Does note taking involve magic?

Photo by Cristian Escobar on Unsplash

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.

“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.

“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:

  1. Does the data that the doctor inputs manually and collect for their patients’ electronic medical records have to be completed manually?
  2. 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?
  3. 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?
  4. 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?

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.

  1. 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.
  2. 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.
  3. 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.

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.

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.

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!

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Jacqueline Chan

Jacqueline Chan

An online diary regarding reflections, thoughts on emerging tech, sales and stuff. Drop me a message at Jacqueline [dot] gotomarket [at] gmail [dot] com