Does note taking involve magic?
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Sure, it does, even if we’re not in wizardry land.
Because of Covid, we’ve seen technologies in healthcare get accelerated adoption. Having a digital presence in the form of a digital clinic is no longer a mere afterthought. Patients have come to rely on their healthcare providers, whether it’s their primary care physician or the medical specialist. We’re now understanding that the merit of portals is an accessibility point of care to facilitate patient health information exchange. The patient does not have to wait for the doctor’s appointment, and see their reports of lab tests at a tap on their phones.
With these noticeable gains in health tech, is this the right time to fix the ongoing physician burnout problem?
According to a study, doctors spend nearly twice as much time on EHR/desk work as their time with patients. — American Hospital Association
“physicians on average had spend 16 minutes and 14 seconds of active time on the EHR per patient encounter.” — Forbes, 2020
The Usability Problem
According to research, among the top problems plaguing doctors are burnout attributing to the time spent taking notes for EHR and EMR (electronic health and electronic medical records). While both electronic health and medical records require doctors’ manual input to store meaningful information regarding their interaction with their patients online and allowing remote access to a patient’s medical history much more easily than the traditional use of paper records.
Doctors claim that they have been spending twice the time spent on each patient visit on note-taking, and yet, they still lack 20% of patient’s data at the point of diagnosis. For instance, patient data is housed in another medical record system that they have no access to. The fact that they’re spending all this time manually logging the patient’s data into their medical record system is staggering considering that they’re not deriving immediate value that is beneficial to their patients. How can they make the best recommendation for their patients?
“Diagnostic errors are the 3rd leading cause of death in Canada” — Radio Canada International
The Design of the User Experience in the Electronic Medical Records need to be fixed.
After seeing improvements to the patient experience after Covid, patients can now quickly log-in to their portals to check their lab test results and forgo unnecessary appointments. The portal is built not only for doctors and is really catered to patients who can have a record of their consultations. If they can retrieve their medical history accurately, then they can relay and show that information to referred specialists quickly. More importantly, for nuanced and complex medical conditions, patients could now refer back to the consultation, research about their condition, and ask follow up questions in an informed manner. The doctor-patient interaction could now be more informed, in an ideal scenario.
Current problematic features in EHR/EMRs
- Copy and paste features encouraged physicians to copy and paste the full reports, neglecting the need to summarize findings. This means when a doctor goes back to previous collections of notes in the EHR, they cannot retrieve pertinent patient information right away. The result is information overload and extra time spent deriving insights from the past.
- User access features allow all types of doctors who were in contact with patients to add and modify the problem lists, causing an ever expanding list that does not offer succinct and meaningful information on the patient.
- Prefilled templates make it easy for doctors to log the wrong information. While the intention behind templates is to guide doctors to only fill the relevant information, it appeared to have the opposite effect. This implies that auto-fill technologies might not be the best because ironically it makes it easy for the doctor to fill in the wrong information and does not help the doctor build a habit of writing only concise notes.
- Point and click design prompts doctors to click on more boxes even when inaccurate.
It’s time to re-imagine the way we collect and access health data. While there have been concerns about the correlation between doctors using transcription services and negative side effects of them not spending time reflecting on their diagnosis through note-taking, certain research has also pointed out the error-prone rate of typed notes instead of dictated notes. Voice transcription can help doctors take notes three times faster than regular typing. According to one research study,
“Typed notes had more uncorrected errors per note than dictated notes (2.9 vs. 1.5), although most were minor misspellings. Dictated notes had a higher mean quality score (7.7 vs. 6.6; p = 0.04), were more complete and included more sufficient information.” — Research Gate
Astute observers will point out there will be generational differences among doctor’s note-taking habits, we can agree that EHR (electronic health record) systems and telehealth are technologies that are here to stay. Indeed, the point isn’t so much about the method of note-taking, rather it’s about the effectiveness of driving health outcomes for patients, and, of course, billing.
The objective for taking notes
Major questions that healthcare startups and future products are trying to answer, with the goal of helping doctors to collect and access more comprehensive and accurate patient data:
- Does the data that the doctor inputs manually and collect for their patients’ electronic medical records have to be completed manually?
- What criteria can ensure that referral specialists only receive the most relevant patient information to ensure the patient referred is the right match to their specialty and appropriate to the level of care the medical specialist caters to?
- Is the design of the future note-taking product conducive to the patient’s health outcomes and needs? To your healthcare team so that they’re in alignment of understanding?
- Do these products enable both patients and doctors to have a meaningful view of the problem? What constitutes a meaningful understanding of a patient’s health problem when the patient can have complex, comorbid conditions?
While interoperability between health IT systems can take time to implement, it is crucial to understand that the patient afflicted with complex conditions is going to consult multiple different doctors and it would be important for them to understand, own and keep their own health record.
What is the magic we’re creating today?
Dictation isn’t exactly a new technology. Imagine the ability to have AI-transcribed notes of your clinical visit with your patient. You’re no longer on the computer typing away while talking to your patient. You can either revise these transcriptions later or ask your nurse to revise them into your EHR.
- The magic of having an audio record of time spent per patient so that you can go back, audit and review clinical effectiveness while driving patient health outcomes, from an operational perspective. This is good for both your patients and your clinic’s financial well-being. This longer term benefit lets you collect hard data to inform actual resource usage and allocation strategy.
- Send post-consultation notes to your patients, healthcare team members, and follow ups easily. This can encourage communication among healthcare team members, meanwhile allowing you to collect data on variations in communication needs for different patients.
- Accept supplementary notes, historical lab reports (perhaps from another country) and other follow up questions from patients through an online portal. Asynchronous communication from from the patient cuts down unnecessary phone calls and follow up visits to the clinic, freeing up the physician’s time spent on admin.
Combined with the ease of accessibility of a portal, a doctor can gently remind the patient to log any negative side effects of the medication they’re taking. If patients have concerns about their medications, such as a potential allergic reaction, they can anticipate next steps and ensure timely communication with their doctor.
Enabling the primary care doctor, then the patient
Another problem is the lack of timely access to adequate medical opinion for the family doctor to treat their patients well. The lengthy time to an appointment with a medical specialist is well-known. Much of the patient’s ongoing health and well-being depends on the family doctor in Canada. Is your family doctor able to get you an appointment to a medical specialist quickly for your condition to get treated? Much of the time it falls onto the patient or their primary care physician to make required follow ups in case the doctor falls through and does not look at the referral document.
Because of burnout, doctors have allegedly cut down on their communication with their patients. This means patients might not always get to ask all the questions they want in a single appointment setting and will have to use the doctor’s secretary as an intermediary for follow up questions. On a patient experience-level, this means the patient-doctor relationship could continue to deteriorate and the patient might not agree with the doctor’s recommended treatment.
Perhaps the doctor doesn’t quite understand that health might not always be a priority for their patient in our workaholic-driven culture. Having a portal to encourage patients to add supplementary health data from other doctors will help primary care physicians have a more comprehensive view of their patient health history. Enabling asynchronous communication helps the doctor save time spent on administrative tasks and developing patient health awareness in the long run.
“Does it have to be the family doctor?”, you could ask.
Not necessarily. The point here is to imagine a controversial scenario where you need informed advice to arrive at a decision for your health. An engaged patient would defer to their family doctor, simply because they’re their first point of access to other medical specialists. Alternatively, in a more likely scenario where they’re too busy and you, the patient, should take responsibility over seeking second opinions.
A paranoid version of myself could ask, why is the doctor recommending me to do the surgery now when I have no known symptoms? Why am I not presented with alternative options? Is doing the surgery the right decision at this point in time? Why couldn’t I just monitor the condition if most of these polyps are benign in nature (non-cancerous)? Are they planning to sell my organ on the black market because my surgery is a financial decision for their hospital? (Highly unlikely)
The above scenario is obviously driven by paranoia. The issue to consider is that patients need a baseline understanding of their condition and adequate time to consider their options.
The primary care physician is usually the first point of access to specialty healthcare for most patients. Enabling the family doctor means that they can do more with fewer resources, achieve better health outcomes for their patients and hit their own financial goals. It also means that when the medical specialist lacks a specific part of their patient’s health history, they can request this information from the family doctor or their patient quite easily.
Our mission is to enable doctors and patients to make data-informed decisions.
This means having an accurate collection of health data at the start of the patient’s relationship with their family doctor, allowing accurate interpretation of patient’s health status and history at point of diagnosis.
Save an hour a day with AI transcribed note taking.
Having the ability to focus on having a conversation with the patient, understanding their full medical history could be an ambitious feat for the doctor. If you can record the interaction with your patient and then get these notes transcribed later, it would mean you have a complete record, a peace of mind to make sure you ask all the questions you need from the patient who have complex conditions.
At this point, we just want to ask: Do you want to change the future of healthcare with us? Do you have particular product features that you believe can massively reduce your workflow?
We’re currently in pre-launch phase and we’re working through to get our product launched!
Sign up here today to enjoy early bird pricing: https://airtable.com/shrVzbbkdrx0PO9By
Sources:
- https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
- https://www.aha.org/news/headline/2016-09-08-study-physicians-spend-nearly-twice-much-time-ehrdesk-work-patients
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6183652/
- https://www.researchgate.net/publication/341422329_Physician_Use_of_Speech_Recognition_versus_Typing_in_Clinical_Documentation_A_Controlled_Observational_Study
- https://www.cmaj.ca/content/190/29/E869
- https://www.rcinet.ca/en/2019/10/28/thousands-die-from-medical-errors-yearly-notes-advocacy-group/
- https://hbr.org/2020/03/the-problem-with-u-s-health-care-isnt-a-shortage-of-doctors
