Month-by-Month Guide to Launching a Digital Health Pilot in Residency

The worst way to launch a digital health pilot in residency is to “just start building an app.” You’re not a startup. You’re inside a bureaucracy. Different game, different rules.

You need a timeline.

Below is a month‑by‑month playbook you can actually follow during residency without blowing up your schedule or annoying your PD. I’ll assume a 9‑month runway from idea to live pilot. If you have more time, stretch the early phases. If you have less, cut scope, not steps.

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Month 0–1: Clarify the Problem and Get Quiet Buy‑In

At this point you should not be coding. You should be listening.

Week 1–2: Pick a problem, not a solution

In residency time, you have one major constraint: attention. You won’t get more than one serious pilot off the ground, so you’d better pick a problem that:

• Hurts every day
• Has a clear measurable outcome (time, errors, readmissions, pages, etc.)
• Involves a small, well‑defined user group

Examples that work:

• Automated discharge follow‑up texts for heart failure patients on your ward
• A simple photos + structured note intake for wound checks in your continuity clinic
• A digital pre‑visit questionnaire for new diabetes patients

Bad ideas at this stage:

• “Platform for all chronic disease management”
• “AI for all note‑writing”
• Anything that touches billing workflows across the whole hospital

At this point you should:

1. Write a one‑page problem brief:

   • Who is affected (residents, nurses, a specific patient cohort)?
   • How often?
   • What’s the current workaround?
   • What would success look like numerically?

2. Talk to 5–10 frontline people:

   • 3–5 residents across different PGY levels
   • 2–3 nurses
   • 1 attending who’s seen everything

You are not selling. You’re confirming that the problem is real and painful.

Week 3–4: Quiet stakeholder scouting

Before you speak to leadership, you need “below‑the‑radar” intel.

At this point you should:

• Identify:

  • A sympathetic attending (your future clinical champion)
  • A chief resident or senior who can protect your schedule a bit
  • Someone who has already done a QI or informatics project and survived

• Ask very blunt questions:

  • “Who actually has the authority to say yes to a small pilot?”
  • “Who kills these projects?”
  • “Where have similar projects died before?”

Start a running stakeholder map. Nothing fancy. Just a list:

• Green – likely supporters
• Yellow – need convincing
• Red – likely blockers

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Month 2: Formalize the Concept and Align with Institutional Priorities

Most resident pilots die here because they never move from “cool idea” to “institutionally acceptable project.”

Weeks 1–2: Draft your one‑pager + 5‑slide deck

You need two artifacts:

1. One‑page concept note (for emails and quick reviews)

   • Problem (3–5 lines, grounded in your setting)
   • Proposed digital solution (1–2 paragraphs, no jargon)
   • Target population and size (e.g., “HF patients on 6E, 15–20/mo”)
   • Outcomes:
     • Primary: something the hospital cares about (readmissions, LOS, no‑show rate, nurse page volume)
     • Secondary: satisfaction, usability
   • Required resources: staff time, IT support, any hardware
   • Rough timeline (when you’d start and for how long)

2. 5‑slide mini‑deck for short sit‑downs:

   • Slide 1: Problem (with one vivid example from your own call night)
   • Slide 2: Proposed solution (single diagram or workflow)
   • Slide 3: Why now / alignment with institutional goals
   • Slide 4: Pilot design – who, where, how many patients, how long
   • Slide 5: What you need & what you’ll deliver (data, report, poster, etc.)

Digital Health Pilot Early Planning Timeline

Period	Event
Month 0-1 - Problem discovery	Define problem and early supporters
Month 2 - Concept framing	One-pager and mini-deck
Month 2 - Leadership alignment	Meet chief, QI, or informatics
Month 3 - IRB and approvals	Submit necessary applications
Month 3 - Technical scoping	Meet IT or vendor

Weeks 3–4: Align with leadership and QI

At this point you should start surfacing the project to people with titles.

Schedule short, focused meetings with:

• Your program director or APD
• A QI lead or patient safety officer
• If your institution has one: Chief Medical Information Officer (CMIO) or clinical informatics lead

In those meetings:

• Lead with the problem and how it hurts your workflow and patients
• Explicitly tie to existing goals:
  • Reduced readmissions
  • Patient engagement
  • Burnout reduction
  • Value‑based care / ACO targets

Ask two direct questions in each meeting:

1. “What are the 1–2 biggest institutional risks you’d be worried about with this pilot?”
2. “Who else needs to bless this before I can run a 3‑month limited pilot in one unit/clinic?”

Write down names. Those become your Month 3 targets.

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Month 3: Approvals, IRB, and Technical Reality Check

This is the least glamorous month. Skip it, and your pilot will never see daylight.

Week 1: Decide IRB vs QI categorization

Most small pilots can be classified as QI rather than full research, which massively simplifies things. But don’t guess.

At this point you should:

• Email your IRB with:
  • Your one‑pager
  • A clear statement: “We intend this as a limited quality improvement pilot. Does this qualify as non‑human‑subjects research/QI, or is full IRB review required?”

They’ll typically respond with:

• A QI determination form; or
• Instructions for expedited review; or
• “Yes, full IRB needed” (rare for low‑risk digital workflows, but it happens)

Week 2–3: Data, privacy, and IT reality

Now you find out what’s actually possible.

At this point you should:

• Meet (or email) someone from:
  • Clinical IT / EHR team
  • Information security
  • Data analytics / quality office

Ask concretely:

• “We plan to do X, in Y clinic/ward, with Z patients/month.”
• “We need these data fields: [list them]. Is this feasible?”
• “Do we have existing tools? (texting platforms, patient portal messaging, survey tools like REDCap, Qualtrics, Twilio integrations, etc.)”

You’re trying to avoid custom builds. Standing up a pilot on top of:

• The existing patient portal
• Institutional texting platforms
• Pre‑approved survey tools
• Off‑the‑shelf remote monitoring devices

…is almost always smarter and faster than inventing infrastructure.

Option Type	Pros	Cons
Patient portal	Integrated, secure	Clunky UX, limited features
REDCap/Qualtrics	Fast surveys, easy export	Not great for real-time care
SMS platform	High engagement	PHI risk if not approved
Vendor app	Turnkey workflows	Contract, cost, integration

Week 4: Lock your scope

By the end of Month 3 you should have:

• IRB/QI status clarified or application submitted
• Confirmation from IT about:
  • What tools you can use
  • Any security/privacy constraints
• A hard‑scoped pilot:
  • One unit/clinic
  • One clear workflow
  • One primary outcome
  • A specific 8–12 week pilot window

If you’re still “thinking about adding a few more features,” you’re about to derail your own timeline. Freeze the scope.

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Month 4: Design the Workflow and Content

Now you build the thing, but from the workflow backwards, not the screen forwards.

Week 1–2: Map the current and future workflows

At this point you should:

• Sit with actual users (nurses, residents, MAs) and sketch:
  • Current‑state workflow: who does what, when, with which tools?
  • Future‑state with your digital layer: exactly where it plugs in

Use a whiteboard, not Figma.

Key questions:

• Who triggers the digital intervention (orders it, enrolls patient)?
• When in the visit/admission does it happen?
• Who receives alerts or responses?
• What happens if no one responds?

If you can’t draw it step‑by‑step, they can’t execute it on a busy Monday.

Week 3–4: Build content and scripts

Digital health pilots fail more from bad content than bad tech.

At this point you should:

• Write every patient‑facing message, question, and instruction:

  • Keep to a 6th–8th grade reading level
  • Translate into top language(s) in your population if possible
  • Include clear opt‑out language for anything using SMS

• Draft staff scripts:

  • How residents explain the pilot in clinic or on the floor
  • How nurses enroll patients
  • What to say when patients ask, “Is this replacing my visit?”

Run the draft by:

• One nurse
• One resident
• One patient (if possible; grab someone from your clinic who’s game)

Adjust for clarity and time. If enrollment takes more than 60–90 seconds, it’s too complicated.

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Month 5: Build or Configure the Tool and Test Internally

You now turn your paper design into something that actually runs. And then you try to break it.

Week 1–2: Configuration and light build

At this point you should:

• Work with:
  • IT / informatics to set up forms, message templates, and triggers inside existing systems
  • Or, if using an external vendor, configure:
    • Patient enrollment logic
    • Message schedules
    • Alert thresholds

Don’t chase perfect integration. For a pilot, it’s fine if:

• Data export is manual once a week
• A nurse checks a web portal daily at 4 pm
• Residents get batched summaries instead of real‑time alerts, as long as clinical safety is maintained

Week 3: Dry runs with fake patients

This is the part most residents skip. Don’t.

At this point you should:

• Run 3–5 complete “fake” journeys:
  • You play the patient
  • A resident or MA plays the staff
  • You simulate:
    • Enrollment
    • Message delivery
    • Patient responses
    • Alerts
    • Documentation

Try:

• A best‑case patient
• A patient who never responds
• A patient who responds with unexpected text (“I have chest pain right now”)

Stress test:

• What happens if the system is down for a day?
• What if a message goes to the wrong time zone?
• How do you manually override or unenroll a patient?

Week 4: Micro‑pilot with staff only

Before going live with patients, test with your actual users.

At this point you should:

• Enroll 3–5 staff members as “test patients”
• Have real staff walk through:
  • Enrollment clicks/taps
  • Scripted explanations
  • Checking and acting on alerts

Collect immediate feedback:

• Where did you get stuck?
• What took longer than expected?
• What would make this usable on a post‑call day?

Make only critical fixes. Don’t re‑architect.

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Month 6–7: Launch the Pilot (Go‑Live and First Month Operations)

Now you’re live. This is where you shift from builder to operator.

Week 1: Soft launch

At this point you should:

• Start with a soft go‑live:

  • Limit to a subset (e.g., 3–5 patients/week, or only the Monday clinic)
  • Explicitly tell staff, “This is week 1; hiccups are expected.”

• Do:

  • Daily quick check‑ins with frontline staff (5–10 minutes)
  • Track immediate issues in a shared doc or simple spreadsheet
  • Shadow the workflow for at least one half‑day

Resist the urge to “fix everything” instantly. Log patterns.

Weeks 2–4: Full pilot ramp‑up

Once basic stability is clear, increase enrollment to your target volume.

At this point you should:

• Set a simple operating rhythm:

  • Who checks the system and when?
  • Who is backup?
  • How are issues escalated?

• Make a basic run chart for weekly tracking:

  • Number of patients enrolled
  • Completion/engagement rate
  • Key clinical metric (e.g., calls avoided, readmissions, no‑shows)

Weekly Enrollment and Engagement in Digital Health Pilot

Category	Patients Enrolled	Active Participation
Week 1	5	4
Week 2	10	9
Week 3	15	13
Week 4	18	16
Week 5	20	17
Week 6	22	19

You don’t need sophisticated analytics. You just need to know if people are actually using the thing.

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Month 8: Monitor, Iterate Lightly, and Protect the Data

Mid‑pilot is where attention drifts. You’re back on nights or on a brutal rotation. This is where your earlier groundwork pays off.

Week 1–2: Structured feedback loop

At this point you should:

• Run one short, structured feedback session with:
  • 3–4 residents
  • 2–3 nurses or MAs
  • Your attending champion

Keep it 30 minutes max:

• What’s working? (Keep it.)
• What’s painful? (Tweak it.)
• Any unintended consequences? (Document them.)

Apply only low‑risk, non‑disruptive tweaks:

• Clarifying message wording
• Adjusting alert timing
• Simplifying enrollment steps

Avoid deep workflow changes mid‑pilot unless there’s a safety concern.

Week 3–4: Clean, label, and back up your data

You think you’ll remember what each column in your spreadsheet means. You won’t. Not in six months.

At this point you should:

• Work with QI/analytics to:

  • Pull clean, de‑identified data if possible
  • Clearly label:
    • Patient cohort definition
    • Time windows (pre‑ vs during pilot)
    • Any exclusions

• Pre‑define your analysis:

  • Primary outcome comparison (before vs during)
  • Basic descriptive stats: adoption rate, completion, message volume
  • Any balancing measures (e.g., nurse pages increased?)

If you want any chance of turning this into a poster, CV line, or publication, this month’s work is non‑negotiable.

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Month 9: Analyze, Present, and Decide the Future

The project is not over when the last patient unenrolls. It’s over when you’ve squeezed the learning out of it and made a decision.

Week 1–2: Quick and dirty analysis

At this point you should:

• With a data‑savvy ally (QI, stats faculty, or analytics person):
  • Run your primary analysis (even if underpowered)
  • Visualize the key outcome over time (simple line or bar charts)
  • Summarize usability/experience data (short quotes help)

Be honest. If the impact is modest, say it. Decision‑makers trust clean negatives more than over‑spun “trends toward improvement.”

Week 3: Debrief with stakeholders

You started with quiet 1:1s. You end with visible, structured reporting.

At this point you should:

• Present a short 10–15 minute debrief to:
  • Your PD / APD
  • Clinical leadership of the unit/clinic
  • QI/informatics leads who supported you

Your structure:

1. The problem we tackled
2. What we built and how it fit into workflow
3. What actually happened:
   • Adoption
   • Outcomes
   • Staff/patient response
4. What we’d do differently
5. Specific next steps:
   • Sunset?
   • Modify and re‑pilot?
   • Scale up to additional units?

Make a recommendation. Don’t punt the decision. Propose:

• “We should run a second 3‑month pilot with X change.”
• Or: “We should transition this to a standing workflow, with Y owner.”
• Or: “We should stop here; the benefit didn’t outweigh the complexity.”

Week 4: Package it for your future self

You’re not just doing this for your current hospital. You’re doing it for Future You, the attending or fellowship applicant.

At this point you should:

• Create a clean package:

  • 1–2 page executive summary
  • Final slide deck
  • De‑identified figures/tables
  • Draft abstract for a conference (SCCM, SGIM, HIMSS, etc.)

• Clarify:

  • Who owns this if it continues?
  • Where the code/configs live
  • How someone else could restart it without you

This is how your pilot becomes part of your narrative, not just a side quest you barely remember.

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Compressed 9‑Month Snapshot

If you want the entire thing in one shot:

9-Month Digital Health Pilot Timeline

Task	Details
Problem & Concept: Identify problem & stakeholders	a1, 2026-01-01, 30d
Problem & Concept: Align with leadership	a2, after a1, 30d
Approvals & Design: IRB/QI & IT scoping	b1, after a2, 30d
Approvals & Design: Workflow & content design	b2, after b1, 30d
Build & Test: Configure/build tool	c1, after b2, 21d
Build & Test: Internal testing	c2, after c1, 9d
Pilot: Go-live & ramp-up	d1, after c2, 45d
Pilot: Monitor & light iteration	d2, after d1, 30d
Wrap-Up: Analyze & present	e1, after d2, 30d

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Final Thoughts

Three points to keep straight:

1. Scope small, but run it like it matters. One unit, one workflow, one main outcome. That’s enough for a real pilot.
2. Sequence is everything. Problem → buy‑in → approvals → workflow → build → test → launch → analyze. Skip a step, and you’ll pay for it later.
3. Leave a trail. Clean data, clear summary, and a simple story turn a chaotic 9‑month experiment into something that advances your career and actually helps your patients.