Most electronic patient-reported outcome programs I have seen begin the same way. A motivated team, a supportive leader, a platform that works well enough, and a pilot population small enough to manage by hand. The pilot succeeds. Patients report their symptoms, someone responds, and the early results look the way the evidence said they would.
Then the program tries to grow, and the things the pilot never needed become the things it cannot live without.
Coverage is the first. A pilot can rely on one or two people who care about it. A program needs a plan for evenings, weekends, vacations, and turnover. Routing is the second. While a pilot’s patients report, someone can read every response. When a whole population does, the program needs rules about what is reviewed, by whom, and how quickly, and those rules have to be ones the team can meet on an ordinary day.
Measurement is the third. A pilot is judged on whether it worked. A program is judged, month after month, on whether it is still working, and it needs a small set of measures that the team can see without anyone building a report by hand.
None of this is glamorous, and none of it appears in the study that made the case for the program. But it is the difference between a pilot that ends and a program that lasts, and it is worth designing for from the first day.