This poster provides a practical roadmap for moving an innovative item type from brainstorming to pretesting in under two years, using telehealth video excerpts as an example. The roadmap includes a prioritization rubric, development timeline, and modified agile workflow that can be adapted to different exam programs and organizational needs. Attendees will see how a broad innovation workshop used criteria such as assessment purpose, feasibility, authenticity, and impact to narrow potential ideas and select a multimedia item type aligned with the assessment mission. Designed to be accessible to new test developers, the poster also supports deeper conversation about evaluating innovations and developing multimedia item types within real-world constraints. The roadmap connects people, innovation, and impact by showing how subject matter experts and assessment staff advanced a fair, authentic approach to assessing physician competencies.