Physician-created KoNote: easy to chart notes and numbers

TORONTO – Dr. David Gotlib has worked with plenty of EMRs in his career as a psychiatrist, but was never very pleased with them. “They were all too structured,” he says. “They’re basically glorified spreadsheets with a Windows front-end.”

This was especially evident in his area, psychiatry and mental health. “I can work much faster using paper than an EMR,” he says.

That’s because mental health charting is so dependent on notes and narrative. “The traditional EMR isn’t so good at organizing narrative information,” he observes.

At the same time, psychiatry and social services records, in general, require a great deal of counting and numeric information to track the performance of a patient. Unfortunately, most EMRs do not help doctors and nurses with this challenge, either.

So Dr. Gotlib decided to create a program that could do a better job. Luckily, he has a background in computer science – in fact, he did a degree in computer science before becoming a physician, and was well acquainted with the ins and outs of software.

With the help of a talented programmer, in 2014 he launched a system called KoNote. (See http://www.konote.ca/)

The solution helps mental health professionals with both charting and counting. In fact, the program reminds users to count various things in the notes, and will automatically generate graphs showing how the patient is doing in different areas.

“The progress note prompts you to fill in a number,” says Dr. Gotlib.

It’s also designed for group work, and shows the notes that others have entered and the reasons why treatment changes were made. “It’s designed to be multi-disciplinary, and it can be used for in-patients and out-patients,” says Dr. Gotlib.

Doctors, nurses and social workers at St. Joseph’s Health Centre, Toronto, used a prototype of the system on a psychiatric inpatient unit for three years with much success. “It’s the compass that aids us to map our care,” one nurse told Dr. Gotlib.

The users like it, said Dr. Gotlib, because KoNote “guides you to chart in a way that you treat people. It also takes less time to chart electronically than on paper.”

And it’s easy to use. Dr. Gotlib says the “most technophobic person as the Griffin Centre liked it the most.”

When you look at the KoNote system, you immediately notice that it has a spare, elegant appearance. That’s intentional. One of the problems with traditional EMRs, says Dr. Gotlib, is that they’re over-engineered and cluttered: “Many doctors hate EMRs because they’re too big, with too many things they don’t need.”

In contrast, KoNote has a simple interface. “It’s designed for my grandmother to use,” he quips.

It also makes use of a different design philosophy. Dr. Gotlib says he was inspired by the work of Dr. Lawrence Weed, creator of the “problem-oriented medical record”. Instead of highlighting the sources of patient information, such as diagnostic images, prescriptions, physician notes, Dr. Weed’s record focuses on a well-defined list of the individual’s problems.

(Dr. Weed was also the progenitor of the SOAP method of medical charting – subjective, objective, assessment and plan.)

When it comes to the problem-oriented record, Dr. Gotlib says he differs from Weed in two respects.

First, KoNote is flexible and allows you to determine how much structure you want. For mental health, this is important, says Dr. Gotlib. “You really want to maintain a level of uncertainty until you are sure about what you’re dealing with.”

Second, the system is multi-disciplinary and can be used by a wide range of healthcare professionals – from doctors and nurses to social workers and community care workers. By having everyone chart in a unified way, and documenting what is relevant to patient-care, more accurate diagnoses and more effective treatments can be made.

“You don’t want to see car-loads of documents,” says Dr. Gotlib. “And you don’t want to have to reconstruct everything in your head.”