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Yury Gargarin

Yury Gargarin

Product Designer

Product Designer

HC

Desk Research • User interviews • concept testing • usability testing • Design System • prototype • Figma

Desk Research • User interviews • concept testing • usability testing • Design System • prototype • Figma

Desk Research • User interviews • concept testing • usability testing • Design System • prototype • Figma

Creation of a medical record model aimed at psychologists

Creation of a medical record model aimed at psychologists

Project made at Dasa for web/desktop applications

Problem

Within Dasa's current record, there are some fields that are not relevant to all health professionals, and this generates frustration when they are forced to fill them in. This problem consequently interfered with the NPS and CSAT decreasing.

Objectives

  • Understand the needs of personality fields for all health professionals on Dasa

  • Understanding what types of personalization will give value to health professionals

  • Validate the concept of "personalization"

My role

I worked with a UX Researcher and a Product Management to create this solution and I'm responsible for all experience, interaction and user interface createde.

Methodology

In order to achieve the research objectives and validate the hypotheses raised, a research plan based on 2 phases was drawn up. The first phase seeks to explore, within the public of health professionals, the level of personalization necessary for their performance. The second phase delves deeper, into specialist doctors, and into the need to personalize medical records for them.

1

Explore, within the healthcare professional audience, the level of personalization of their profession

We were here

2

Deepen, among medical specialists, the need to personalize medical records for them.

Methods

Due to the number of services at Nav and business needs, we chose to start exploring psychology professionals.

1

Desk research

Collection of data on legislation and use of psychological records

2

User interviews

Exploratory conversations focusing on the need for personalization

3

Concept testing

Validation interviews with solutions proposed by PD and UXR

The public

Interviews

7 psychologists from Dasa's psychology program, who use Nav's records and/or Feegow's records.

Concept testing

5 psychologists from Dasa's psychology program, who use Nav's medical records.

"My goal is for my patient to become their own therapist."

Main findings

Main findings

Who are our psychologists

  • They are between 30-45 years old

  • Majority female

  • Live in São Paulo

  • They work with the CBT (Cognitive Behavioral Therapy) approach

Follow several protocols

The Dasa psychology program has a variety of mandatory protocols to be followed by participating psychologists.

These rules mean that they need to adapt the way they work and conduct their sessions, as they force them to focus treatment only on the initial complaint, within a certain number of sessions.

Some protocols:

  • Use brief focal therapy

  • Limit treatment to 18 sessions

  • Sessions last 30 minutes

  • Apply clarification term

  • Apply assessment scales in the first and penultimate session

“

In brief focal therapy, the patient brings a complaint. For example: "I can't work on my anxiety at work." So we will work through therapeutic techniques so that the patient can better face this situation within 18 sessions. There are patients who resolve the problem after 12 sessions, while other patients need to go beyond 18 sessions.

In brief focal therapy, the patient brings a complaint. For example: "I can't work on my anxiety at work." So we will work through therapeutic techniques so that the patient can better face this situation within 18 sessions. There are patients who resolve the problem after 12 sessions, while other patients need to go beyond 18 sessions.

Psychologist

“

Privately, I always ask my patients to bring whatever they feel most comfortable bringing to therapy. The more the patient gains trust in me and feels at ease, he or she can bring up more delicate topics, which make them more indomitable. In brief focal therapy we don't have much time to make the person comfortable to bring all of this up. So, sometimes by pushing a little we can achieve a lot.

Privately, I always ask my patients to bring whatever they feel most comfortable bringing to therapy. The more the patient gains trust in me and feels at ease, he or she can bring up more delicate topics, which make them more indomitable. In brief focal therapy we don't have much time to make the person comfortable to bring all of this up. So, sometimes by pushing a little we can achieve a lot.

Psychologist

They use multiple tools

Throughout the conversations, it was possible to see that psychologists use different tools during their treatment.

Although many share the same purpose, the tools are very varied and very personal, that is, many psychologists create their own tools. Breathing and relaxation techniques were the most cited among the psychologists interviewed.

Some tools:

  • Breathing techniques (one of the most used)

  • Relaxation techniques (one of the most used)

  • Meditation

  • Deck of self-knowledge

  • Movies and series

  • Emotions diary

  • Self-knowledge notebook

  • Letters and lists for patients to write

Homework for "sewing" the sessions

Homework proved to be a powerful and widely used tool among our interviewees.

The majority of interviewees do exercises at home and use them to connect one session to another and maintain the focus of the treatment, being an efficient practice for the brief focal therapeutic methodology.

“

Due to the little time we have, we do homework on this approach so that the person always brings us an evolution, even if we haven't spoken to the patient during the week.

Due to the little time we have, we do homework on this approach so that the person always brings us an evolution, even if we haven't spoken to the patient during the week.

Psychologist

“

In the next session I will open up to the patient first. I ask how the week was, I give him space to talk. If there is something specific that appeared there at that time, I will work on it. If I don't have anything on time, I'll work on my homework, which was already something that had been structured since last week.

In the next session I will open up to the patient first. I ask how the week was, I give him space to talk. If there is something specific that appeared there at that time, I will work on it. If I don't have anything on time, I'll work on my homework, which was already something that had been structured since last week.

Psychologist

Psychological treatment journey

The red dots indicate where the record has failed

The red dots indicate where the record has failed

Your greatest tool

Your greatest tool

An essential tool

One of the objectives of the medical record is to record the patient's progress and thus enable monitoring. In this way, it also helps the professional not to deviate from the focus of the treatment and resume where they left off in the last consultation.

“

If I don't have a medical record I don't know where I came from, where I'm going [...]. The medical record shows what has progressed and what has not progressed.

If I don't have a medical record I don't know where I came from, where I'm going [...]. The medical record shows what has progressed and what has not progressed.

Psychologist

“

It serves to guide the next sessions. For example, before providing care, I have access to the medical record. As I serve a lot of people, I see what was done there, and then it gives me guidance to follow up. So as not to get lost.

It serves to guide the next sessions. For example, before providing care, I have access to the medical record. As I serve a lot of people, I see what was done there, and then it gives me guidance to follow up. So as not to get lost.

Psychologist

Helps to bond with the patient

According to some psychologists, picking up where you left off in the last consultation generates acceptance and strengthens bonds with the patient because it shows that this professional is attentive and cares.

“

Tell me, as smart as I am, will I remember everything the patient told me? I won't [...] So, what happens? Not that I can't get confused, it's human, we can, but in psychological care, the patient, he wants this, he wants to know that he is being heard. So, this is the importance of medical records for me.

Tell me, as smart as I am, will I remember everything the patient told me? I won't [...] So, what happens? Not that I can't get confused, it's human, we can, but in psychological care, the patient, he wants this, he wants to know that he is being heard. So, this is the importance of medical records for me.

Psychologist

Psychologists have the session number and the patient's evolution as fundamental items

Both perform important functions to enable patient monitoring and help the professional not to deviate from the focus of the treatment.

These were the most cited items when asking psychologists what could not be missing from a psychological record.

“

If you don't have that control, you lose yourself. I myself rely heavily on the number of sessions. And what session am I in? Is it in the second, third, fourth, or fifth? Which one am I? Because if you don't have a way to register the session, you lose the content. You also get lost in your planning and the patient’s evolution.

If you don't have that control, you lose yourself. I myself rely heavily on the number of sessions. And what session am I in? Is it in the second, third, fourth, or fifth? Which one am I? Because if you don't have a way to register the session, you lose the content. You also get lost in your planning and the patient’s evolution.

Psychologist

It's confidential!

As it is a document that can be requested by the patient and other health professionals, the psychological record needs to be confidential and not exposed the patient.

Among our interviewees, many use keywords, abbreviations and/or acronyms in the record to deal with this confidentiality.

“

I never explain what the person said, not a single word, you know? [...] No, I don't, because I know that other people may be accessing this medical record and I don't want to expose my patient. So I put in what is necessary for me to continue

I never explain what the person said, not a single word, you know? [...] No, I don't, because I know that other people may be accessing this medical record and I don't want to expose my patient. So I put in what is necessary for me to continue

Psychologist

“

We have some acronyms that we use, which don't expose as much. We don't talk, for example, in detail about how it happened, perhaps who performed the abortion, for example, cases of abuse...

We have some acronyms that we use, which don't expose as much. We don't talk, for example, in detail about how it happened, perhaps who performed the abortion, for example, cases of abuse...

Psychologist

The psychological record is different from the medical record

Naturally, as it is not intended for medical consultations, a psychological record does not have the same fields as a medical record. According to our interviewees, the graph below shows which (non-mandatory) fields are least used among psychologists.

The ideal psychological record

The solution

The solution

Two evolution sheets

To implement the planned value proposition, based on the psychological care journey and also on the telepsychology program protocols, 2 evolution sheet templates were designed for Nav's psychological record.

Welcome

sheet

This will be the sheet intended for the first consultation with the patient, carried out by the reception team of psychologists.

Tracking

sheet

It will be the sheet used for the rest of the consultations, carried out by the team of monitoring psychologists.

Medical record sheet used by psychologists during Discovery to use as a comparison to the medical record sheet created specifically for psychologists:

Consulta Online Agora

Anamnese

Queixa ou motivo da consulta

Insira uma observação

Medicamentos em uso

(opcional)

Insira aqui os medicamentos que o paciente está usando e/ou os medicamentos de uso contínuo.

Insira uma observação

Avaliação física

(opcional)

Peso

kg

Altura

cm

Insira uma observação

Exames e anexos

Anexe arquivos complementares ao prontuário

Envie até 5 arquivos. Com até 10mb cada, nos formatos: .pdf, .jpeg, .png, .mp4, .mov, .avi, .wav, .mp3

Anexar arquivo

HIPÓTESE DIAGNÓSTICA

Buscar CID

Conduta

Prescrição

(opcional)

Utilize a ferramenta da MEMED para criar sua prescrição. Enviaremos ao paciente uma SMS com a cópia dos medicamentos prescritos e exames solicitados.

Criar prescrição

Descrição da conduta

Insira uma observação

Desfecho

O paciente precisa ser encaminhado?

Sim

Não

Observações

Observações sobre este atendimento

(opcional)

Insira uma observação

new psychological record

Welcome sheet that will be used in reception consultations, that is, in initial assessment sessions.


Because it is (within Dasa's telepsychology program) a single session, this template is a little leaner. It has the same functions as the monitoring sheet, except for the function of ending treatment, which, in this case, is replaced by the function of referring the patient to treatment.

acolhimento

Última alteração salva há 15 segundos

Anamnese

Queixa inicial

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor.

Evolução

Sessão de acolhimento

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

Sinais e sintomas

Abuso crônico de álcool

Abuso de drogas

Abuso de medicação

Adolescência - sinais e sintomas relacionados ao comportamento

Alterações de memória

Ansiedade - sinais e sintomas

Autoagressão

Depressão - sinais e sintomas

Dificuldades de aprendizagem

Mostrar mais

Escalas

O tratamento está próximo do seu fim e você precisa aplicar as escalas novamente.

Escala PHQ-9

Sessão de Acolhimento • 01/09/2022

15 - 19

Moderadamente severo

Aplicar escala

Escala GAD-7

Sessão de Acolhimento • 01/09/2022

10 - 14

Moderado

Aplicar escala

Anexos

Anexe declarações, fomulários e outros arquivos complementares ao prontuário

Envie até 5 arquivos. Com até 10mb cada, nos formatos: .pdf, .jpeg, .png, .mp4, .mov, .avi, .wav, .mp3

Anexar arquivo

Encaminhar paciente

O paciente será encaminhado para:

Telepsicologia

Outro tratamento

Observação sobre o encaminhamento

O paciente lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.


O paciente lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

Encaminhar

Submission sheet that will be used for follow-up appointments in Tracking sheet:

Sessão 12 de 18

Solicitar sessões

Última alteração salva há 15 segundos

Anamnese

Queixa inicial

Editar

A paciente tem um histórico de trauma e dificuldade de relacionamento. Ela relata sentir uma sensação de solidão e isolamento. Ela também relata dificuldade em confiar nos outros e administrar suas emoções em relacionamentos íntimos.

Evolução

Total: 11 evoluções

Sessão atual

Sessão Anterior - 11 de 18 - 29/09/2022

Visualizar prontuário

Na sessão, o paciente demonstrou uma tendência a ruminar sobre pensamentos e experiências negativas. Ele também relata sentir-se sobrecarregado por suas responsabilidades e falta de controle em sua vida.

Mostrar todas as evoluções

Sinais e sintomas

7 selecionados

Abuso crônico de álcool

Abuso de drogas

Abuso de medicação

Adolescência - sinais e sintomas relacionados ao comportamento

Alterações de memória

Ansiedade - sinais e sintomas

Autoagressão

Depressão - sinais e sintomas

Dificuldades de aprendizagem

Mostrar mais

Escalas

O tratamento está próximo do seu fim e você precisa aplicar as escalas novamente.

Escala PHQ-9

Sessão de Acolhimento • 01/09/2022

15 - 19

Moderadamente severo

Sessão 12 • 01/12/2022

0 - 4

Nenhum ou mínimo

Editar

Aplicar escala

Escala GAD-7

Sessão de Acolhimento • 01/09/2022

10 - 14

Moderado

Sessão 18 • 01/02/2023

5 - 9

Leve

Editar

Aplicar escala

Anexos

Anexe declarações, fomulários e outros arquivos complementares ao prontuário

Envie até 5 arquivos. Com até 10mb cada, nos formatos: .pdf, .jpeg, .png, .mp4, .mov, .avi, .wav, .mp3

Anexar arquivo

Encaminhamento

Indique ao paciente a necessidade de buscar um outro profissional especialista.

Indicar ao paciente a necessidade de procurar um profissional de outra especialidade?

Sim

Não

Qual tipo de encaminhamento o paciente precisa?

Encaminhar a um pronto-socorro presencial

Encaminhar a outras especialidades médicas/terapêuticas

Para quais especialidades médicas/terapêuticas deseja encaminhar?

Buscar especialidade

Psiquiatra

Insira uma observação

Nutricionista

Insira uma observação

Encerrar tratamento

Business gains

Reminder system linked to the session counter

Ensure maintenance of program protocols (application of schedules and extension requests at the right time)

Automated session extension request flow

Reduce authorization SLA and effort for users and psychology team (CES)

Automated scale application flow

Unification and standardization of data

Treatment closure flow

Greater control and visibility for management

Construction of treatment logic

Greater control and visibility for management

Concept testing

Concept testing

Method

To validate the designed concepts, we used the prototype alongside the interviews. The method consists of exposing the solution to the user to collect their perception of what is being built and validate the proposed concepts.

Validated proposal

The highlights

  • Scales

  • Session count

  • Evolutions

Validated

  • Initial complaint

  • Signs and symptoms

  • Absence of CID

Deprioritized

  • My annotations

Scales and session counter caught the attention

Both functions stood out among the psychologists interviewed. They were noticed from the first impression and their value was widely commented on by professionals.

“

Session 4 of 18. I think it's cool, because it lets us know more or less which session we are in with the patient. That's it, we don't need to keep typing it in the medical record. Extend sessions. That's cool here.

Session 4 of 18. I think it's cool, because it lets us know more or less which session we are in with the patient. That's it, we don't need to keep typing it in the medical record. Extend sessions. That's cool here.

Psychologist

“

I liked session 4 of 18, this is important for us to have control over how we are in the consultations

I liked session 4 of 18, this is important for us to have control over how we are in the consultations

Psychologist

Success in facilitating follow-up

The functions of initial complaint, evolution record and signs and symptoms, designed to facilitate patient monitoring, have had their value proven and recognized by psychologists. Some professionals highlighted the value of the initial complaint to facilitate compliance with the psychology program protocols.

“

And it's also great to have the previous evolution here, because it helps us remember what was said in the previous session, right?"

And it's also great to have the previous evolution here, because it helps us remember what was said in the previous session, right?"

Psychologist

“

The signs and symptoms that I think are something that I didn’t have before and that will help a lot.”

The signs and symptoms that I think are something that I didn’t have before and that will help a lot.”

Psychologist

“

What caught my attention the most was really this part, the evolution of the current session and the previous sessions. I think this will really work very well on a daily basis and make our work a lot easier.

What caught my attention the most was really this part, the evolution of the current session and the previous sessions. I think this will really work very well on a daily basis and make our work a lot easier.

Psychologist

Deprioritized secrecy area

Throughout the conversations, we realized that the function did not generate value for all professionals and that it needed to be designed outside the medical record, as an independent flow and this generates a high effort for the team. Therefore, we decided to work better on the function in the next evolution.

“

It's just that everything I put in the session notes, you managed to cover very well. So today I don't know how I would use this specific annotation field.

It's just that everything I put in the session notes, you managed to cover very well. So today I don't know how I would use this specific annotation field.

Psychologist

“

I don't know if I'll feel safe putting them in the system because they're personal notes that I don't want anyone to see. Sometimes we even have the issue of confidentiality. I think it doesn't make much sense to leave it in the system because this encryption will fail and I will have something confidential being exposed. So I don't know if every professional will use this.

I don't know if I'll feel safe putting them in the system because they're personal notes that I don't want anyone to see. Sometimes we even have the issue of confidentiality. I think it doesn't make much sense to leave it in the system because this encryption will fail and I will have something confidential being exposed. So I don't know if every professional will use this.

Psychologist

Proposal validated!

All psychologists liked the proposal. They felt that the evolution sheet was now more complete, easier, and better structured.

“

It's much easier to identify where the information is, you know? Everything is fine. These records will make it much easier for us to fill in the information at the time of care.

It's much easier to identify where the information is, you know? Everything is fine. These records will make it much easier for us to fill in the information at the time of care.

Psychologist

“

The layout of this medical record is psychological. He's not a doctor.

The layout of this medical record is psychological. He's not a doctor.

Psychologist

“

I think it's more complete now and easier to understand. It is easier for us to follow up on the patient's treatment.

I think it's more complete now and easier to understand. It is easier for us to follow up on the patient's treatment.

Psychologist

“

The thing about anamnesis, about it being a fixed thing, and about evolution having something that I can do continuously... Which isn't all called anamnesis. It's not all under the same name as "initial complaint", for me, that's great! The option to hide, to show progress. Excellent! Showing the session number is great! So, I really liked the improvements, a lot! And there is no obligation to the CID.

The thing about anamnesis, about it being a fixed thing, and about evolution having something that I can do continuously... Which isn't all called anamnesis. It's not all under the same name as "initial complaint", for me, that's great! The option to hide, to show progress. Excellent! Showing the session number is great! So, I really liked the improvements, a lot! And there is no obligation to the CID.

Psychologist

Learnings and next steps

Learnings and next steps

During the project, we recognized that by allowing users to personalize the medical record according to their needs, we could improve efficiency and overall professional satisfaction.

Additionally, we also work closely with the development team to ensure the technical feasibility of the proposed solution. We work together to find the best way to implement customizable fields, ensuring seamless integration with your existing system.

We also intended to carry out more usability tests and launch the solution to a pilot group of psychologists to collect continuous feedback and make adjustments based on needs. As we move forward, we plan to continue refining the solution, expanding to a wider audience, and closely monitoring success indicators.

However, due to some internal changes in Dasa's product teams and the Nav product metrics, we had to freeze the initiative to prioritize others.

Thanks! 😁

Thanks! 😁