The Digital Stacking Method

CirrusMD is an async telemedicine platform where providers manage multiple patient conversations simultaneously through a text-based interface. During peak shifts, most providers were handling 25+ active encounters at once.

The platform's left-hand panel showed a single flat list labeled “Active Encounters” – every patient in one undifferentiated column. The list was sorted by time of first encounter and never reordered, so even if a provider had just sent a message to someone, that patient stayed buried in the same position. There were no status indicators showing how long a patient had been waiting, no distinction between active conversations and closed encounters awaiting notes, and no way to reorganize.

On top of this, the workflow required providers to complete all progress notes on a patient before they could effectively move on. Think of it like an ER that can't clear a bed until the chart is filled – patients stack up, not because the doctor is still treating them, but because the paperwork isn't done.

The original ticket was framed as “fix the progress notes to make them more efficient for providers.” That turned out to be wrong.

Before: A single flat list labeled ‘Active Encounters’ with no status indicators, no wait-time visibility, and no way to reorganize. The list was sorted by time of first encounter – not recent activity.

I facilitated workshops with the 10 providers who sat on CirrusMD's provider advisory board – a mixed group spanning psychiatry, family medicine, and internal medicine. Due to HIPAA, I couldn't observe real patient sessions, so I arranged mock encounter sessions with a few providers and my product owner, watching how they navigated the platform and managed their queue in simulated conditions.

What I discovered surprised me. The progress note panel wasn't the bottleneck. 70% of providers' in-person workflows involved simply setting aside patient files to finish notes later – before lunch, at the end of a shift, during a lull. It's how medicine has always worked: you see the patient, you stack their chart, you move on.

But the platform didn't allow this. There was no concept of “done with the visit but still need to write notes.” Every patient stayed in the active list until everything was complete, which meant the provider's list grew and grew with no way to organize it. New patients were harder to find. The provider's acceptance rate for new patients slowed down – not because they were busy, but because their workspace was a mess.

“I need a way to stack my patients’ files in the corner of my desk when their visit is over. This way, when I have some downtime – or my workflow is to finish notes right before clocking out – I can complete their patient notes.”

— Provider discovery note, CirrusMD advisory board workshop

A digital chart basket modeled on how doctors actually work.

The solution reorganized the left-hand encounter panel from a single flat list into distinct sections that match the natural lifecycle of a patient encounter:

Active Encounters – patients currently in conversation, with a count displayed. Each patient card now shows “Sent at [time]” instead of the old plan/pronouns/age info, giving providers the temporal context they actually need when triaging.

Incomplete Charts – the digital chart basket. Encounters that are clinically complete but need progress notes. Providers move patients here and come back on their own schedule.

Grabber handles for manual reordering – every provider had their own distinct workflow for prioritizing patients, so rather than imposing an automatic sort, I gave them full control.

Pulsing red indicators on patients waiting 60+ seconds for a response, so providers could spot who needed attention at a glance.

Color-coded profile strokes – green for active encounters, yellow for incomplete charts. Designed for peripheral vision: a provider glancing between the chat and their panel could instantly register a patient's status without reading text.

The critical design boundary was separating “clinically done” from “administratively done.” When a provider moves a patient to Incomplete Charts, the encounter ends for the patient – they receive their satisfaction survey immediately. But the provider retains access to finish their notes on their own schedule.

After: The encounter panel reorganized into ‘Active Encounters’ and ‘Incomplete Charts’ with counts, expand/collapse chevrons, grabber handles, color-coded profile strokes, and pulsing red indicators for patients waiting 60+ seconds.

The ‘Add to Incomplete Charts’ button placed at the top of the progress note panel – prominent by design, because 70% of providers wanted to hit it without thinking

End-of-shift alert showing shift end time, total duration, and a warning for incomplete encounters

The most important design decision was not designing a better notes panel.

This project taught me something I think about on every project since: the stated problem is rarely the actual problem. We went in assuming the progress notes UI needed to be more efficient. If I'd just redesigned the notes panel, we would have shipped a marginally better form and called it done.

Instead, the workshops and mock sessions revealed that the core issue was about workflow – the platform was imposing a sequence that didn't exist in the real world. The providers didn't need a faster way to write notes. They needed the ability to not write notes yet and keep working.

The solution came from their language, their metaphors, their daily habits. I just gave it a digital shape.