Designing a clinical trial database is a balancing act. Any clinical program has multiple stakeholders who have both short-term and long-term goals to achieve. A good database designer must understand the needs and goals of the sponsor and its various functional project team members. The designer must consider the ease of use for the clinical trial sites who will be entering the trial data, with the needs of the downstream stakeholders in biostatistics, programming, and medical writing. Additionally, we not only need to consider today’s priorities, we also must understand the overall strategy of the clinical program, especially as it moves forward past the current stage.