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Mark Shapiro is the COO of xCures and principal investigator for XCELSIOR and BEAT19, two patient-powered real-world data and outcomes registries in cancer and COVID-19, respectively. He has been focused on innovation and growth in clinical research for more than 20 years. Prior to joining xCures, Mark was SVP, Operations for a global CRO where he was responsible for a team of about 500 drug development professionals in 30 countries, and a portfolio of more than 100 active clinical trials. In his role at xCures, he has been focused on developing and implementing AI and Machine Learning-enabled software systems for clinical research. In this episode we discuss the strengths and weaknesses of decentralized clinical trials, the dilemma of patient referrals in clinical trials, and the challenges of scaling research site networks.