Conclusions
Our work explored the realities of offering multiple mechanisms for sites to participate in EHR-sourced trials that may broaden the number and type of sites able to participate in EHR-sourced trials, leading to more participation by sites and potentially greater generalizability. Given the wide variation in site-level resources and experience, central coordinating center support is essential to facilitate the successful execution of operational processes. Future work should focus on sharing lessons learned and creating reusable tools to facilitate participation of heterogeneous trial sites.