Issues with recruitment and retention of clinical trial participants are obvious in the numbers, 11% of sites fail to enroll a single patient and 37% under enroll, while 30% drop-out rates in clinical trials all lead to delays. The rise of niche drugs has led to more pressure to identify from smaller (albeit more strictly defined) pools of patients with rare conditions. Digital health tools are helping pharma to reach new cohorts of patients either directly or in coordination with healthcare providers. They can, for instance, enable patients to partake in trials from their homes to in theory improve recruitment and retention. However, it is still early in the demonstration that full online-only engagement modalities will dramatically increase patient enrollment into clinical trials or retain patients in clinical trials. We will discuss the strategies that have worked so far as deployed during Covid, what has been learned as we operate in this new normal and what changes are here to stay as we look to speed up the time it takes for new medications to reach patients.