Introducing the OpNote Consultants: Carl Brown, MD, MSc, FRCSC

March 26, 2010 at 4:18 pm 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.

Dr. Carl Brown completed medical school at McMaster University in 1995 and his general surgery training at the University of Calgary in 2003.  He subsequently worked as a general surgeon at the Peter Lougheed Centre in Calgary.  In 2004, he moved to Toronto to train as a sub specialist in Colorectal Surgery. Concurrent with his fellowship, Dr. Brown completed his master’s degree in clinical research at the University of Toronto.   In 2006, he joined the surgical staff of St. Paul’s Hospital in Vancouver.

Dr. Brown is the chairman of the Research and Outcomes Evaluation Committee at the British Columbia Cancer Agency and an active member of the Colorectal Cancer Outcomes Unit. He is a member of the Surgical Oncology Network of British Columbia Executive. The goal of these groups is to improve the outcomes of patients with colorectal cancer through research initiatives.

Dr. Brown is the assistant program director of the general surgery residency program at the University of British Columbia. He coordinates the Surgery Leadership Program for general surgery trainees.  Over the past three years, Dr. Brown has published several studies on surgery for colorectal cancer, the ileal pouch procedure and surgery for Crohn’s disease. Furthermore, he has taught courses in laparoscopic colorectal cancer surgery.

How did you get interested in medicine?

I was always interested in science but, more importantly, I like interacting with people and helping people.  While it may seem cliché, [medicine] has turned out to be everything I had hoped it would be.  I do get to help people every day.  There’s never a day that I go home after work without feeling satisfied that I’ve accomplished something.

Wow – that’s great.

Yeah, it’s really true.  You know, it sounds kind of clichéd and maybe even a little cheesy, but it is so true.

What attracted you to surgery?  What made you go with that specialty out of all the possible paths in medicine?

Firstly, I’m a fix-it kind of guy.  I like to fix things.  It’s always been something I’ve been fairly strong at – growing up in a small town, we always took it upon ourselves to fix things around the house.   A lot of what we do in medicine is tweaking things: giving a little medication to make someone feel a little bit better.  And that is very important.

But I like the “fix”.  I like the stress and the pressure of having someone who has a life threatening illness and taking on the incredible responsibility and trust of that person by operating on them.  Many times what I do cures the person of that problem.  It’s very gratifying – very immediate.  It’s sort of what I think medicine’s all about.

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

I’m an academic surgeon at a major Canadian university.  My main research interest for over seven years now has been synoptic reporting and improving processes of care in surgery.  About 6 years ago I published an article in the journal Surgery about synoptic reporting and its benefits.  It’s always been an interest of mine.

Concurrently, as I’ve worked through my career, I’ve become more interested in cancer.  There’s a big push to have synoptic reporting in cancer surgery – much like there is excellent synoptic reporting in cancer pathology.  I feel strongly that [synoptic reporting in surgery] is a simple thing that we can add that can potentially improve patient care and save lives.

Through my work with the provincial organization in British Columbia I was introduced to the mTuitive products.  I saw it as a possible solution to a lot of our problems.

How did you decide – “Okay, OpNote is a product I want to work on?”  How did you determine that it was worth your time and effort?  There are other possible solutions for synoptic reporting for surgery.  What stood out about OpNote that it was worth investing your expertise and your energy?

A few reasons:

1.  OpNote is designed to be a comprehensive solution for operative reporting.   As opposed to some other products which only deal with one or two operations, or one or two different disease processes.  The solution to the problem [of operative reporting] has to be comprehensive and mTuitive’s goals seem to be in line with that.
2.  At the same time, OpNote is focused on the operation.  Its mission and priorities are certainly achievable; it’s not trying to replace an entire electronic medical record.  It really is creating a better operative report.  Which is the key starting point, in my opinion.
3.  mTuitive has a proven track record with pathology reporting.  Obviously [mTuitive] has been through this process once before and developed a synoptic report that is being used for pathology in multiple Canadian hospitals.  So clearly [mTuitive] went through the process of working within the Canadian healthcare system and is familiar with it.

All of those elements made me excited about working with mTuitive on OpNote.

Currently there are no clearly defined standards for postoperative reporting.  There are some minor lists of requirements put out by Joint Commission, Medicare (in U.S.), and some defined by the health facilities where the surgeon is working.  Do you think standardization is something that should happen?  And if it should happen, how do you think it would best be accomplished?

There are many elements of operations that should be standardized.  There has to be some flexibility to allow for variations in the operations; it cannot be so rigid that it’s only checklists.  But many operations can have standard elements.

A standardized electronic reporting product has to be easier than dictation in order to really be worth it for surgeons.  Not only does the product have to generate a better report (which I think synoptic reporting does), but it also has to be an easier report to complete.  The beauty of this strategy is that, by its nature, OpNote is both.

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?

One of the sources of medical error can be incomplete medical data for attending physicians.  Having a comprehensive electronic medical record eliminates all kinds of problems that comes with trying to treat problems, which includes poor handwriting, incomplete records and unavailability of records – to name a few.  Having an electronic record, which could be available at any bedside, anywhere will help physicians treat patients better.

The irony is that if you traveled to any country in the world, you can use your Visa card to buy something.  But if you go to a hospital anywhere in the world, there’s no way they’d know your medical history.

What were the most common problems you found in dictation and transcription process of operative reporting?  Or what is the biggest problem you see in that process?

The biggest problems stem from a lack of the types of reminders that come along with a synoptic report – where you remember all the details that should be in the report.  Humans are fallible.  No matter how much you try to be complete, you may forget something that is important.  And if you forget at the time you’re making the dictation, you will not remember it a month or two months later, with all the hundreds of patients you see.  If that information is critical, then that can be a serious problem.

[At my hospital], we train residents and presently use an alternative way of doing synoptic reporting that I’ll call a non-electronic synoptic reporting system.  We’re using this system in anticipation of (hopefully) getting an electronic one in the future.  It’s clear that having synoptic elements helps train physicians and surgeons by defining the important aspects of a surgical procedure.

If you’re a trainee trying to learn the important parts of an operation, you do the operation under someone else’s tutelage – but then it’s often your responsibility to dictate the report after it’s done.  And while you were there when it happened, you may not fully appreciate all the important aspects of the procedure.  For us, as an academic center, if they just “freewheel it,” they may miss something that is important.  Whereas having a synoptic guide is almost like a surrogate training opportunity for residents.

As an industry, we use checklists and synoptic reporting in so many other areas of medicine.  But for some reason we have not deployed it in operative reporting.

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