< CASE STUDY 4: Mental Health EHR & Referral Portal

StarlingHQ is a full-featured mental health EHR and referral system. As Chief UX Architect, I designed the product and led the team in development.

Project Title: StarlingHQ

Company: Starling Minds

Years: 2020/21

Role: Head of Product, Design & Research, Chief UX Architect

Design Methodologies: design thinking, rapid prototyping

Research Methodologies: card sorting, lab usability testing, user interviews, survey design

HQ Member Details Report - Symptom Charts.png

The Challenge

As we were developing Starling v5.0, an adaptive Cognitive Behavioral Therapy (CBT) app, we also needed to design and build an interface for our customers to manage their program members. The interface needed to have features basic to any EHR system, such as user management and mental health record details, but it also had some more specific requirements.

The Solution

Business Requirements

The Starling CBT app, although it was based on standard CBT practices, was designed to help employees struggling with mental health issues. There were two main product lines providing tailored educational experiences to two main user types:

Starling Mental Fitness was designed for employees still at work but suffering from absenteeism or presenteesim due to mental health issues,
Starling Return to Health was designed for employees on a short-term or long-term disability claim.

Target customers for the Starling Mental Fitness solution were enterprise employers, self-insured enterprises, and employee benefits providers. The target customers for Starling Return to Health were employee benefits providers and other organizations managing disability claims.

Organizations offering Starling Mental Fitness could simply direct employees to a public registration website and limit users by offing a confidential registration code. However, because of the billing structure of the product, disability claimants needed to be referred by a case manager to Starling Return to Health.

Functional Requirements

Because the mental health solution was to be deployed in disability management and potentially in primary care scenarios, a mechanism was needed to give disability case managers or healthcare providers the ability to refer to solution to claimants or patients and track the referrals.

Next, since the system provided personalized CBT training that would adapt to changes in user data and decisions, we needed a way to present user progress and condition to the care provider or case manager as the user progressed through the training.

Data Requirements

Since the initial value proposition of StarlingCBT was to increase employee wellbeing and reduce presenteeism and absenteeism by helping employees overcome stress, anxiety, and depression, the bulk of data collected on the platform was sufficient to show engagement and efficacy linked to mental health improvement. However, to prove a hypothesis that early-intervention mental health support would shorten disability claims and decrease overall STD and LTD claim costs, we needed to gather certain data points from our customers as we would not have ready access to those data from our solution. These data included the date that an employee stopped working, the claim start date, the claim duration, the back-to-work date, and back-to-work rate, as most people do not return to work at 100% capacity right away. In order to streamline the CBT training experience and reduce emotional stress and cognitive load, we decided not to ask users for these data, so asking the case manager in StarlingHQ was the best source for these inquiries.

A Mental Health EHR (electronic health record)

Much like an EHR for physical health history, our mental health EHR divided user data into several categories: user contact information, course details, progression through the CBT training, level of activity in multiple aspects of the CBT training, level of engagement in the program, and progression in their levels of stress, energy, anxiety, and depression. All of these data could be helpful to the case manager or healthcare provider responsible for the end user, providing them with insights into the user's state of mind and commitment to the CBT training program.

Because the Starling training program was based on standardized CBT techniques in a linear format, increasing complexity and skill-building much in the same way that a video game builds player reflexes and sophistication the more they play a game, then it was a straightforward task to identify the skills acquired throughout the CBT training and display them in a record format. This record display (below) broke the training progression out into three phases: initial assessments, CBT strategies, and—in the case of the Return to Health product—plan to manage return to work stress. In each phase, there were specific skills or goals to be achieved. For each of these tasks was an indicator of its completion status: complete, in progress, or not started. Displaying the progression data in this way would give the case manager or healthcare provider some insight into the user's success and commitment to the program.

Additionally, in our user research we learned that one of the pains felt by case managers not trained in mental health was a reluctance to talk to claimants about mental health issues, even if the claimant was on a mental health disability claim. Having some insight into the claimant's progress would give the case manager a touchpoint around which to start a discussion with the claimant about the state of their mental health and determine what other services they could arrange or provide to the claimant. This aspect of the mental health EHR proved to be very valuable to many of our case manager users.

Symptom charts and CBT training progress detail from user's mental health record.

Referral Features

As the Chief UX Architect and lead designer on this project, I leveraged my experience building customer referral programs for companies such as AT&T, Sprint, and T-Mobile. There were several elements that were required in the specifications for the referral features.

First, case managers needed a simple form to add the claimant's contact and claim information. In this form, they could enter the claimant's contact information that the Starling system would use to communicate with the user. They could also indicate the user's occupation and reasons for their disability claim, information that would help the Starling system tailor the CBT training program to the user—all of the course content was occupationally aware to make it more reflective of the user's experience and promoting inclusion.

One important feature of the referral system was to give the referrer the ability to create a personal message that would appear in the referral email received by the claimant. We found that referral conversions increased by 87% when accompanied by a personal message.

Another helpful feature was the status of the referral itself. The case manager or healthcare provider could see if a referral had been accepted or expired. In either case, the referrer could resend the referral to the claimant to get them into the program.

Referral dashboard.

Referrals history.

Results

StarlingHQ was launched initially to disability case managers at Fraser Health Authority, one of our largest customers and an enthusiastic participant at all stages of the product development, from customer and user research, to Beta testing, and usability testing. As was the case with all of our customers, about 20% of referring case managers were responsible for 80% of successful referrals. We considered these case managers to be "power users" and our ambassadors within a customer organization. From these users we received resounding approval of the StarlingHQ features and usability. Among their favourite features were the personal referral message and the user progress dashboard.

Since the release of StarlingHQ:

Referral conversions resulting in claimant registration into the program increased by 78%,
Case manager satisfaction in the product increased by 97%,
Claimant user engagement in the Starling CBT program increased by 89%,
Claimant completion of the Starling CBT program increased by 78%,
75% of referred claimants registered for the StarlingCBT program the day of the referral,
Customers had 90% reduction in related disability claim costs compared to human-guided support.

"Starling Minds is the only digital mental health solution that fits exactly into our approach for addressing workforce mental health. Our workplace health and safety strategy touches employee experience, early intervention and prevention, and absence and disability management. Starling’s spectrum of programs couldn’t be a better fit for our people leaders and the employees they serve." - Executive Director of Workplace Health & Safety, Healthcare Authority