to seeing how their efforts continue to shape this era.
Note: I’ll be exploring the commercial implications further in a whitepaper-style piece planned for early 2026, focusing on how AI-assisted workflows are redefining sales enablement, feasibility storytelling, and sponsor engagement across research sites (timing pending collaboration details).
Disclaimer: The information in this publication is for general informational purposes only and should not be construed as legal, financial, or regulatory advice. Armani Consulting Group, LLC, doing business as ACG-Clinical, disclaims any liability for errors, omissions, or actions taken in reliance on this content. Please consult qualified professionals for advice specific to your situation.