The Referral Readiness Gap: What 100 U.S. Clinical Trial Sites Told Us About Referral Quality

Introduction

Clinical trial recruitment isn’t only a question of how many referrals a site receives — it’s whether those referrals are ready to act on. A new myTomorrows survey of 100 U.S.-based clinical trial site professionals reveals a growing focus on referral readiness: whether patients arrive qualified, documented, and prepared for assessment. 

What is the referral readiness gap? 

The referral readiness gap is the difference between the volume of referrals a clinical trial site receives and the number that actually arrive qualified, documented, and ready to move efficiently through enrollment. In our survey, 52% of sites said at least one in five referrals are ruled ineligible before formal screening even begins — a clear signal that referral quality, not just quantity, is central to recruitment success. 

For the clinical research teams living this every day, the gap shows up as wasted review hours and fragmented workflows that pull time away from the patients most likely to progress. Our new report ”The Referral Readiness Gap: Why clinical trial sites need better qualified, better documented, and easier-to-act-on referrals” sets out what site teams are really up against and what they say would help

Why myTomorrows conducted this research 

Research sites have become the operational center of modern clinical trial recruitment. As eligibility criteria grow more complex and timelines more pressured, site teams are asked to evaluate patients faster, coordinate across more stakeholders, and manage rising referral volumes — often through workflows that remain fragmented and highly manual. 

We wanted to understand that experience directly. Much of the industry conversation focuses on generating more referrals, when the professionals doing the work are telling us something different: they need better qualified ones. By listening to sites and building solutions we reduce complexity, improve patient-trial matching, and strengthen collaboration across the ecosystem. We aim to help create a more connected, efficient, and equitable route from research to real-world impact — for patients, sites, physicians, and sponsors. 

This research is part of that commitment. Understanding the true experience at the site level is how we build tools that genuinely support clinical trial recruitment rather than adding to the burden. 

Inside the survey: our approach and methodology 

To understand the essential work taking place at sites, myTomorrows surveyed 100 U.S.-based clinical trial site professionals across a range of roles and responsibilities, assessing how teams manage referrals, evaluate patient eligibility, and approach recruitment workflows and operational processes. 

The research, conducted in May 2026, included respondents from across the country: clinical research staff, study and trial coordinators, clinical research nurses, study nurses, clinical research associates, principal investigators, sub-investigators, clinical project managers, heads of site research, and directors of clinical trials. All participants were actively involved in clinical trial recruitment at the time of the survey. 

The five core findings 

The report tells a connected story across five themes, each backed by a proof point from the survey. 

1. More referrals do not guarantee recruitment progress 

Sites are receiving referrals, but many are ruled out before formal screening begins. Referral volume can create workload without creating progress — the real value lies in referrals that are better qualified and protocol aligned. 

2. Poor referral quality creates hidden workload for site teams 

Every incomplete or ineligible referral adds review time, coordination, and follow-up. The burden of recruitment inefficiency is paid in site staff time — time that could otherwise go to patients most likely to progress. 

3. Fragmented tools and incomplete information slow recruitment down 

Sites are managing referrals across multiple systems, channels, and information gaps. When referrals, data, and decisions are spread across too many places, friction builds at exactly the point where speed, accuracy, and clarity matter most. 

4. Recruitment inefficiency affects trial performance 

The impact extends well beyond site operations, into enrollment, timelines, targets, and costs. Poor referral quality and inefficient pre-screening can slow studies, increase costs, and reduce the number of eligible patients who make it through recruitment. 

5. Sites want smarter pre-screening and patient support 

Site teams are clear about what would help. AI can help them quickly assess the quality and fit of incoming referrals, giving teams the confidence to move forward efficiently and cutting the manual review time that slows recruitment down. Patient navigation, meanwhile, helps patients arrive prepared and supported. The two solve different parts of the same problem: AI helps sites act on referrals once they arrive, while navigation helps patients arrive better informed and qualified in the first place. 

What the findings mean for the clinical trial ecosystem 

The strain sites describe does not stay at the site.  When patients are referred without meeting basic eligibility criteria, with incomplete information, or through fragmented processes, the effects are felt throughout the clinical trial ecosystem. The result can be delayed study timelines, missed enrollment targets, increased costs, protocol amendments, and additional burden on both research teams and patients. 

That makes referral readiness a broader issue. Sponsors depend on site performance to deliver studies on time. Physicians depend on clear routes to connect patients with relevant research. Patients depend on all of it working together. Strengthening the quality of referrals upstream — before they arrive at the site — can help more eligible patients move efficiently through recruitment, improving outcomes for everyone connected to the study. 

This is why understanding the true site experience matters so much. The site is where the pressures of modern trial design converge, and where better infrastructure has the greatest downstream effect. 

How myTomorrows supports clinical research teams 

myTomorrows is a global healthtech company that connects patients, physicians, trial sites, and BioPharma partners to enable earlier and better access to emerging therapies. Our support for clinical research teams is built to address the exact barriers this research surfaced. 

A unified referral platform centralizes internal and external referrals in one place, with the ability to integrate into existing EMR and CTMS systems and secure communication with referring physicians — replacing the disconnected tools and channels that slow recruitment down. 

AI-powered pre-screening. Designed to deliver highly qualified referrals through criterion-level eligibility matching for site review, helping reduce the share ruled out before screening and cut the hours site teams spend on manual triage. 

Personalized patient navigation. Multilingual navigators, available across global time zones, help patients arrive informed, qualified, and prepared. This lowers screen failures and drop-off, and easing the burden on site staff. 

Real-time visibility and connection. Keeps trial status and requirements current and connects sponsors, physicians, and patients in one workflow — reducing misdirected referrals and missed enrollment targets. 

To date, we’ve supported more than 2,244 clinical research teams.1 

Support in action: our site partnerships 

These capabilities are already at work with leading research institutions. 

In Spain, our partnership with Clínica Universidad de Navarra (CUN) brings AI-assisted patient–trial matching directly into the hospital’s electronic health record and governed clinical environment. With more than 200 active trials, CUN needed a way to consistently assess patients against every relevant trial option; the integrated system helps clinicians see potentially eligible trials during routine review, while a CUN-branded referral environment gives external physicians visibility into current trial status before a referral is ever submitted. 

In the U.S., our partnership with Rare Disease Research (RDR) — an independent site network focused exclusively on rare disease studies — supports more structured, better-qualified referrals into complex trials. By supporting preliminary matching and improving the completeness of referral information before site-level review, the collaboration is designed to help RDR teams spend less time managing incomplete or mismatched requests and more time supporting patients who may be a fit for active studies. 

Both partnerships demonstrate the same principle the research points to: when referrals arrive more complete and better qualified, sites can focus on the science, and patients connect with relevant research more efficiently. 

Download the full report 

The Referral Readiness Gap explores all of the findings in full — including the hidden workload behind referral review, the scattered systems slowing sites down, the downstream impact on trial performance, and what site teams say smarter support should look like.