For more than a decade eClinical technologies have been steadily transforming clinical trials for the better. Yet despite delivering improved trial efficiency, the proliferation of diverse tools – clinical trial management systems (CTMS), randomization and trial supply management (RTSM), and electronic data capture (EDC) to name just a few – has also produced a ‘technology chaos’ as users and vendors struggle to knit the new tools into comprehensive solutions. To a large extent this isn’t surprising. Technology adoption across most industries, especially operational technologies, follows a similar pattern.