Redesign grounded in the 7/15 Outpatient Working Session transcript. Where the meeting decided, I built it. Where it didn't, there are options.
I pulled the full 3-hour transcript. My first pass was for acute tele-stroke and was wrong on the premise; this one is built against what you, Melanie, Prachi, Neha, Smriti and Dr. Peeyoosh actually said. The time rail is parked for the Synapse 3.0 acute conversation.
Nine calls the room actually made. They're baked into the mockups below rather than offered as choices.
The entry model is settled. What's open is the half you flagged as missing entirely — "In an actual EHR, in Epic, I go to the diagnostics tab and I can see everything that they've had forever. We don't have that."
The 🔖 flag on labs is your "save this, this is important… so it always is always flagged visit to visit" — the genetic test, the "crazy antibody that I found five years ago." No mechanism was decided in the meeting, so treat this as a strawman for one: a per-result pin that survives into every future encounter's header, separate from the note body. It's a small build with outsized clinical value, and it's the only idea in the session that had no owner when the meeting ended.
Smriti asked for exactly this: "We should discuss this with the UI UX team… we should maybe suggest a couple of the ways." So — three ways. Your constraint on all of them: "That doesn't need to go into my note from 2015, but I still want to remember that they had it in 2010. So that's the history versus the documentation."
| 01/16/26 | CT head — no acute |
| 12/02/25 | EEG — normal |
| 08/14/24 | MRI brain — 2 T2 lesions |
| 03/02/21 | MRI c-spine — mild sten. |
| 06/11/18 | MRI brain — unremarkable |
| 09/30/10 | LP — OCB positive |
| Study | '10 | '18 | '21 | '24 | '25 | '26 |
|---|---|---|---|---|---|---|
| MRI brain | ||||||
| MRI c-spine | ||||||
| CT head | ||||||
| EEG | ||||||
| LP | ||||||
| EMG/NCS |
A as the page, C as the behavior inside it. They're complementary rather than rival: two zones structure the page, and expanding any row in the prior record gives you C's inline-prior comparison. That covers both questions — what have they ever had (the list) and is this one different (the nesting) — with no new structured fields.
I'd hold B. It's the most impressive view here and the one that most looks like Epic, but it only works if every study carries a normal/abnormal flag, and that's a structured field you explicitly said you didn't want to force. B is worth revisiting only if the AI can infer that flag from the free text reliably — which is testable, and worth testing before anyone commits to the grid.
The pill order is settled. The clickable exam is the thing you've built repeatedly and never liked — so that gets the real work.
You said it twice: "I've built this several times and I'm never really satisfied… it's never very efficient for some reason, and I struggle with that" and "my most recent AI build was a million different click boxes… ugly as sin. And I hate it."
Here's my read on the "some reason": every clickable exam is built around the wrong ratio. A normal neuro exam is roughly forty assertions. An abnormal one is those same forty, minus three. So the information you're actually adding is three items — but every design makes you handle all forty to express them. Your own instinct already names the fix — "save as their favorite… and then they can just pull up their favourite and then unselect the items that are abnormal" — but a saved template still renders forty rows, so the screen stays as noisy as before even though the clicking got cheaper. The clicks went away; the cognitive load didn't.
The efficient design makes the exception the only thing that occupies space. All three options below are variations on that, differing in how much of the normal stays visible — which matters, because what you're attesting to has to stay legible.
C. Your stated preference is free text, and every clickable exam you've built has fought that preference instead of serving it. C doesn't fight it — the structure is just a fast way to produce prose you can still edit, and you always see the prose. If my theory about the ratio is right, C is the one that fixes both halves of it: the exception is the only thing you touch, and you never have to imagine what the checkboxes will read like.
If C is too much build, B is the safe fallback — but I'd say plainly that B is closest to what you've built before, so if the theory is wrong, B is where you'd find out by being disappointed a fourth time.
You: "I'm thinking like the UPDRS — is that an exam or is that a scale? … similar with the EDSS for MS. Where do we put those kind of things? And I'll have to actually kind of think about that a little bit."
Your working answer was NIHSS stays exam-embedded, everything else goes to Scales under History. The mockups above assume exactly that. It's the one structural assumption I'd most like you to confirm or break, since it changes both tabs.
Glucose, BP, O₂ sat, Pulse, and Febrile/Afebrile are in the current Figma and were never mentioned once in three hours. I left them untouched and greyed rather than redesign something nobody discussed. Worth a direct question to Neha and Smriti — in a tele-outpatient visit where an MA is assisting, it's not obvious these should be typed at all.
The genetic-test / five-year-old-antibody problem was raised, agreed to be valuable, and then the conversation moved on without a mechanism or an owner. My 🔖 pin above is a strawman, not a decision.
Prachi: "This needs to be positioned in a way where we can mine data off of it quickly… it can't be all these free text."
Your history-vs-orders split resolves this cleanly on paper, and I've built to it. But note what it costs: Option B for diagnostics (the flowsheet) dies under that split, because a grid needs a structured normal/abnormal flag that pure free text can't give it. That's the one place where "free text everywhere" has a visible price, and it's worth deciding with eyes open rather than discovering later.
You framed the ambition deliberately: "can we push it further and faster and harder than we would our own internal people?" Prachi's counterweight was equally deliberate: "we still have to maintain this internally. So we need to be reasonable."
Both are right, and the split isn't 50/50 across this document. The diagnostics tab is mostly cheap — pills and free text are ordinary work, and Option A is a list. The exam tab is where the real money is, and Option C's prose renderer is the single most expensive thing here. If something gets handed to an external team, C is the candidate that actually justifies it — it's self-contained, spec-able, and it's the piece your internal team would most likely descope under pressure. The pills you could ship yourselves next sprint.