Although specific aspects of clinical trials decentralization were in place before the pandemic, COVID-19 has accelerated decentralization and innovative trial design in approaches that are likely to become permanent. As roughly 70% of potential trials participants live more than 2 hours from trial sites, decentralization methodologies can create efficiencies, increase engagement, and potentially reduce disparities in clinical trial participation. While the benefits of decentralized trials are clear, the path to adopting them at scale have been challenging. Further collaboration among stakeholders, including sponsors, investigators, patients, and technology providers will result in continued development of solutions that work to advance patient therapies. This panel will highlight the key technology advances that characterize both decentralized clinical trials and innovative clinical trial design with a focus on the successes, challenges, and effects on the trial participant.