What we have actually built

Proof

One engagement, de-identified — what we found when we mapped it, and what we designed in response.

A multi-site behavioral health practice in Southern California ran its entire operation on free Trello: eight boards, patient names and clinical reports inside cards, no healthcare BAA. Mapping the workflow surfaced an eight-stage intake pipeline documented nowhere, the same record re-entered into four separate systems, and a 23-field public intake form collecting diagnoses and medications through a consumer tool.

The asset

This is what an intake pipeline actually looks like

De-identified from a real behavioral health practice. Most owners have never seen their own operation drawn out — and the two things worth seeing are not the boxes. They are the layers underneath.

Eight-stage behavioral health intake pipeline A referral enters by email, moves through eight stages from intake to billing complete, with a supervisor review loop that can return a case for edits. Two annotation layers show four points where the same record is re-keyed into a separate system, and three points where protected health information passes through a tool with no Business Associate Agreement. Referral arrives 1. NewIntake 2. ClientContacted 3. Assignedto Clinician 4. ReportSubmitted 5. Supervisorreview 6. Sent toCase Mgr 7. Submittedfor Billing 8. BillingComplete Archived& closed returned for edits Admin / coordinator Clinician Supervisor Billing 1 2 3 4 The same record, typed four times 1  Re-keyed by hand from an emailed PDF referral  ·  2  Copied into a second tracking board 3  Copied into a spreadsheet that exists only so contractors can be given read access  ·  4  Counted again by hand for the year-end report Public intake form — no BAA DOB, diagnoses, medications, legal history Reports as email attachments Clinical documents outside the boundary Every red box holds patient information in a tool with no Business Associate Agreement The board itself carries names and clinical detail in card titles and attachments. Free and standard plans of common task tools are not BAA-covered — and no staff member here can see only their own caseload.

The same eight stages, laid out for a phone. The interactive diagram is above on a larger screen.

  1. 1. New IntakeReferral arrives by email as a PDF. Re-keyed by hand — entry 1 of 4 Outside the BAA boundary
  2. 2. Client ContactedCoordinator reaches out; some go non-responsive. Outside the BAA boundary
  3. 3. Assigned to ClinicianCase routed to a therapist. Copied to a second tracking board — entry 2 of 4
  4. 4. Report SubmittedClinician writes and submits the report. Clinical documents sent as email attachments
  5. 5. Supervisor ReviewApproved, or returned to the clinician for edits.
  6. 6. Sent to Case ManagerReport goes back to the referring body. Copied to a contractor-readable spreadsheet — entry 3 of 4
  7. 7. Submitted for BillingHanded to the biller.
  8. 8. Billing CompleteArchived and closed. Counted again by hand at year end — entry 4 of 4

Where the hours go. The same record typed into four separate systems, none of which talk to each other.

Where PHI leaves the boundary. Three points where patient information sits in a tool with no Business Associate Agreement — and no staff member can be limited to their own caseload.

Nobody had drawn this

The eight stages existed in one coordinator’s head. Not in a process document, not in a manual, not anywhere a new hire could find them. That is the normal case, not a failing.

The hours were invisible

Because the duplication was spread across four systems, no single step looked wasteful. Only the map makes the total visible — and the total is what justifies fixing it.

The risk was already known

Staff usually know which tool is the sketchy one. What they do not have is a written, dated analysis saying so — which is the exact document regulators ask for.

Your version of this diagram is what the free 30-minute review produces. Book one →

Behavioral health · multi-site · Southern California

A psychology practice running its entire operation on free Trello

Eight boards. Multiple regional-center contracts. Patient names and clinical reports inside cards, on a plan with no healthcare BAA. Nobody had ever written down how any of it worked.

What we found in the map

  • An eight-stage intake pipeline that existed only in one coordinator’s head, from referral received through to billing complete.
  • Roughly half of referrals arriving as PDFs attached to emails, re-keyed by hand into the board — the single largest time sink in the practice.
  • The same record entered into four systems: the board, a tracking board, a spreadsheet kept only so contractors could be given read access, and a second spreadsheet for the year-end count.
  • A 23-field public intake form collecting dates of birth, mental-health diagnoses, psychiatric medications and legal-case details through a consumer form tool almost certainly not covered by a BAA.
  • No per-clinician record privacy — any staff member with board access could read any patient’s case.
  • Data retained since 2019 with no retention policy and no archive strategy.

What we built

  • Eight workflow boards in SharePoint with Power Apps, keeping the kanban interface the team already knew.
  • Record-level per-clinician permissions enforced at the data layer, so a therapist sees only their own cases — identical on desktop and mobile, not merely hidden in the interface.
  • A read-only role for contractors, which removed the reason the shadow spreadsheet existed at all.
  • Microsoft Forms intake landing inside the practice’s own BAA-covered tenant, replacing the consumer form tool.
  • Automated notifications — due dates, overdue escalation and daily digests, with templates the office could edit without calling us.
  • Reporting that generated the annual per-contract counts directly, retiring the year-end spreadsheet.
  • Everything inside the practice’s own Microsoft 365 tenant, with the build performed against dummy data.
What actually happened

Built, deployed, and demonstrated — twice

This did not stop at a diagram. The system was built and deployed into the practice’s own Microsoft 365 tenant, then demonstrated live: first to the operations lead who runs intake day to day, then to the practice’s clinical leadership. In both sessions we showed record-level per-clinician permissions working against real staff accounts — a therapist signed in and could see their own caseload and nothing else, on desktop and on a phone. That was the piece everyone said could not be done in SharePoint.

What we will not claim: this engagement did not run through to full go-live, so we have no post-launch hours-saved figure to show you and we are not going to manufacture one. What we can show you is the working system, the map, and every decision behind it — in as much detail as you want, on a call.

The finding that mattered most was not the compliance gap. It was that fixing the compliance gap also removed most of the duplicate data entry consuming the intake coordinator’s week. The regulator gets a practice’s attention; the coordinator’s calendar is what actually justifies the work.

Why this matters to you

The map is the part that transfers

The boards above were built for one practice. The method that produced them works on any practice whose operations grew one tool at a time.

What carries from an engagement like this to yours is not software. It is the pattern recognition — knowing to look for the record that gets typed four times, the spreadsheet that exists only because a permission does not, the intake form that quietly sits outside the compliance boundary. Those are not unusual findings. They are what happens to every practice that grows faster than its systems.

It is not limited to behavioral health, either. The same archaeology applied to an ENT practice surfaced a completely different shape of the same problem — a single staff member losing most of a working week to insurer hold queues verifying hearing-aid benefits. Different specialty, different bottleneck, identical method: watch the work, write it down, cost it, then decide what is worth automating.

It also means the second build is cheaper than the first. The workflow patterns, the per-clinician privacy architecture and the delivery playbook are already written. Where that reuse applies, the saving shows up in the prices published on this site rather than in our margin.

What you can ask us on the call

Anything about the engagement above — how long each phase took, what we got wrong the first time, where the estimates moved and why. We will walk you through it in as much detail as you want, including the parts that were uncomfortable.

What we will not do

Name a client without written permission, describe an engagement as ongoing when it is not, or show you a number on a proposal that you have not already seen published on this website.

Want to see your own map?

The free 30-minute review produces a smaller version of exactly what is described above, for your practice, at no cost and with no obligation.

Book a Free 30-Minute Workflow Review

30 minutes with Paul Tran, who runs every one of these calls. Evening slots available — we know your day is patients.  ·  paul@maxpowerlabs.ai