SPEED NOTE

Problem Space 

Problem Statement  

How might we increase the efficiency of completing clinical documentation (e.g., progress notes) so that clinical therapists can spend less time doing mundane (but legally required) paperwork and more time devoted to their patients. 

Problem Background  

Not so fun fact: the United States does not have enough mental health professionals (MHPs) to treat the growing population of those who suffer from mental disorders. In addition, there are more than 150 million people who live in a federally designated mental health professional shortage area (think: food desert). Within just a few short years, the US will be short an estimated 14k-31k MHPs. This includes psychiatrists, psychologists, social workers, and counselors. This means that current MHPs will be overworked, which will lead to severe and chronic burnout (AAMC, 2024). 

With the addition of the COVID-19 pandemic, many MHPs transitioned to providing services via telehealth. While this proved to be convenient and increased their overall safety, many providers found that offering telehealth services brought on unforeseen concerns. We quickly saw an increased need for services and limited access to care. In other words, the increase in demand for therapy outpaced the supply of available therapists (ACA, 2024). As you can imagine, this created a significant problem as clinicians had full caseloads and there were longer wait times to see providers. In addition, due to full caseloads, clinicians found themselves experiencing chronic burnout, which quickly impacted other areas of their livelihood (e.g., health outcomes). 

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life (CDC, 2024). In other words, the more positive an individual’s SDOH, the happier they are and the less likely they are to experience burnout at work. Factors that led to burnout included treating complex mental health conditions (e.g., severe trauma, sucide/self harm, major depression). According to Lyra Health (2024), ⅕ of US workers considered leaving their job due to its negative impact on their mental health. This statistic also included clinical therapists as many clinicians reduced their caseload due to experiencing burnout or left the field altogether. When experiencing burnout, small tasks often feel insurmountable because you do not have the emotional (or cognitive) capacity to deal with them. A small task can include completing clinical documentation (e.g., progress notes). When a clinician is experiencing burnout, in addition to Zoom fatigue, a decline in their personal health, more patients on their caseload, and decreased work satisfaction (Mittal et al., 2024), completing progress notes at the end of a long day of seeing patients, feels like a big hurdle. Thus, therapists may be less likely to complete progress notes due to having a limited emotional capacity. 

However, clinical documentation is an ethical and legal requirement for counselors/therapists regardless of role, length of time in the field, or population. Clinical documentation serves several purposes; including, but not limited to: documenting the course of treatment, serving as a basis for continuity of care, risk management, compliance with legal, regulatory, and institutional requirements, quality assurance, and coordination of care between professionals (Bodek, 2010). In other words, you cannot avoid it! It is a requirement of your job. However, for many providers, completing clinical documentation can be cumbersome, stressful, and often repetitive, which leads to avoidance, delays in completing documentation, and overall poor quality. 

The target customers are clinical therapists who work in a private practice and typically see a high volume of patients. Due to the nature of their work, therapists do not often have time to complete progress notes at the end of their day (or week) due to exhaustion, or simply deciding to put the task off until a later time. Additionally, therapists are often inundated with other administrative tasks, supervising clinicians, administrative meetings, researching interventions, or attending training to maintain their clinical license. Therefore, clinical documentation may often fall to the end of their to-do list or the number of progress notes may increase overtime due to backlog. A large portion of my survey respondents noted that completing progress notes was boring or felt like it was “another thing to do” at the end of a long clinical day. SpeedNote aims to make this process faster, so that therapists are more inclined to complete progress notes in a timely fashion, have the ability to spend more time treating patients, and overall feel an increase in their work satisfaction. 

Goals

1. Reducing the amount of time it takes to write a single progress note. Reducing from several minutes to seconds (<1 minute). 
2. Simplifying the process of writing a progress note so that therapists are not expending too much mental energy at the end of a difficult session or at the end of a long workday. 
3. Increase their confidence in completing clinical documentation 
4. Allow clinicians to select from various progress note formats or templates depending on their target population 

Research Insights

User Pain Points

I surveyed therapists who work in a variety of settings and these common challenges/pain points were identified:

• Working to maintain the patient’s confidentiality when writing progress notes
• Completing progress notes does not feel as important as other tasks (i.e., crisis intervention, research, supervision)
• Having difficulty accurately capturing what occurred during the session
• Having difficulty deciding how much clinical information to share/write in the progress note
• Not having enough time in their schedule to complete progress notes
• Completing progress notes feels boring, repetitive, formal, tedious, or “just another thing to do”
• Difficulty capturing the necessity of services for insurance payors

Landing on the Solution 

Based on our target users’ pain points, I decided to develop the following:

A HIPAA-compliant platform that utilizes AI to help reduce the amount of time it takes to write a progress note. This platform can also be integrated into other B2C EHR systems (ie, simple practice, therapy notes). Current methods of clinical software that utilize AI, use audio and video recording. This can be problematic for HIPAA compliance and can also make clinicians feel uncomfortable with uploading patient sensitive information to a third-party app or database. By only utilizing the clinician’s in-session notes, the clinician maintains the authority over how much information they would like to upload into the system. 

Features

• AI-Assisted Note Generation: incorporate machine learning to improve the accuracy and efficiency of progress notes
• Editing: allow the clinician to add or remove information from the progress note
• Voice-to-text feature: for those who would rather increase efficiency by verbalizing their notes instead of typing
• Customizable Templates: provide a variety of pre-designed templates for different types of progress notes utilizes different formats (e.g., SIRP, SOAP)
• Integration into existing EHR platforms: seamless integration into popular EHR systems (e.g., TherapyNotes, Simple Practice)
• Collaboration and Review Tools: facilitate collaboration amongst multiple users to review and edit (e.g., supervision - trainee) 
• Security and Compliance: ensure compliance with HIPAA and industry standards
• User Roles: develop various roles for users (e.g., administrative, clinician, reviewer)
• Intuitive Interface: easy to use interface, ensuring compatibility with desktop and mobile devices
• Performance Metrics: developing metrics to ensure accuracy, efficiency, and user satisfaction (e.g., measure the percentage of progress notes generated by the system that were completed in under one minute with minimal corrections/editing)

User Flows/Mockups

Scenarios

• As a therapist, I want to reduce the amount of time I spend writing progress notes so that I can devote more time to my patients. >>> I have reduced the amount of time I spend writing progress notes on a daily basis by at least 50%some text
  1. ACCEPTANCE CRITERION:some text
     1. User can easily access client demographic information through the platform
     2. User can access demographic information about the client for insurance quality
     3. User can manually type in their notes from the session and have the platform organize their notes into the template
     4. User has the option to edit the template, which can mean adding or removing information 
     5. User can receive a reminder after 24 hours if the progress note has not been completed 
     6. Generate summary reports based on needed metrics

• As a clinical supervisor, I want an easy and effective way to review the progress notes that were completed by my intern so that I can provide feedback. >>> I can support my intern in taking more effective in-session notes by reviewing how much information they included (or did not include) into their progress note for insurance compliance some text
  1. ACCEPTANCE CRITERION:some text
     1. User can review intern’s in-session notes 
     2. User can provide feedback on the intern’s in-session notes
     3. User can edit intern’s progress note for quality purposes
     4. User can provide direct feedback on the template for the intern 
     5. User receives a notification once the intern has completed the progress note
     6. Generate summary reports based on needed metrics

• As a student/trainee, I want to learn a quick way of completing clinical documentation so that I do not feel overwhelmed or inundated. >>> utilizing AI software allows me to spend less time completing clinical documentation and more time honing my clinical skillssome text
  1. ACCEPTANCE CRITERION:some text
     1. User has access to a wide variety of progress note templates to reduce ambiguity
     2. User can review live feedback from their supervisor regarding the quality of their progress note and in-session notes 
     3. User receives a notification when progress notes are not completed after 24 hours

• As a patient, I want the opportunity to view the progress notes that were completed by my clinician >>>> I am able to log into the system and view my progress notessome text
  • ACCEPTANCE CRITERION:some text
    • User has access to their EHR chart where they can review the completed progress note

Measuring Success

• Initial mock-up of the home page
• Client directory which includes demographic information (e.g., name, date of birth, address, diagnosis, treatment plan)
• Progress note templates
• Sample notes page
• Sample progress note
• Reminder feature 

Product Success Metrics

• User feedback reporting at least a 50% reduction in the time it takes to complete progress notes 
• User feedback reports increased confidence with completing progress notes
• User retention, users are continuously using the product over a long period of time (> 1 year)
• More users have downloaded the product
• Decrease in delay of completing progress notes >>> users report completing progress notes within 24 hours after session
• Incorporating user feedback surveyssome text
  • How satisfied are you with the product?
  • How much time per day did you spend completing clinical documentation prior to using Speed Note? How much time per day do you spend completing clinical documentation after using Speed Note?

Milestones & Timeline

• Ideation
  • Problem statement 
  • Define roles/responsibilities
• Research/Validation
  • Interviews, surveys, user stories, scenarios, and pain points.
• Product Requirements Document
  • Prioritized list of features, roadmap, and backlog.
• Design
  • Initial mock up of the home page, client directory, progress note template, notes page, progress note page, reminder feature
  • Develop core AI algorithms 
• Development
  • Development of each page (from the design stage)
• Beta Testing and Feedback
  • User recruitment, pilot MVP, feedback collection
• Phase 2
  • Conduct testing and reiteration based on user feedback
• Launch
• Maintenance 

Open Questions / Appendix

• Ethical use of AI
• Issues with integrating into established EHR systems