Hello and welcome to Careviser by Marie Loubiere. Years of research summarized in 5-minute emails. Spot emerging opportunities in healthcare.
Have you ever received a clinical note shared by a medical provider? Well, it’s about to become a standard practice in the US and some physicians are worried.
Rubin R. How Sharing Clinical Notes Affects the Patient-Physician Relationship. JAMA. 2021;325(16):1596–1598. doi:10.1001/jama.2021.4755
🗝️ Why it matters: US medical practices and health systems will soon have to make patient data stored in their EMR available to them at no charge. This is a major shift towards more transparency and empowerment of patients. These include major clinical notes such as discharge, procedure, and progress notes.
🔎 The article aims to report how providers and patients react to the change, and to what extent it is beneficial.
✅ Findings: Providers had a lot of worries before sharing notes.
Workload: they will have to spend too much time reworking their notes to make them understandable by patients. They fear it will add to their busy workload. A study among providers already sharing clinical notes found that more than a third reported spending more time on documentation.
Contacts: Providers also worried that by giving more information to patients, they would contact them more frequently with questions. A study among providers sharing notes found that the vast majority (84%) did not experience an increase in contact frequency. Almost all patients (96%) felt that they understood the content of the notes shared with them.
Loss of valuable information: Providers worried that by making their notes understandable to patients, they would remove valuable information for care coordination with other providers.
Perception by patients: Some providers worried patients would feel offended by the content of a note (e.g., labeling, surprise items) but only 11% of patients felt offended mostly by terms such as “obese” or “elderly” or “patients claims”. They also worried that giving access to all that information could be anxiety-inducing.
🚀 Opportunities ahead: The concerns expressed by providers before they started sharing notes have not materialized so far. However, whether sharing notes actually impacts outcomes still needs to be assessed.
I started writing this episode right before the Christmas break. It’s funny how it related to what I went through when I had a ski accident in early January. I was actually upset by some of the terms used by the ER provider in the notes they printed out for me such as “Patient claims that she is not at risk for X” as if they did not believe me.
Clinical note sharing has become a feature in many EMRs either. A growing number of practice EMRs offer a patient portal where the notes can be securely shared. I looked for software solutions offering patient portals independently from EMRs but could not really find any. So today, let’s focus on data intake from patients before consultations.
Arintra started in 2019.
🤯 The problem: Capturing patient information takes time during consultations. Every minute matters to optimize practice profitability and time spent talking to patients as opposed to filling out the EMR manually.
🤗 The solution: Patient fills out an online form with their health history and present illness (HPI) before the consultation which is automatically synced to their health records. Arintra is integrated with some of the leading EMR vendors (Cerner, Epic…). The solution also extracts all the valuable information and automatically generates billing codes saving a lot of admin time.
📈 The traction: They have a team of 20+ people between the US and India and attended YC at the beginning of 2022.
Healthnote was funded a year prior with a similar product positioning but with a focus on patient data entry (including payment details). They don’t offer automated coding. They have raised over US$6m so far.
That’s a wrap for today! Don’t hesitate to reply to this email with comments, I read and answer all emails :)
In Australia, there is a company that seems very similar to Arintra: BetterConsult (https://au.betterconsult.com/). I am a doctor but have used this a couple of times as a patient and the main problem is that the doctor paid no attention to it (however, that is a small sample size).
As a doctor, I can see the benefit in it (mainly, reducing the time to write notes). And it would have greater benefit if there was a way for the patient to have the information stored on the application (such as their past medical history and current medications). Looking further into the future, this might be the way two problems can be solved: (1) giving patients more control over their health information and (2) enabling every member of the team (i.e. primary care, specialists, emergency doctors, allied health) to have the same information.
With respect to problem 2: I am not sure about the US, but this is a big problem in Australia where many hospitals remain paper-based and there are only a couple of instances in which information can be shared between different systems (in other words, most of the time you are relying on the information in your own system or having to start from scratch).