I used CRIO for three years, then RealTime. Here is when a spreadsheet was still enough.

If you run a small site, a spreadsheet is enough when you have fewer than about six studies, one or two coordinators, sponsor systems that carry most of the data, and no real pain around invoicing. A CTMS is worth it the day you need one of the things a spreadsheet cannot do: finance and invoicing, a regulatory binder, sponsor-facing reports, or oversight across more than one site. That is the whole answer. The rest of this post is how to tell which side of the line you are on, and what to do about the shadow spreadsheet that most small sites keep either way.

I should say up front: I kept five spreadsheets as a coordinator in Hampton Roads, and the thing I make now is not a CTMS. Every other page you will find on "CTMS vs Excel" is written by a CTMS vendor and ends with "CTMS wins." This one is trying to be the fair map.

I used CRIO for about three years at a retina site in Hampton Roads, then RealTime after we moved for budget and finance reasons, and I demoed Florence and eClinPro along the way. I like CRIO; it has a lot going for it. But with CRIO we still kept an external spreadsheet for invoices, because receivables ran long and the tool's view of money did not match ours. RealTime was better on the finance side and still not perfect. What every one of them shared was the level they lived at: the study and the invoiceable procedure. The granular, site-specific how-to of a visit was either not there or became a separate "EDC" product with its own coding and cost.

What a CTMS actually does for a small site

Strip away the demo and a CTMS does four jobs.

1. Subject and visit tracking. Who is enrolled, which visit is next, when the window opens and closes, what happened at each one.
2. Finance. The budget per visit, what each completed visit earns, what the sponsor has paid, what is still owed, and the invoices to chase it.
3. Regulatory. The binder: 1572s, CVs, training, IRB approvals, protocol versions, the delegation log, and who signed what and when.
4. Reporting. Enrollment against target, screen-failure rates, visits done versus scheduled, anything a sponsor, a CRA, or a PI asks for on a slide.

The first job is the one every coordinator feels. Small sites buy a CTMS for job one and then discover they are paying mostly for jobs two through four. A spreadsheet can do job one for a small site. It does job two badly, job three not at all, and job four only if one person knows the formulas.

When a spreadsheet is enough

The signs, from having lived them:

• Under about six studies. Each study gets a tab or a file. Six is roughly where a human can still hold the whole book in their head.
• One or two coordinators who sit near each other. The spreadsheet does not need to explain itself, because the person who built it is in the room.
• The sponsor's tools carry the data. The EDC holds the CRFs. The IWRS handles randomization and drug. The sponsor's portal holds the regulatory documents they care about. Your spreadsheet only has to hold what is left.
• No invoicing pain. Payments arrive on the sponsor's schedule, a bookkeeper reconciles them, and nobody at your site has ever said "I think they owe us for three visits from last quarter."

If that is you, a well-built spreadsheet is not a compromise. It is the right tool. The free visit-window tracker spreadsheet on this site is the one I wish I had been handed on day one, and it needs no account and no email.

When it isn't

The signs that a spreadsheet has stopped being enough are all the same sign: the knowledge has moved out of the sheet and into one person.

• The tabs multiply. One file per study became one file per study plus a master, plus a copy the PI wanted, plus the one with the formulas fixed.
• Only one person knows why column Q goes red. There is conditional formatting in there from 2024, and it is right, and nobody can explain it.
• A monitor asks for a report you cannot make. "Can you send me visits completed out of window this year, by study?" and the answer is a Saturday.
• Someone leaves. The sheet stays, the understanding goes. This is the one that actually ends spreadsheets at small sites, and it usually happens with two weeks' notice.
• Money is getting lost. You suspect a sponsor has not paid for visits you completed and you cannot prove it without opening every EDC.

Any two of those together and you need a CTMS, not a better spreadsheet. If invoicing, the binder, sponsor reporting, or oversight across sites is where your pain is, go buy one, and do not let a former coordinator with a tracker talk you out of it.

The middle ground most small sites are actually in

Here is what I saw at my site and what I heard from coordinators at investigator meetings: the site has the sponsor's EDC, sometimes a CTMS the site pays for, and also a shadow spreadsheet where the windows actually live.

The EDC does not tell you Subject 012's Week 4 window closes on Friday. It tells you the visit is due, in a format built for data entry, for that one study. The CTMS, if there is one, often has the windows, but the visit names do not match the protocol and updating it is a chore that comes after the visit, not before. So the coordinator keeps a spreadsheet: one row per subject, one column per visit, a target date and a window, colored by hand.

The shadow spreadsheet is where visits get lost. It is a copy of the schedule, and copies drift. A screening date gets entered as the anchor when the protocol anchors on randomization. A window gets typed as plus or minus three days when the protocol says minus two, plus three. Nobody re-anchors after a visit lands late, so every downstream date is quietly wrong. I lost PK data to an out-of-window visit that way; a sheet that recomputed would have caught it. If you have ever had to answer which date you count from after a missed visit, you know how a shadow sheet fails: silently, and downstream.

So the real question for most small sites is not "CTMS or spreadsheet." It is "what do we do about the shadow sheet." Build it so it recomputes, or use something small that recomputes for you.

"The sponsor already gives us a tool"

This is the objection I hear most, and it is a fair one. Why pay when the sponsor provides a system?

Because the sponsor's tool covers their study, not your Tuesday. It knows about the twelve subjects on their protocol. It does not know that you also have nine subjects on the dermatology study, four on the vaccine study, and a screening visit at 2 p.m. that the other coordinator booked. Your day is the union of every sponsor's schedule, and no sponsor builds the tool for that, because it is not their problem.

The sponsor's tool is also built for the sponsor's questions: is the data in, is it clean, is it locked. Yours are different: what is due this week, what closes Friday, what did we forget to prep. If a sponsor system answers those across every study you run, you do not need anything else. Most do not.

What to say to IT

The second objection, verbatim from a coordinator online: "I can't download any software without IT's approval. If it was web based, they'd probably have even more of a problem with it."

They might. But the conversation with IT is usually about two things: what gets installed on the machine, and what patient information leaves the building. Ask any small tool, mine or anyone else's, those two questions first.

Does it install anything? A browser-only tool does not. Does it hold PHI? A tracker that holds subject IDs and dates, and nothing else, does not, and that is the sentence to put in the email to IT: "It holds study subject IDs and visit dates only. No names, no dates of birth, no contact details, no medical information." A tool that needs a name or a DOB to work is a different conversation, and it should be, because that is a tool that needs a business associate agreement and the infrastructure behind it.

At an academic or health-system site, IT may still say no, and that is their call. At a private practice the person you ask is often the practice manager, and those two questions are usually the whole review.

What "free CTMS" really means

Free tiers exist, and they are fine until they are not.

The clearest one is Veeva SiteVault Free, which as of 2026-09-09 covers up to 20 concurrent active studies with unlimited users and documents, and moves you to a contact-sales Enterprise tier past that (plans, FAQ). Twenty active studies is more than most small sites will ever run, so for the four jobs above, and especially the regulatory binder, it is a real option and I would look at it before paying anyone. The cost is not money; it is the setup, and the fact that a full regulatory platform is a lot of platform when the thing you needed was to know what closes Friday.

The paid end is less transparent. The only public number I can point to is RealTime CTMS, listed on Capterra at $500 per month with no free trial (Capterra, checked 2026-09-09). Most of the rest say "contact sales," which at a site level tends to mean four or five figures a year plus an implementation.

Free is fine until it isn't: the day you outgrow the cap, need the API, or need someone to configure it for you, you are a customer. That is not a trick. It is how every free tier works, including mine, and you should walk in knowing it.

The thing neither of them gives you

A CTMS tells you a visit is due. A spreadsheet, if it is good, tells you when the window closes. Neither tells you what happens at this visit, in what order, the way your site does it.

That is the run sheet: for Subject 012's Week 4, the vitals before the ECG because the protocol says so, the PK draw at the sponsor's timepoint with the second tube on ice, the drops in the Imaging 2 fridge, the questionnaire the sub-I scores because the delegation log says the sub-I and not you. A CTMS holds that visit as a row with a date and a payment. The EDC holds it as forms to fill after the fact. Your spreadsheet holds a color. The order, the site steps, the room, and who is delegated live in the coordinator's head, and on the day the coordinator is out, they live nowhere.

CRC Run Sheet is a tracker and a run sheet for that: windows computed from the anchor so the shadow sheet stops drifting, and a per-visit sheet for what gets done, how your site does it, where, and who is delegated. It sits beside the EDC and the CTMS, not instead of either, and it is not a system of record. If your pain is finance, the binder, or sponsor reporting, this is not your tool, and the honest thing is to say so on the page that ranks for the question.