Treatment Plan & Progress Note Forms

Clinical documentation for mental healthcare treatment planning and tracking

Late 2022

Foundational work to overhaul the design of critical forms at the center of user workflows.

Project Details

Primary Tools

Product Type

Form Design in
B2B SAAS App

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Project Background

The Brief

Create a flexible template for progress notes and treatment plans that met all clinical and insurance requirements for a wide variety of treatment cases.

This will serve as a template for all forms going forward.
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Treatment Plan

The road map for most mental healthcare treatment is the Treatment Plan. This is something the clinician will create around the beginning of treatment, and is sometimes worked on collaboratively with the patient.
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Progress Notes

After each encounter with the patient, the clinician will complete a progress note. This is the clinicians way of tracking progress on their treatment.

Discovery/Research

Industry Research

Before speaking to our current users, it was important as part of this project that I understood the full context of how these documents are used in a mental health setting.
I used a combination of reputable industry organizations as well as guidaince from industry professionals.

Goals

  • Better familiarize myself with the day-to-day occupational duties of the clinicians who use TiQ.
  • Understand why different approaches to mental healthcare treatment are taken.
  • Learn the needs of different types of clinicians.

Takeaways

I familiarized myself with a number of standard templates like DAP, SOAP, BIRP and many more that are used depending on the preferences of the clinician or therapy modality. There can be further customization based on the needs of the Practice or clinicians.
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It is common to attach screening forms to progress notes, to evaluate the patient's current state specific issues like drug use/abuse, mood disorders and more. Some specialties require additional data points. A prescriber may need to enter a patient's physical vitals, or a drug addiction specialist may need to document instances of use.

I learned that treatment plans and progress notes can be requested by insurance to verify that the care they pay for is yielding results. Courts may also request these documents if the client is involved in a case where insight into their mental state is important. A Treatment Plan may also be worked on collaboratively with the patient.

After this I felt I knew what to look for as I put on my sleuthing cap and peaked over at how our competitors were handling these documents.
SimplePractice, TherapyNotes and Tebra software

Competitor Research

Compared progress note and treatment plan templates offered by top competitors TherapyNotes, SimplePractice, Tebra and more. Research was compiled in Google Sheets and Docs.

Goals

  • Learn the experience users switching to our platform are accustomed to.
  • Identify discrepencies between our forms and competitors, determine if any gaps need to be addressed.

Takeaways

SimplePractice as one might suspect provided a very minimal default template, allowing users to get as simple as a single text box field. Event information is sticky to the right side, and the rest of the note is divided into tabs, keeping the information on screen at once to a minimum.
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TherapyNotes had more granular controls than SimplePractice, allowing target dates and frequency to be included alongside objectives and interventions.

Tebra's configurations took it another step further, with options for a range of niche clinical scenarios. However, increased functionality came at a cost of usability, as forum posts from users revealed.

With a clear understanding of how other platforms have chosen to format these documents and the decisions they made, I was ready to start speaking with users who had recently transitioned from using these platforms.

User Research

I conducted half hour interviews with clinicians from 3 Practices of varying size, prescribers and therapists.

Goals

  • Learn how progress notes and treatment planning integrated into real world workflows.
  • Learn how clinicians were using notes and treatment plans within the context of the EHR and discover limitations they are facing.
  • Learn how we can speed up the documentation process.

Takeaways

All clinicians agreed that progress notes were an essential part of tracking a client's treatment progress and also a mandatory step in all of their workflows.

The number of notes completed per day varied by the discipline, with clinicians having to complete anywhere from 3-12 notes a day. On the high end was a therapist who specialized in family therapy and as such needed to complete a note for each family member present. Notes could be created in 5 minutes or can take as long as 30 minutes for an eventful session

There was a wide range of data points each Practice wanted to include from a clinical perspective that varied by the type of treatment being offered, preferences of the clinician or Practice and whether insurance was accepted.
Some just didn't find certain fields necessary in their work, but others were happy with the fields included in the default template.

While the narrative sections took up the majority of the time to complete a note, the repitition of having to enter time and event info in each note drew more ire from interview participants. Anything that can speed up this process for them is helpful.

Constraints & Considerations

Constraints

This project represented one of the most central parts of mental healthcare treatment, so the needs of therapists and treatment teams guided development requirements and constraints.
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There were very few business and technical constraints for this project.
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  • Must retain existing field logic.
  • Must comply with ADA guidelines.
  • Must be customizable within our form builder, including custom forms that had already been created by users.
  • Certain fields must be included for insurance and auditing purposes.

Considerations

  • Printing, PDF conversion - Many forms need to be sent as a PDF or printed.
  • Mobile, responsive behavior - less common for clinicians to use mobile devices, but must still be supported.
  • Multi-tasking - Progress Notes may sometimes be completed alongside a telehealth session, or alongside a previous note.
  • Logic triggers - Many fields and interactions were connected to downstream logic which would need to be handled carefully.
  • Review by supervisors - For many Practices, notes from interns and junior therapists will be reviewed by a supervisor.
  • Repetitive nature of tasks, especially for family, group therapists.
  • Documents being accessed, referenced at later dates.

Family Therapy Journey Mapping

Utilizing a Persona of a family therapist, we were able to pressure test our documentation workflow with a complex scenario like Family Therapy.

property of Therapy iQ

Architecture

Limiting width to match paper

The decision was made that for the following reasons, formatting for forms in Therapy iQ would no longer expand horizontally infinitely. They would be limited similar to a piece of paper.

PDF-ability

Every form we built required a PDF companion. If we continued to use forms that take the full width of the display, we would need to create custom pdfs that reduced the amount of information stored horizontally.

Print-ability

Athough the world has rapidly moved online, healthcare has been slower to adapt and it is still necessary for many Practices to have print versions of many of their forms.

Splitscreen-ability

Another advantage is that it allows split screen capabilities that can be very useful in the context of a therapy session, if for instance a progress note could be open alongside an e-prescribe or even a telehealth session.

Familiarity

From competitor research, I had found forms were commonly displayed at paper width in similar software. Since we were expecting to onboard many Practices who were acustomed to the experiences on these platforms, there was an advantage to presenting a familiar pattern.
property of Therapy iQ

Arguements against changing to paper width

Change is scary

Existing users already have familiarity with the existing interface design. Changing where fields are located risked frustrating users. If we were going to make significant changes to how these forms were formatted, we wanted to limit the amount of changes we made to the organization of the fields.

Fit more content on screen

When content is allowed to fill all available space, more content can fit on screen simultaneously on larger displays.
Although this can have the positive impact of less scrolling needed, it also comes at the cost of user attention and comprehension.

Form Structure

The form would be built around 2 primary columns, that would respond to the device width only to a certain point.
Some fields had short enough content that they could even be half size.

Spacing

20px vertical spacing was used for related items, with 40px between unrelated items and 60px to delineate the end of a section.

Mobile

On mobile, the form responds by displaying content in a single column in order to be easy to read and interact with.
Spacing guidelines were reduced on mobile to allow more content to fit on screen.
property of Therapy iQ

Content Structure

Changes to the structure of content were minimized in this phase in order for users to adapt to the other layout and interface changes. Content was organized around these 3 broad sections.

Time & Event Info

This information was easy to automate because most of it was being dictated by the event. This also meant it was important that users always had an event connected to their note. Clinical timelines were separated from session time information.

Clinical

This section is where the clinician will include identified problems and define goals for treatment. They can can get very long and detailed. Many insights were gained about opportunities to improve this section, but changes were limited upon initial release to not overwhelm users and allow the team to evaluate changes separately.

Signatures

This section's layout remained mostly unchanged during this phase, though insights from interviews informed future changes.

Release & Feedback

Release

Internal testing was conducted prior to releases. I worked with technical team members to ensure the interface changes were implemented to UI specifications. An overhaul to our UI kit informed by the research conducted was released first.
Form refactoring followed soon after. Treatment Plan was released first, followed about a month later with the new layout for progress notes.

Old Treatment Plan Design

The old interface, with fields stretching to extremes, difficult to read fields, and emphasis on optional elements.

property of Therapy iQ

New Treatment Plan Design

  • Fields populated via automations are highlighted prominently, demonstrating the power of the software and allowing users to understand how fields were populated.
  • 2 column grid acts as the foundation of the form design, with short content fields acting as half-size elements.
  • Sections are more clearly deliniated, and legibility is improved throughout.
  • Experience is standardized accross all but the smallest device widths.
property of Therapy iQ

User Feedback

Positive

New users and prospective customers were really happy with the new form design. This helped our sales team close deals with Practices that were thinking about switching.
Many existing users also were excited about the new design, attesting to better legibility and content organization.

Negative

As expected, there was opposition from some users. We collect feedback via an feedback forum we call the Idea Board, and one post wanting the fields to stretch accross the whole screen garnered few dozen votes.
This was a fairly significant number, however one key piece of context, was this was received before features that took advantage of this space, like an eprescribe panel or Practice Intelligence AI assistant were rolled out.

Future enhancements

This was only the first step in a series of enhancements to the Note taking and Treatment Planning, and many more phases of enhancements followed in the months and years that followed. Each building on the foundation established here.
Progress note with prescription management panel splitscreened.
Property of Therapy iQ

Project Takeaways

Planning and preparation

Being methodical in my approach to research allowed me to start broad and go deeper at each step in the process, which helped inform the goals and objectives of each next step.

Allowing customization

Anytime you can offer users customization without creating unnecessary tech complexity, is a win for users, and allows the business to appeal to more customers.

Room to Grow and Evolve

It was important to consider the longevity of these changes. This was to be the first phases of note and treatment planning template improvements as we increased the level of sophistication of the forms and supported treatment processes. It was only possible to build and evolve from a strong, flexible foundation.

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