Medical Documentation Innovation: How Does It Happen?
Interview by Paulius Mui, MD who writes for the MedTechEntrepreneurs Slack Community, a landing spot for people interested in medtech and entrepreneurship to meet, exchange ideas, and collaborate.
Tell us a bit about yourself. Where did you grow up? What kind of training do you have? What’s your typical week like?
I was born and raised in Monterrey, Mexico, and received my medical degree in 2009 from Universidad de Monterrey. My career path has been non-traditional. Let me try to summarize it.
During my last year of medical school, I was selected as an exchange student at University of Miami’s William J. Harrington Program. I then attended clerkships at Baylor College of Medicine in Houston and Harvard Medical School and served as a pre-doctoral research fellow at Baylor College of Medicine. Afterwards, I returned to Mexico and developed research laboratories and a preventive health clinic to serve vulnerable communities in Nuevo Leon, Mexico. After completing medical school, I served as director of medical education for a telemedicine company. In 2012, I was selected as a UCLA International Medical Graduate scholar and completed my Family Medicine residency at UCLA-affiliated Northridge Hospital.
I’m now a practicing family medicine physician in California. For almost four years I primarily practiced in the outpatient setting, serving a large Hispanic community in Yolo County. When the pandemic started I began to work solely as a hospitalist. I take care of patients who are very sick and require to be hospitalized. Taking care of acutely ill patients is very mentally stimulating. It’s like playing detective, having to find clues in the patient’s history, the labs, and imaging studies. The answer to their diagnosis usually lies in among all these clues.
I work as a nocturnist, which means that I work exclusively at night. Working at night is very different from a day shift. There is usually less chatter around, and usually you have a more peaceful environment at work. But then there are intense episodes full of adrenaline, like when one of your patients is coding or you are called in for a rapid response.
Between shifts and in my spare time, I devote about 20 hours a week towards my startup company.
What kind of problem is your innovation trying to solve?
Any clinician would agree that onerous medical documentation requirements are the bane of our existence. Being forced to prioritize paperwork over patients causes physician burnout and dissatisfaction. Even though recent changes in billing and coding guidelines were introduced in 2021 to reduce “note bloating” as a way to fight this endemic problem, completing notes and data entry will always be a clerical task that takes time. In 2019, American Medical Association CEO Dr. James L. Madara noted that for every hour of face-to-face time with patients, physicians spend nearly two additional hours on administrative tasks throughout the day.
At StatNote we believe that doctors should spend more time with their patients and less time in front of their computers. Our goal is to serve health professionals by providing tools that facilitate medical documentation so they can enjoy seeing patients and have a healthy work-life balance.
In the midst of the pandemic, we started working on an idea that turned into a web application. Chartnote is a complementary electronic health record (EHR) solution to complete medical documentation using templates.
What are some of the big challenges you’ve faced along the way, whether technology-related or at system level?
I always had a vision of the product that I wanted to build. But as a non-technical founder, building a tech product without knowing how to code can be tricky. So I started with a very basic minimal viable product (MVP) — I wrote a book. I basically self-published a book on Amazon with all my dot phrases and templates that I had accumulated since residency and regularly use for medical documentation.
After a few months of publication, the book became very popular and was featured frequently as the #1 Best Seller in the Amazon charts for Practice Management & Reimbursement as well as for the Medical History & Records books category. This compelled me to offer my dot phrases online. This meant learning how to create a website on WordPress and learning how to use Google Cloud.
Another big challenge is time. When I started to sense that my little project could turn into a profitable company, I decided to switch jobs. I took a position as a nocturnist. This enabled me to work fewer hours without compromising my income and benefits.
One of the advantages of being a non-technical startup founder is that you are forced to delegate most of the technical tasks early on. This can be a challenge for a bootstrapped startup, but learning how to find the right people and rely on their expertise can be an asset that can help you realize your vision.
What’s your long-term vision for technology-enabled health care?
I haven’t met a doctor who praises their EHR the way they praise their car or iPhone. A car takes you where you need to go, and it also gives you pleasure along the way. Apple products just work. Seamlessly. So many industries have been transformed by information technology, but healthcare remains siloed and still relies on faxes and beepers.
My moonshot goal would be to develop technology to empower clinicians and their patients. I envision Chartnote evolving into a hub of electronic health record information that both patients and doctors can access — where the patient is the real owner of the information and has complete control of who they share their information with. I envision a healthcare “passport” that carries all the patient’s information wherever they go and breaks the EHR silos. If telehealth becomes mainstream, it would be super useful for a doctor anywhere in the country to have access to the patient’s medical record.
For now our goal is to empower clinicians with technology and efficiency tools that simplify medical documentation and bring back the joy of practicing medicine. Our next milestone is to enable the use of dictation and voice recognition within the web app.
How did you seek out mentorship? Which individuals or communities have contributed to your success?
A big-shout out to Y Combinator’s Startup School. This is a free online program for founders actively pursuing their own startup. They have so many online resources and tools that help you build your startup. They also have an international community of like-minded entrepreneurs and organize weekly virtual group sessions via online video. I have met so many interesting people and had many engaging conversations in this community. Thanks to the program I have developed good relationships with people from Intel, NASA, PhD’s who work in very reputable institutions, and entrepreneurs from all over the world.
I should also mention the MedTech Entrepreneur Community on Slack. It is very energizing to talk to entrepreneurs in the healthcare technology field with the same mindset: improving healthcare. This community is all about helping each other.
Unfortunately, I haven’t had the opportunity to connect with a real mentor for my current project. But, I have had great mentors along the way. I’ve found that the mentor-mentee relationship is not always explicit, but one common aspect of these relationships is the willingness of the mentor to offer time to nurture you and help you grow. They are also a great source of encouragement that can help you believe in yourself. Two of my great mentors include my former residency program director and the dean of the Department of Health Sciences back when I was in medical school. In Mexico, where I’m from, part of medical school includes a year of social service. This is a way to give back to the community. I had the opportunity to participate as the project manager for the development of research laboratories and a dental clinic. Having an impact in the life of many people is so rewarding. This sparked my interest to get involved in the business side of medicine.
How can current physicians, residents, med students take part in your work?
We are trying to grow a community of clinicians at Chartnote. The idea is that everyone shares their dot phrases and templates so that we can all help each other with best documentation practices. We offer free accounts for anyone to explore Chartnote’s library of snippets as well as the ones from the community. You can discover and add snippets to your own library. Once a snippet is part of your library, you can edit and tailor it to your own needs. You can change the wording, add text fields and drop-down menus, or make certain parts of the text optional.
We are also working on adding speech recognition. Once we implement this feature, we will need a lot of input from our users. Our current accuracy rate is about 85% (Google, Amazon, and other services offer a 95% accuracy rate). We expect our current model to work well once it has trained on the voices using it, so feeding it the data of users will improve its accuracy quickly. We would love to grow our user base so that they can help us finetune our model for greater speech recognition accuracy.
What is the next big question you’re trying to answer?
Healthcare is full of inefficiencies. There is at least a 4:1 ratio of people who need to support a clinician for them to be able to provide care. For example, a physician needs supporting staff like a biller & coder, a receptionist/phone answerer, a medical assistant, and other team members who can help with administrative tasks like prior authorizations, medication refills, handling patient messages in the portal, etc. And even with all this help, a physician spends two hours of administrative work for every hour of patient care.
Can technology help us automatize these repetitive tasks so that we can take better care of our patients?
What’s one resource you wish you had right now that would help you move forward?
Capital. StatNote has been bootstrapped from the beginning, and I have self-funded the company. With no external funding you learn to manage the company’s money efficiently very quickly. This forces you to be creative, wear all the hats in the company, and obviously to keep a full-time job. It’s a great learning experience. While we are not actively looking for investors, I realize that as the company gets more traction I would need some capital to keep going. I have started to reach out to friends and family to fund the next stage, but I’m happy with our current growth rate.
