# Point-of-care randomisation built into the oncology record

Source: https://onco.cc/ideas/idea-data-point-of-care-randomisation/  
OnCo record `idea-data-point-of-care-randomisation` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When two accepted treatments are equally reasonable, the computer system would offer to randomise the choice and track the result, turning ordinary care into a continuous trial.

## Summary

Learning health systems embed randomisation into workflow where genuine equipoise exists (dose schedules, supportive care, sequencing). The US Veterans Affairs system and the NHS have run point-of-care trials; oncology has few. The proposal builds a reusable EHR module (consent, randomisation, outcome capture via registry linkage) so that any cancer network can run a low-cost comparative effectiveness trial in weeks.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Embedded randomisation will enrol more than ten times as many patients per year as conventional comparative effectiveness trials at less than a tenth of the per-patient cost.
- Rationale: Registry-based randomised trials in cardiology (TASTE, SWEDEHEART) enrolled thousands at roughly 50 dollars per patient; the design transfers to questions with routine outcomes.
- Proposed test: Run one embedded trial (for example, two accepted anti-emetic regimens or two follow-up imaging schedules) in one network; measure enrolment rate, cost and completeness of outcome capture.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Data silos): AACR Project GENIE: https://www.aacr.org/professionals/research/aacr-project-genie/

## Connected records

- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/)
- terms: [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [Data silos](https://onco.cc/bottlenecks/b-data-silos/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)

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