In 2001, ECHO began the pilot program with 2-3 small pilot awards to junior faculty. Since then, the program has evolved into an annual call for proposals that supports multiple, high quality pilot projects led by junior faculty across the state of North Carolina. In 2002, ECHO created the Carolina-Shaw Partnership to Eliminate Health Disparities (Project EXPORT) which was funded by the National Institute for Health's National Center on Minority Health and Health Disparities. This partnership's pilot program was aligned with the ECHO parent pilot and the merging of these two programs resulted in an increase in the number of pilot grants per year, each ranging from $10,000 to $12,000.

Annually, ECHO  widely distributes a ‘call for proposals' several months in advance of the due date for each round of pilots using the UNC health disparities e-mail listserv and fliers.  As part of this RFA, ECHO requests but does not require, a one-page ‘letter of intent' briefly describing the project about four to six weeks prior to the due date for the pilot proposals.  The letters of intent serve to identify faculty who are at risk of being unresponsive to the call for proposals, and for matching junior faculty who may be in need of mentoring from appropriate experienced faculty.  The 10-page final proposals are peer reviewed by faculty from UNC-Chapel Hill and local Historical Minority Institutions (HMI) and written feedback is provided to all applicants.  The reviews are conducted in a fashion similar to a study section, with scoring on an NIH 1-5 scale.  In an effort to support new investigators with varying levels of research experience, a pre-pilot planning grant program began in 2004 to focus on junior faculty who may be new to research or desire to be involved in research and need support developing their research concepts. These pre-pilot planning grants range from $2,000 - $3,000 and provide much needed resources for junior faculty to focus on their research plans.

Each year, ECHO gives 3-4 awards for a total amount of $40,000-$50,000 in pilot project funding per year. Award funds may be used for data collection, mailing of surveys, analyses of any type, interventions, or for other resources necessary to the completion of the project, except that award funds may not be used to pay for clinical patient care, for purchase of computer hardware, PI salary, or for investigator travel. Exception: Faculty at the Historical Minority Institutions can use a portion of their grant funds to cover release time for the principal investigator.

Each pilot awarded is anticipated to last for about 12-16 months.  There is an initial period builit in for IRB clearance issues, identification of research assistants, and other project components which generally entail a several month start-up period.  All pilot awardees are oriented to the management and budget issues of a pilot project, and ECHO coaches them on frequently challenging areas through semi-annual pilot networking meetings.  These networking meetings also provide an environment for hearing concerns and encourage awardees to share their experiences with one another.  Former pilot awardees are surveyed annually regarding publications, presentations, and grant submissions arising out of their pilot awards. Award recipients are also asked to submit a final report on the project after its completion and are expected to be working on a draft proposal to a federally funded agency or foundation. With support from the GlaxoSmithKline Foundation, the ECHO program in collaboration with the Carolina-Shaw Partnership to Eliminate Health Disparities (Project EXPORT) has sponsored a total of 38 pilot projects since the program's inception in 2002.