A multi-tenant clinical trial platform for European healthcare
Worthmed's clinical research customers coordinated protocol design, ethics approval and regulatory submission across email, spreadsheets and paper. Twistag built a multi-tenant platform that models the whole trial lifecycle in one schema, exchanges data with hospital records through FHIR and logs every action for audit. Protocol design now takes 6–8 weeks instead of 12–16.
- 6–8 wksprotocol design, down from 12–16 weeks
- FHIRcompliant interoperability with hospital EHRs
- Multi-yearengagement, from MVP to ongoing development
- Client
- Worthmed
- Industry
- Healthcare & life sciences
- Practices
- Product Engineering
- Timeline
- Multi-year, ongoing
- Stack
- .NET Core, Blazor WASM, PostgreSQL, FHIR
Trials held up by paperwork.
Twistag built a multi-tenant clinical trial platform for Worthmed, a clinical research organisation based in Portugal serving hospitals and research centres across Europe, compressing protocol design from 12–16 weeks to 6–8 weeks without loosening regulatory compliance or data governance. Clinical teams had been coordinating protocol design, ethics approval, site management and regulatory submission across email, disconnected spreadsheets, paper forms and vendor-specific systems. Twistag modelled the entire trial lifecycle into a normalised PostgreSQL schema, built the interface in Blazor WebAssembly on a .NET Core backend, and made the platform emit and consume FHIR bundles.
Clinical trials are among the most regulated activities in European healthcare. Every study requires protocol design, ethics approval, patient recruitment workflows, data collection governance, and regulatory readiness across INFARMED, EMA and national standards — and those tasks are fragmented across email, disconnected spreadsheets, paper forms and vendor-specific systems. A single trial's design phase consumed months of coordinated work from R&D, compliance, patient services and regulatory teams before patient enrolment even began. Worthmed saw this as a structural problem across the market: its customers were losing competitive advantage because they could not move from protocol concept to regulatory submission quickly. Delayed trials mean delayed patient access to new treatments and delayed revenue for sponsors.
The trial lifecycle in one schema.
Start with the data.
Protocols, site networks, regulatory templates, audit trails and patient cohorts modelled in one normalised PostgreSQL schema, built to run hundreds of studies at once.
One language across the stack.
Blazor WebAssembly and .NET Core put C# on client and server, and gRPC keeps collaboration fast when teams build protocols in parallel.
Built for hospital review.
FHIR bundles connect to partner hospital records, S3 versioning keeps document history, and role-based access with cryptographic audit logs makes every action traceable.
Shaped by real protocols.
Hospital CUF Descobertas brought live protocols at onboarding, and each feature was validated against real hospital workflows before it was generalised.
Submission becomes documentation.
Protocol design time compressed from 12–16 weeks to 6–8 weeks. Studies that were blocked waiting for approvals now move, and hospital teams have real-time visibility into regulatory readiness instead of chasing status emails. Worthmed's customers, including multiple top European healthcare organisations, are onboarding because the platform works at hospital scale. The engagement has scaled from initial MVP into ongoing multi-year product development. Compliance submissions became a record of what happened, written as it happened, because role-based access control and cryptographic audit logging record every action as it occurs.
When the platform is built for regulation from day one, a submission is simply the record of the work.
- .NET Core
- Blazor WASM
- PostgreSQL
- FHIR
Twistag has delivered a ready-to-use MVP on time that received great feedback. The team has exceptional project management skills, excellent communication, insightful feedback, and dedication. Their proactiveness and profound understanding of our product and business are impressive.
