Introducing the OpNote Consultants – Dr. Seth Goldberg

March 17, 2010 at 10:25 am Leave a comment

While creating our surgical reporting product, the OpNote, we at mTuitive have been working with many highly skilled surgeons.  These surgeons are from a diverse group of specialties and backgrounds and help to shape the future and efficacy of the OpNote.  We’re introducing these consultants to all of you in the coming weeks.

After 27 years as an otolaryngologist/facial plastic surgeon in Rockville, MD, Dr. Seth Goldberg launched a new career as a health care consultant specializing in clinical information technology development, utilization management, continuous quality improvement, and risk management. He conducts accreditation surveys of outpatient medical facilities for the Accreditation Association for Ambulatory Health Care. Dr. Goldberg holds board certifications in Otolaryngology-Head & Neck Surgery, and Facial Plastic and Reconstructive Surgery.

He earned his B.S. degree in Molecular Biophysics and Biochemistry from Yale University, and his M.D. degree from Tufts University School of Medicine. He recently received his Masters of Medical Management degree from Carnegie Mellon University. Washingtonian Magazine and Washington Consumers Checkbook have included him in their list of Top Doctors.

In conjunction with his solo clinical practice, Dr. Goldberg was Chief of Otolaryngology at Holy Cross Hospital in Silver Spring, MD, and Shady Grove Adventist Hospital in Rockville, MD. He also served as a member of the Peer Review Committee of the Montgomery County Medical Society and as a peer review consultant with the Delmarva Foundation, Medical Mutual Liability Society of Maryland and the Medical Chirurgical Society of Maryland.

How did you get your interest in medicine?

I’m at the leading edge of the baby boom generation and my role model was – and we can joke about this – it was the TV show “Marcus Welby, MD.” He was a very respected individual and it was clear, back in the sixties, that physicians were highly respected members of and contributors to the well-being of  society.  So I think that’s what originally piqued my interest.

There were other factors, of course – I excelled at science and math.  I had an inquiring, experimental mind – I worked as a lab assistant for one of my biology teachers in addition to taking Advanced Biology as an elective in high school.  I taught tomato plants to say, “feed me, Seth.”

(Laughs)

Once I got into college, I fast tracked into medicine – that seemed to be the thing to get into at the time.  So I did my pre-med and the process for getting into medical school was actually pretty easy.  I had an interview at Tufts that consisted of the interviewer informing me that they had already decided to admit me.

(Laughs) So then you clearly felt like “I nailed it!”

(Laughs) Basically, yeah – I felt like I had nailed it, right.  Also, at the time, there was this other little thing called the Vietnam War.  I had a high lottery number, or I guess it was actually a low lottery number.  So there was only one other choice and that was be cannon fodder.

Why surgery?

The surgical specialties that I rotated through in medical school were the ones that interested me the most.  The type of people who gravitate to surgery – we all have similar personalities, and those were the people I got along with best.  They were also role models.

So I got a residency in general surgery at Harbor General Hospital in the Los Angeles area.   My first rotation as an intern was ENT.  One week after I completed that rotation, I got a phone call from the chairman of the ENT department at UCLA (the number one ENT residency in the country at that time).  So this is 1974, and I had only been an intern for a month.  He said we have opening in the department for 1976.  I’m offering you that position.  I asked, “Can I think about it for a day or two?” And he said, “no.”

(Laughs)

So then I said, “I’ll take it!”  So that’s how I became an otolaryngologist.

How did you first hear about mTuitive and the OpNote Product?

John Murphy (CEO & Founder of mTuitive) sent out an email questionnaire.  I filled out the survey and at the end of it, there was a question saying “if you’re interested in assisting us in the project, please contact us.”  So I was quite interested, and I spoke with John Murphy for half an hour.  Clearly it was a project that the two of us were enthusiastic about it.  It sounded like just the sort of thing that I had a background for – between a master’s degree in medical management that emphasized entrepreneurship and marketing, gathered with some background in the use of development software and grouped with my general medical knowledge.  It just seemed like all of it fit in with OpNote development.

Once you learned more about OpNote, how did you decide this is something you really wanted to work on?  What about the product seemed like a worthy investment of your time and effort?

I saw the immediate value in OpNote – in terms of the efficiency that it created for physicians, the accuracy in documentation, the ability (because it’s digitized) to search and report.  And to expand on the accuracy in reporting: it’s not just accuracy in the details but the accuracy in coding, which then turns into quicker and improved reimbursement.

Joint Commission, Medicare and individual facilities all have their own sets of requirements for operative reports.  However, there is no universal set of requirements for post-operative reporting.  Is standardization of operative reporting something that should happen?  Can it be accomplished?

As I see the OpNote progress, I see information “bins” develop in the operative report.  Within those bins, there can be variation – every surgeon does his procedure a little bit differently.  But each surgeon does the majority of his procedures the same way.  So it is possible to compare and contrast techniques.  Initially, things are going to be at the gross level.  But you can certainly, for instance, look at operative times, look at blood loss, you can look at indications for surgery; the more documentation in there about all of these things, the better it is for everyone involved.

In recent years, there has been a rise of funding for Health IT and EMRs – there’s certainly an increase in use of those things as buzzwords and in the amount of exposure they’re garnering in the medical field.  What do you hope will come out of this resurgence for Health IT/EMRs?  What do you think will actually come out of it?

Firstly, what I hope will come out of it is that surgeons’ time is used more efficiently, more productively.  The less time spent on dictation and documentation, and the more time spent in the operating room the better – in terms of income because clearly the amount of money we spend on healthcare is finite and (if anything) is going to be cut somewhere down the road.

Secondly, is cutting overhead.  Cutting out the transcriptionists, eliminating the professional coder – anything that can cut the overhead as well as increase productivity, is going to make a difference in the future.  So just from that singular point of view, the business point of view, having software like the OpNote will be obligatory in the future.

In terms of documentation for medical/legal reasons, the better the documentation, the stronger risk management becomes for the physician.

What were the most common problems you found in dictation and transcription process of operative reporting?

The longer or more complicated the report, the more errors I found in the transcription.  When they’re listening to dictated reports, transcriptionists spell everything phonetically so extensive time-consuming review and editing is necessary. In addition, as the transcriptionists forward and reverse the dictation, they can and do leave sentences out – critical sentences that can change the whole meaning of the report.  Many times, a week or more after performing the procedure, I had to recognize and fill in these gaps by my own potentially faulty recollection.  The turnaround time for the operative report through the hospital dictation system – although it was supposed to be within 48 hours – pretty much turns out to be around 30 days, because it takes that long before the completely corrected report comes back after 2 or 3 revisions.

Again, from the point of view of risk management, if wording is incorrect and the surgeon misses it, and something comes up down the road – how are you going to be able to back up your assertions for what happened in that procedure?  If what’s written down is incorrect, and no one caught it – then that’s the only version that exists.  So the accuracy of the operative report is critical, and that’s the advantage of having something you can easily go through, click on and arrange to your satisfaction.

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