This poster presented at the ISOQOL 2025 annual meeting presents a comprehensive literature review of electronic Clinical Outcome Assessments (eCOA) spanning 1998–2025, examining the scientific rigor underlying current best practices. Findings reveal a marked shift: while early eCOA research emphasized empirical validation of design and usability, recent years have seen a surge in non-empirical publications—particularly consensus and best practice papers—outpacing hypothesis-driven studies. This trend, accelerated by the COVID-19 pandemic and rapid adoption of decentralized and BYOD approaches, raises concerns about the evidence base supporting modern eCOA implementation. The authors advocate for renewed focus on empirical research to strengthen the foundation of best practices and ensure robust, evidence-based patient outcomes.Listen now to Lindsay Hughes as she provides an overview of the poster and key takeaways.