This white paper explores why useful RTSM functionality is often discussed, valued, and then left out when studies move from planning into execution. It argues that the problem is not a lack of innovation, but a tendency to evaluate functionality through the lens of launch rather than the longer realities of live study maintenance, operational burden, and change.

Key takeaways:

• Understand why advanced RTSM capabilities are often deferred, even when their operational value is clear.

• Learn why build-phase priorities and live-study realities are not the same, and why that distinction matters.

• See which capabilities most often fall into the implementation gap, from barcoding and single sign-on to forecasting, resupply logic, and accountability design.

• Explore how the barrier differs by sponsor type, with larger organisations slowed by complexity and smaller sponsors by operational capacity.

• Take away a more practical way to evaluate RTSM functionality, based not only on go-live needs, but on long-term control, usability, and resilience once the study is underway.